Possible factors affecting the mortality rate in patients undergoing surgery for aortic type A dissection

Abstract

Objectives: Aortic dissections of type A are clinical emergencies that can prove fatal if not managed promptly in specialized care facilities. Poor clinical management is the cause of approximately 1% of deaths in patients; however, with advances in clinical practice, diagnostic imaging and clinician awareness, the mortality rate has been dramatically reduced to below 30% in most international centers. We examined the potential factors involved in mortality after surgery for type A dissections.
 Methods: In this descriptive-analytical study, patients who underwent acute aortic dissection surgery in the Shahid Madani Hospital of Tabriz, Iran, between March 2009 and March 2020 were evaluated. Exclusion criteria included those who died before the surgery, patients with descending aortic dissection, and high-risk patients for surgery who were candidates for medical treatment. Among 185 operated patients, 137 were included. Males comprised 62.8% of the patients. Their mean (±SD) age was 53.9 (±15.3) years.
 Results: Age (p-value < 0.0001), the presence of hypertension (p-value = 0.015), the amount of packed red blood cell transfusion (p-value = 0.024) and the amount of platelet transfusion (p-value = 0.018) were associated with increased mortality. Duration of intubation, use of fresh frozen plasma, postoperative drainage, duration of intensive care unit recovery, high serum creatinine, duration of aortic clamping, brain protection method, and smoking were not associated with increased mortality.
 Conclusions: These findings suggest that participants' mortality is dependent on several variables. Mortality of the patients with type A dissection can be reduced by interventions and reducing those factors.