doiSerbia

In-hospital mortality predictors after surgery for Stanford type A aortic dissection - single-center five-year experience

Zdravković Ranko (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia), ranko.zdravkovic@ikvbv.ns.ac.rs
Redžek Aleksandar (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia)
Šušak Stamenko (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia)
Tatić Milanka (University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + Institute of Oncology of Vojvodina, Sremska Kamenica, Serbia)
Videnović Nebojša (University of Priština, Kosovska Mitrovica, Faculty of Medicine, Kosovska Mitrovica, Serbia)
Majdevac Slavica (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia)
Vujić Vanja (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia)
Vučković-Karan Jelena (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia)
Miljković Tatjana (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia)
Velicki Lazar (Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia)

Introduction/Objective. Stanford type A aortic dissection is a surgical emergency associated with high mortality. The aim of this study was to determine which group of patients and which characteristics were associated with postoperative, in-hospital mortality. Methods. The retrospective study included 116 patients with type A aortic dissection surgically treated over a five-year period. The association between postoperative, in-hospital mortality and patient characteristics was examined. Results. Total postoperative, in-hospital mortality was 22.4% (26 out of 116 patients). The variables that, after a multivariate analysis, showed a direct correlation with mortality were as follows: admission creatinine value [OR 1.026 (1.006–1.046), p = 0.009], C-reactive protein (CRP) > 10 mg/L [OR 4.764 (1.066–21.283), p = 0.041], and stroke [OR 6.097 (1.399–26.570), p = 0.016]. The receiver operating characteristic (ROC) curve showed that creatinine could be a good predictor of mortality (area under the ROC curve = 0.767; p < 0.0005). The cut-off point was 124.5 μmol/L. The sensitivity was 65% and the specificity was 80%. The cut-off point for CRP was 14.5 mg/L – sensitivity 71.4%, specificity 75% (area under the ROC curve = 0.702, p = 0.021). Conclusion. Surgery for type A aortic dissection is still associated with relatively high mortality. A lower chance of survival may be indicated by elevated admission creatinine and CRP values, as well as stroke.

Keywords: aorta, dissection, mortality, creatinine, CRP, stroke