The profound impact of combined severe acidosis and malperfusion on operative mortality in the surgical treatment of type A aortic dissection

The Journal of Thoracic and Cardiovascular Surgery

Jennifer S. Lawton¹  Marc R. Moon²  Jingxia Liu³ 

[1] Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md;Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo;Division of Public Health Sciences, Washington University School of Medicine, St Louis, Mo

关键词: aorta;    aortic dissection adult cardiac;    operative mortality;    malperfusion;    acidosis;   

DOI  :  10.1016/j.jtcvs.2017.11.002

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectivesSurgery 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.MethodsCharts 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.ResultsBetween 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).ConclusionsThe 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.

【 授权许可】

Unknown