Perioperative Predictors of 30-day Mortality in Ascending Aorta and Aortic Arch Surgery

Vladimir Krivopalov, Gennadiy Khubulava, Andrey Peleshok, Dmitriy Ushakov, Valeriy Sizenko

Russian Military Medical Academy, Saint-Petersburg, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – C

Abstract

Introduction: Pathology of the thoracic aorta is an actual problem of modern cardiac surgery due to its high prevalence and the dangers of sudden death. Surgical treatment of this pathology is usually urgent and in high risk of mortality. 
Aim: to reveal new predictors of mortality in ascending aorta and aortic arch surgery.
Materials and methods: In our retrospective study 100 patients who had surgery for thoracic aorta aneurysms and Type A aortic dissection in our clinic from 2010 to 2017 years were included.To reveal new predictors of 30-day mortality in our study multiple logistic regression was used.
Results: 30-day mortality in this patients was 16%. The incidence of death was higher in patients with acute aortic dissection (OR=13,9; P=0,016) and critical preoperative status (OR=12,6; P=0,003) and for patients who were needed in emergency surgery (OR=16,8; P=0,002). Patients with extracardiac arteriopathy (OR=11,2; P=0,005) and chronic arterial hypertension (OR=7,5; P=0,022) were at increased chance of death. EuroScore II scale had good prognostic value (OR=1,12; P=0,015). Predictors of 30-day mortality during surgery were: long time of CPB (OR = 1,3; P<0,001), low mean blood pressure during CPB (BP<60 mmHg) (OR=8,2; P=0,016), primary cannulation in femoral artery (OR=9,9; P=0,016).
Conclusion: The main predictors of 30-day mortality in type aortic dissection and thoracic aorta aneurisms are the emergency character of surgery, critical perioperative status, extracardiac arteriopathy, chronic arterial hypertension, long time of CPB, low mean blood pressure during CPB (BP < 60 mmhg), primary cannulation in femoral artery. EuroScore II is a good model to predicting 30-day mortality in aortic surgery.