Preoperative risk factors and 180-day postoperative mortality in type a aortic dissection: a cohort study

To explore modifiable risk factors associated with 180-day postoperative mortality based on preoperative examinations in patients with type A aortic dissection. From August 2021 to November 2024,86 patients with TAAD attending the Emergency and Trauma Center of the First Affiliated Hospital,Zhejiang University School of Medicine were included in this study.The primary endpoint was follow-up of patients 180 days after operation. 25 (29.07%) of the 86 patients were dead within 180-day, with preoperative cardiac arrest and postoperative multiple organ failure being the primary causes of death. Comparison of baseline data between the survivors and the 180-day postoperative mortality revealed statistically significant differences in gender, age, mean arterial pressure, lactate, hemoglobin, D-dimer, fibrinogen, albumin, ST-T abnormalities, impaired intestinal blood supply, coronary artery bypass graft surgery, and GERAADA score (P < 0.05). By multivariate logistic regression analysis, fibrinogen, albumin, ST-T abnormalities, and impaired intestinal blood supply were risk factors of 180-day postoperative mortality, while gender was a protective parameter of 180-day postoperative mortality. Preoperative risk stratification demonstrates significant predictive value for 180-day postoperative mortality in TAAD patients.Our findings identify a high-risk profile characterized by hypofibrinogenemia,electrocardiographic ST-T abnormalities,and intestinal malperfusion.A multimodal therapeutic approach incorporating aggressive preoperative fibrinogen replacement guided by ROTEM/TEG,consideration of visceral stenting prior to central repair in cases of severe malperfusion,high suspicion for coronary involvement in patients with ST-T abnormalities,may potentially reduce early postoperative mortality in this vulnerable population.