Predictors of complications in acute type B aortic dissection.
- Genoni M Clinic of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland. michele.genoni@triemli.stzh.ch
- Paul M
- Tavakoli R
- Künzli A
- Lachat M
- Graves K
- Seifert B
- Turina M
- 2002-07-10
Published in:
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - 2002
Adult
Aged
Aged, 80 and over
Aneurysm, Dissecting
Aortic Aneurysm
Female
Hospital Mortality
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors
Survival Analysis
English
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 >4.5 cm (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.
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 >4.5 cm (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.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/s1010-7940(02)00203-8
- PMID 12103374
- Persistent URL
- https://sonar.ch/global/documents/179455
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