Key result
Preoperative hematological markers were inadequate for predicting in-hospital mortality in acute Type A aortic dissection repair, whereas prolonged total circulatory arrest (OR 1.089) and cross-clamp times (OR 1.031) were independent predictors.
Why the study?
Mortality in acute Type A aortic dissection remains high and unpredictable, prompting investigation into whether preoperative hematological markers and risk factors can predict in-hospital mortality after deep hypothermic circulatory arrest repair.
Do preoperative hematological parameters and intraoperative variables predict in-hospital mortality in patients undergoing Stanford Type A aortic dissection repair?
Cohort (n=78)
No
Do preoperative hematological parameters and intraoperative variables predict in-hospital mortality in patients undergoing Stanford Type A aortic dissection repair?
Intraoperative variables such as cross-clamp and total circulatory arrest times, rather than preoperative hematological markers, are independent predictors of in-hospital mortality in patients undergoing Stanford Type A aortic dissection repair.
Answers are grounded in this paper and cite their sources.
Minimizing cross-clamp and circulatory arrest times warrants attention in Type A repair; this cohort study leaves open the added value of preoperative hematological markers.
Background: Mortality in acute Type A aortic dissection is still high and unpredictable. We aimed to investigate the validity of preoperative hematological markers and possible risk factors in predicting in-hospital mortality in patients operated with deep hypothermic circulatory arrest method. Methods: 78 consecutive patients who were admitted to the emergency service and operated on were retrospectively analyzed. Risk factors for in-hospital death were investigated to develop a predictive model. Results: There was no difference between patients in terms of the were demographic data of the patients. In the mortality group, only preoperative creatinine levels were found to be higher (p < 0.05). Factors affecting mortality were found as total circulatory arrest (TCA) and cross-clamp (X-clamp) times when intraoperative data were examined (p < 0.05). ROC analysis was performed to determine the power to predict mortality and to determine the cut-off point. In ROC analysis to predict mortality, X-Clamp time > 71 minutes, 68.2% sensitivity and 66.1% specificity, TCA > 44.5 minutes, 72.7% sensitivity and 73.2% specificity were found. In the mortality group, these values were found to be significantly higher than those who were discharged. Conclusion: In the surgical treatment of Type A aortic dissection under deep hypothermia, hematologic biomarkers may be insufficient in estimating the risk for mortality.
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Durmaz et al. (2021) conducted a cohort in Acute Type A aortic dissection (n=78). Preoperative hematological parameters and intraoperative variables (X-clamp and TCA times) vs. Discharged patients (survivors) was evaluated on In-hospital mortality (OR 1.089, 95% CI 1.025-1.157, p=0.006). Preoperative hematological markers were inadequate for predicting in-hospital mortality in acute Type A aortic dissection repair, whereas prolonged total circulatory arrest (OR 1.089) and cross-clamp times (OR 1.031) were independent predictors.
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