Left Ventricular Systolic Dysfunction in Patients With Type-A Aortic Dissection Is Associated With 30-Day Mortality

• Published in: Journal of cardiothoracic and vascular anesthesia 2019-01, Vol.33 (1), p.51-57
• Main Authors: Thurau, Jana, Habazettl, Helmut, El Al, MD, Alaa Abd, Mladenow, Alexander, Zaschke, Lisa, Adam, MD, Uyanga, Kuppe, Hermann, Wundram, Maximilian, Kukucka, Marian, Kurz, MD, Stephan D.
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Aneurysm, Dissecting - complications; Aneurysm, Dissecting - diagnosis; Aortic Aneurysm, Thoracic - complications; Aortic Aneurysm, Thoracic - diagnosis; Echocardiography; Female; Germany - epidemiology; Humans; Incidence; left ventricular dysfunction; left ventricular ejection fraction; Male; Middle Aged; predictors of perioperative mortality; Prognosis; Retrospective Studies; Stroke Volume - physiology; Survival Rate - trends; Systole; Treatment Outcome; type-A aortic dissection; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left - physiology; Young Adult
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2018.07.046

The aim of this study was to analyze preoperative and postoperative echocardiographic parameters in patients with type-A acute aortic dissection (ATAAD) and to analyze whether impaired preoperative left ventricular function was associated with short- and long-term survival. To enable multivariable analysis, established risk factors of ATAAD were analyzed as well. Retrospective single-center study. The German Heart Center Berlin. The retrospective data of 512 patients with ATAAD who were treated between 2006 and 2014 were analyzed. None. Preoperative versus postoperative left ventricular ejection fraction (LVEF), right ventricular ejection fraction, left ventricular end-diastolic diameter, and right ventricular end-diastolic diameter were not significantly different, and the mean values were within the reference ranges. Because of the surgical intervention, incidences and severities of aortic regurgitation and pericardial effusion decreased. In multivariable logistic analysis, the authors identified age (odds ratio [OR] 1.04, p < 0.001), preoperative LVEF ≤35% (OR 2.20, p = 0.003), any ischemia (Penn non-Aa) (OR 2.15, p < 0.001), and longer cardiopulmonary bypass time (OR 1.04, p < 0.001) as independent predictors of 30-day mortality. Cardiopulmonary resuscitation, tamponade, or shock, and pre-existing cardiac disease, were not predictors of death. After surgery, aortic insufficiency and pericardial effusion decreased, whereas cardiac functional parameters did not change. Severe LV dysfunction was identified as a new independent predictor of 30-day mortality.