TY - JOUR
T1 - The profound impact of combined severe acidosis and malperfusion on operative mortality in the surgical treatment of type A aortic dissection
AU - Lawton, Jennifer S.
AU - Moon, Marc R.
AU - Liu, Jingxia
AU - Koerner, Danielle J.
AU - Kulshrestha, Kevin
AU - Damiano, Ralph J.
AU - Maniar, Hersh
AU - Itoh, Akinobu
AU - Balsara, Keki R.
AU - Masood, Faraz M.
AU - Melby, Spencer J.
AU - Pasque, Michael K.
N1 - Publisher Copyright:
© 2017 The American Association for Thoracic Surgery
PY - 2018/3
Y1 - 2018/3
N2 - Objectives: Surgery for type A aortic dissection is associated with a high operative mortality, and a variety of predictive risk factors have been reported. We hypothesized that a combination of risk factors associated with organ malperfusion and severe acidosis that are not currently documented in databases would be associated with a level of extreme operative risk that would warrant the consideration of treatment paradigms other than immediate ascending aortic surgery. Methods: Charts of patients undergoing repair of acute type A aortic dissection between January 1, 1996, and May 1, 2016, were queried for preoperative malperfusion, preoperative base deficit, pH, bicarbonate, cardiopulmonary resuscitation, severe aortic insufficiency, redo status, and preoperative intubation. Multivariable logistic analyses were considered to evaluate interested variables and operative mortality. Results: Between January 1, 1996, and May 1, 2016, 282 patients underwent surgical repair of type A aortic dissection. A total of 66 patients had a calculated base deficit −5 or greater. Eleven of 12 patients (92%) with severe acidosis (base deficit ≥−10) with malperfusion had operative mortality. No patient with severe acidosis with abdominal malperfusion survived. Multivariable analyses identified base deficit, intubation, congestive heart failure, dyslipidemia/statin use, and renal failure as predictors of operative death. The most significant predictor was base deficit −10 or greater (odds ratio, 9.602; 95% confidence interval, 2.649-34.799). Conclusions: The combination of severe acidosis (base deficit ≥−10) with abdominal malperfusion was uniformly fatal. Further research is needed to determine whether the identification of extreme risk warrants consideration of alternate treatment options to address the cause of severe acidosis before ascending aortic procedures.
AB - Objectives: Surgery for type A aortic dissection is associated with a high operative mortality, and a variety of predictive risk factors have been reported. We hypothesized that a combination of risk factors associated with organ malperfusion and severe acidosis that are not currently documented in databases would be associated with a level of extreme operative risk that would warrant the consideration of treatment paradigms other than immediate ascending aortic surgery. Methods: Charts of patients undergoing repair of acute type A aortic dissection between January 1, 1996, and May 1, 2016, were queried for preoperative malperfusion, preoperative base deficit, pH, bicarbonate, cardiopulmonary resuscitation, severe aortic insufficiency, redo status, and preoperative intubation. Multivariable logistic analyses were considered to evaluate interested variables and operative mortality. Results: Between January 1, 1996, and May 1, 2016, 282 patients underwent surgical repair of type A aortic dissection. A total of 66 patients had a calculated base deficit −5 or greater. Eleven of 12 patients (92%) with severe acidosis (base deficit ≥−10) with malperfusion had operative mortality. No patient with severe acidosis with abdominal malperfusion survived. Multivariable analyses identified base deficit, intubation, congestive heart failure, dyslipidemia/statin use, and renal failure as predictors of operative death. The most significant predictor was base deficit −10 or greater (odds ratio, 9.602; 95% confidence interval, 2.649-34.799). Conclusions: The combination of severe acidosis (base deficit ≥−10) with abdominal malperfusion was uniformly fatal. Further research is needed to determine whether the identification of extreme risk warrants consideration of alternate treatment options to address the cause of severe acidosis before ascending aortic procedures.
KW - acidosis
KW - aorta, aortic dissection adult cardiac
KW - malperfusion
KW - operative mortality
UR - http://www.scopus.com/inward/record.url?scp=85039041434&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2017.11.002
DO - 10.1016/j.jtcvs.2017.11.002
M3 - Article
C2 - 29249502
AN - SCOPUS:85039041434
SN - 0022-5223
VL - 155
SP - 897
EP - 904
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -