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Predictors of complications in acute type B aortic dissection

Genoni, M. ; Paul, M. ; Tavakoli, R. ; Künzli, A. ; Lachat, M. ; Graves, K. ; Seifert, B. ; Turina, M.

In: European Journal of Cardio-Thoracic Surgery, 2002, vol. 22, no. 1, p. 59-63

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    Title
    • Predictors of complications in acute type B aortic dissection
    Author
    • Genoni, M.. Clinic of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
    • Paul, M.. Clinic of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
    • Tavakoli, R.. Clinic of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
    • Künzli, A.. Clinic of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
    • Lachat, M.. Clinic of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
    • Graves, K.. Clinic of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
    • Seifert, B.. Department of Biostatistics, University of Zurich, Zurich, Switzerland
    • Turina, M.. Clinic of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:304758
    Summary
    Objectives: Medical treatment is generally advocated for patients with acute type B aortic dissection without complications. The objective of this retrospective analysis was to determine whether there are any initial findings that can help predict the long-term course of the disease. Methods: Case records of the 130 patients treated for type B aortic dissection between 1988 and 1997 were reviewed; 41 (31%) were operated on in the acute phase (≪14 days), 31 (24%) were operated on in the chronic phase and 58 (45%) were treated medically. Results: Overall acute mortality was 10.8%; 22% for patients operated on in the early phase and 5.6% for medically treated patients. Age (P=0.002), persistent pain (P=0.01) and malperfusion (P=0.001) were significant independent predictors of the need for surgery. Paraplegia/para paresis (P=0.0001), leg ischaemia (P=0.003), pleural effusion (P=0.003), rupture (P=0.0001), shock (P=0.0001), age (P=0.003), cardiac failure (P=0.002) and aortic diameter ≫4.5cm (P=0.002) were significant predictors of poor survival. Age and shock also emerged as independent risk factors. Patients without malperfusion (P=0.0001), pleural effusion (P=0.003), rupture (P=0.0001) and shock (P=0.0001) had a significantly better event-free survival (freedom from repeat surgery and death). The actuarial survival rate for high-risk patients (malperfusion, rupture, shock) was 62% at 1 year and 40% at 5 years; the corresponding values for low-risk patients were 94 and 84%, respectively. Conclusions: Rupture, shock and malperfusion are significant predictors of poor survival in patients with acute type B aortic dissection