Risk analysis for early mortality in emergency acute type A aortic dissection surgery: experience of Tokyo Acute Aortic Super-network

Abstract

OBJECTIVES We investigated the various pre- and postoperative complications related to early (30-day) mortality after open surgery for acute type A aortic dissection. METHODS Data from the Tokyo Acute Aortic Super-network database spanning January 2015 to December 2017 were retrospectively reviewed. Pre- and postoperative factors related to early postoperative mortality were assessed in 1504 of 2058 (73.0%) consecutive patients [age: 66.6 (SD: 13.5) years, male: 52.9%] who underwent acute type A aortic dissection repair. RESULTS The early mortality rate following surgical repair was 8.9%. According to multivariable analysis, male sex [odds ratio (OR) 1.670, 95% confidence interval (CI) 1.063–2.624, P = 0.026], use of percutaneous circulatory assist devices (n = 116, 7.7%) including extracorporeal membrane oxygenators or intra-aortic balloon pumps (OR 4.857, 95% CI 2.867–8.228, P < 0.001), shock (n = 162, 10.8%) (OR 3.06, 95% CI 1.741–5.387, P < 0.001), cardiopulmonary arrest (n = 41, 2.7%) (OR 7.534, 95% CI 3.407–16.661, P < 0.001), coronary ischaemia (n = 36, 2.3%) (OR 2.583, 95% CI 1.042–6.404, P = 0.041) and cerebral ischaemia (n = 59, 3.9%) (OR 2.904, 95% CI 1.347–6.261, P = 0.007) were independent preoperative risk factors for early mortality, while cardiac tamponade (n = 34, 2.3%) (OR 10.282, 95% CI 4.640–22.785, P < 0.001), cerebral ischaemia (n = 80, 5.3%) (OR 2.409, 95% CI 1.179–4.923, P = 0.016) and mesenteric ischaemia (n = 15, 1.0%) (OR 44.763, 95% CI 13.027–153.808, P < 0.001) were independent postoperative risk factors. CONCLUSIONS Not only critical preoperative conditions but also postoperative cardiac tamponade and vital organ ischaemia are risk factors for early mortality after acute type A aortic dissection repair.

Association of NFE2L2 Gene Polymorphisms with Risk and Clinical Characteristics of Acute Type A Aortic Dissection in Han Chinese Population

“…Our study also found the correlation of rs2364723 and rs35652124 polymorphisms with incidence of organ ischemia such as brain ischemia and coronary artery involvement. Recent data showed that vital organ ischemia was a risk factor for early mortality after AAAD repair [34]. These evidences suggested that NFE2L2 gene polymorphisms not only correlated with onset risk but also severity of AAAD.…”

Sex‐Related Differences in Clinical Features and In‐Hospital Outcomes of Type B Acute Aortic Dissection: A Registry Study

“…The Tokyo Acute Aortic Super‐Network currently consists of 39 participating hospitals with specialized care for AAD and ruptured aortic aneurysm; patients with suspected or confirmed AAD are first referred to such hospitals, as reported elsewhere. 20 , 21 Detailed data on all patients treated in their emergency departments, cardiovascular surgery departments, and cardiovascular care units were routinely recorded and submitted to the data management center on specific survey forms.…”

Role of Helicopter Transfer and Cloud-Type Imaging for Acute Type A Aortic Dissection

“…To date, there have been several attempts to shorten the transfer time to a cardiovascular operating unit. One of the famous models is the Tokyo Acute Aortic Super-network (TAAS) [3]. TAAS was established in 2010, and covers approximately 70 participating hospitals.…”