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Preoperative predictive factors for mortality in acute type A aortic dissection: an institutional report on 217 consecutives cases

^a Department of Cardiac Surgery, CHU, Grenoble, BP 217 University Hospital, Grenoble cedex 9, France
^b Thoracic and Cardiovascular Intensive Care Unit, Grenoble University Hospital, Grenoble, France
^c Department of Radiology, Grenoble University Hospital, Grenoble, France

*Corresponding author. Tel.: +33 4 76 76 54 62; fax: +33 4 76 76 52 81.

E-mail address: OChavanon{at}chu-grenoble.fr (O. Chavanon).

Surgical treatment of type A acute aortic dissection remains a challenge, especially in elderly patients or in patients with a critical preoperative status. We have retrospectively assessed our series over a 15-year period starting in 1990, including patients operated under cardiac massage for preoperative cardiac arrest occurring in the operating room. There were 217 patients (mean age, 61.5±13.5 years; 16 patients >80 years). Preoperative shock was noted in 21.7%, including 14 patients operated under cardiac massage. Operating procedures were: modified Bentall (31%), aortic tube (67.1%), other (1.9%), aortic arch procedure in 26.4%. Overall mortality rate was 19.8% with an exponential increase with age (50% over 80 years). Of 14 patients operated under cardiac massage, three have been discharged: one ventricular fibrillation due to an acute myocardial infarction and two among the 13 with acute aortic ruptures in cardiac arrest (one being a redo, the adhesions limiting the tamponade). Our results confirmed age and preoperative shock prior to surgery as risk factors, and the fact that operating on a patient under cardiac massage for cardiac arrest due to an aortic rupture is probably not a reasonable therapeutic choice.

Key Words: Acute; Aortic dissection; Cardiac arrest; Elderly