Harris et al reported risk factors for death within 48 hours for a patient with a type A acute aortic dissection. These can help to identify a patient who may require more aggressive management. The authors are from multiple institutions from around the world.
Patient selection: type A acute aortic dissection
Mortality if managed medically: 23.7% at 48-hours (0.5% per hour)
Mortality if managed surgically: 4.4%
Reasons why patients were treated medically:
(1) advanced age (mean 70 +/- 14.9)
(2) comorbidities
(3) patient preference
Items 1 and 2 indicate a poor operative candidate.
Risk factors for in-hospital death for patients undergoing surgery:
(1) age (OR 1.5 per 10 years)
(2) hypotension, shock or tamponade at presentation (OR 2.6)
(3) prior cardiac surgery (OR 2.8)
(4) preoperative malperfusion (OR 3.1)
(5) BMI (1.05 per unit)
(6) time from admission to surgery in hours (OR 0.96)
