Risk Factors of In‐Hospital Mortality After Acute Type A Aortic Dissection Surgery

Dear editor, We read with interest the paper by Zhang et al. [1] entitled “Neutrophil Percentage to Albumin Ratio Is Associated With In-Hospital Mortality in Patients With Acute Type A Aortic Dissection.” We congratulate the authors for their valuable contribution. However, we want to discuss some issues about in-hospital mortality risk factors after Stanford Type A aortic dissection (STAAD) surgery. The current retrospective study included 813 consecutive patients who underwent STAAD surgery. In-hospital mortality occurred in 137 (16.9%) patients. According to the multivariate analysis results, long cardiopulmonary bypass times, prolonged mechanical ventilation and the neutrophil percentage to albumin ratio value were determined as independent predictors of in-hospital mortality [1]. However, it should not be forgotten that parameters other than the data used in the study may also affect mortality. Left ventricular ejection fraction is an important predictor of mortality in all cardiac surgery operations. It is also known as an important predictor of early mortality after STAAD surgery [2]. Other important predictors of mortality are the presence of preoperative malperfusion syndrome and hemodynamic instability (shock, hypotension, cardiac tamponade) at the time of admission. The presence of patients in shock or cerebral and gastrointestinal malperfusion before STAAD surgery will increase in-hospital mortality. In addition, the Penn classification, which also includes different organ malperfusion, is an important predictor of early mortality after STAAD operations [3]. Prolonged mechanical ventilation was found to be a significant predictor of in-hospital mortality in the study [1]. The cause of prolonged mechanical ventilation after STAAD surgery may be cerebrovascular problems that develop due to operative management. Antegrade and retrograde brain protection methods can be used in surgeries involving the aortic arch. Failure to complete these applications at the specified body temperatures and within the specified periods may lead to significant problems. In addition, the complexity of the surgery on the aortic arch may also affect early mortality [4]. Stanford Type A aortic dissection affects the ascending aorta and can spread to the descending aorta and aortic arch. It can be referred to as DeBakey type II if it just extends to the ascending aorta, and DeBakey type I if it extends from the ascending aorta to the distal aorta. In hemodynamically stable DeBakey type II dissection, the operation can be completed easily and with a high success rate under a single aortic cross-clamp. In DeBakey type I dissection, the operation can be more complicated depending on malperfusion in the distal structures and the status of the aortic arch. In a study conducted in this direction, in-hospital mortality was found to be three times less after DeBakey type II dissection surgery [5]. All authors contributed to (1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published. The authors have nothing to report. The authors have nothing to report.