Results
In this study, 313 surgically treated ATAAD patients were included. Of
these patients, 32 (10.2%) died within 30 days.
Compared to the nonsurvivor group, the survivor group had lower heart
rates and blood potassium levels. Moderate or severe pericardial
effusion, suprasternal branch involvement, myocardial ischemia and lower
limb ischemia were less common in patients who survived than in those
who did not. However, there were no significant differences in age;
blood pressure, blood leukocytes, neutrophils and platelet counts on
admission; serum creatinine; ascending aorta diameter; left ventricular
ejection fraction; degree of aortic regurgitation; dissection involving
the ascending aorta and aortic arch; or lining breach position between
the two groups (table 1).
Regarding the intraoperative factors, the durations of procedure and
cardiopulmonary bypass time (CPBT) of the patients in the
nonsurvivor group were
significantly longer than those in the survivor group.
Coronary artery bypass graft
(CABG) was performed more frequently in the nonsurvivor group than in
the survivor group. There were no statistically significant differences
between the two groups in terms of aorta occlusion time, cessation time,
cerebral perfusion time, ascending aorta replacement, aortic valve
replacement, half or whole arch replacement, stenting rhinoplasty or
sinus molding (table 2).
ROC curves were used to determine the optimal truncation values for
operation time, extracorporeal circulation time, admission heart rate
and blood potassium level to identify early mortality in ATAAD patients
(table 3, figure 1). ROC analysis revealed that duration of surgery
>9.5 h [area under the curve (AUC): 0.73], CPBT
>227 min (AUC: 0.72), heart rate >82 beats/min
(AUC: 0.65) and plasma potassium >3.8 mmol/l (AUC: 0.71)
were more likely to be associated with 30-day mortality in patients with
ATAAD.
Multivariable logistic regression analysis revealed that operation time
>9.5 h (OR: 4.5; 95% confidence interval
[CI]:1.9-10.6; p=0.001), a CPBT >227 min (OR: 5.3; 95%
CI:2.1-13.9; p=0.001), moderate to severe pericardial effusion (OR: 3.3;
95% CI: 1.1-9.6; p=0.017), supraventricular branch involvement (OR:
4.9; 95% CI:1.8-13.4; p=0.002), and lower limb ischemia (OR: 7.6; 95%
CI: 2.6-22.2; p<0.001) were independent risk factors for early
postoperative mortality (table 4).