CC BY 4.0 · Aorta (Stamford) 2017; 05(02): 33-41
DOI: 10.12945/j.aorta.2017.16.034
Original Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cause of Death Following Surgery for Acute Type A Dissection

Evidence from the Canadian Thoracic Aortic Collaborative
R. Scott McClure
1   Division of Cardiac Surgery, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
2   Division of Cardiac Surgery, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada
,
Maral Ouzounian
3   Division of Cardiac Surgery, Peter Munk Cardiovascular Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
,
Munir Boodhwani
4   Division of Cardiac Surgery, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
,
Ismail El-Hamamsy
5   Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
,
Michael W.A. Chu
6   Division of Cardiac Surgery, University Hospital, Western University, London, Ontario, Canada
,
Zlatko Pozeg
7   Division of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
,
Francois Dagenais
8   Division of Cardiac Surgery, University Laval, Quebec City, Quebec, Canada
,
Khokan C. Sikdar
9   Mozell Family Analysis Core Lab, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
,
Jehangir J. Appoo
1   Division of Cardiac Surgery, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
› Author Affiliations
Further Information

Publication History

07 June 2016

12 March 2017

Publication Date:
24 September 2018 (online)

Abstract

Background: Surgery confers the best chance of survival following acute Type A dissection (ATAD), yet perioperative mortality remains high. Although perioperative risk factors for mortality have been described, information on the actual causes of death is sparse. In this study, we aimed to characterize the inciting events causing death during surgical repair of ATAD.

Methods: Nine centers participated in the study. We included all patients who died following surgical repair for ATAD between January 2007 and December 2013. An aortic surgeon at each site determined the primary cause of death from seven predetermined categories: cardiac, stroke, hemorrhage, other organ ischemia (peripheral, renal, or visceral), multiorgan failure, sepsis, or other causes. Additional characteristics and variables were analyzed to delineate potential modifiable factors for mortality.

Results: Of the 692 surgeries for ATAD, there were 123 deaths (17.8% mortality rate). Mean age at death was 66 years. Events contributing to death were: cardiac (25%), stroke (22%), hemorrhage (21%), multiorgan failure (12%), other organ ischemia (11%), sepsis (4%), and other causes (5%). Neurologic injury at presentation was a predictor of stroke as the inciting cause of death (p = 0.04). Peripheral, renal, or visceral ischemia at presentation was highly predictive of death due to these presenting ischemic conditions (p = 0.004). We found no associations between cardiogenic shock, tamponade, or cardiopulmonary bypass duration and cardiac death.

Conclusion: Operative mortality for ATAD remains high in Canada. Nearly 70% of deaths arise from cardiac failure, stroke, or hemorrhage. Therefore, novel surgical, hybrid, and endovascular strategies should target these three areas.