Risk Analysis For Surgical Mortality In Patients With Acute Type A Aortic Dissection

Acute type a aortic dissection is severe, life-threatening emergency with much complication. Despite development of surgery and extracorporeal circulation, its surgical mortality is still higher than other cardiovascular disease.Clinical factors as self condition of patients, pattern of surgery and extracorporeal circulation all affect prognosis. The complication varies from primary tear of intima and expansion of dissection, but rupture of aorta in all patients leads to mass bleeding to death. So, we should be highly suspicious with onset of severe chest pain, make imaging investigations instantly, arrange surgery after conviction of type a aortic dissection. The prognosis varies with different complication, for instance: involvement of common carotid artery may cause ischemia of cerebra, leads to postoperative nerve deficit; involvement of intercostal artery may cause ischemia of spiral, leads to postoperative paraplegia; involvement of renal or mesenteric artery may cause organ ischemia, leads to disorder of body fluid and endogenous infection;involvement of coronary artery may cause myocardium ischemia, leads to angina pectoris or myocardial infarction, cover the presentation of acute aortic dissection, leads to misdiagnosis, delaying the timing of salvage. So, when suspect the diagnosis of type a aortic dissection, we should check the patient overall, exclude complication of each system, and make sure no delaying of timing of surgical repair. The affection of primary intima tear and organ complication caused by involvement of dissection to branch artery to prognosis have gained a lot of attention, many medical center have analysis and summary about clinical factors, although there is no consensus, these researches may help doctors nurses and other medical personalities understand conditions of local acute type a aortic dissection patients, reducing surgical mortality, improving prognosis, serving better for health of patients.Objective: risk analysis for surgical mortality in patients with acute type aaortic dissection, research for affection of relative symptomatic treatment to prognosis.Method: retrospective analysis for clinical data of 25 patients with acute type a aortic dissection from January 2010 to December 2015.Result: 5 patients died after surgery.(20%) Single factor analysis demonstrated that preoperative risk factors are inflammation and renal insufficiency, operative risk factors are time of extracorporeal circulation,clamping time of aorta and lowest rectal temperature. Multiple logistic analysis demonstrated independent risk factor is preoperative renal insufficiency.(OR=1.020,95%CI0.999-1.041,P =0.045).Conclusion:1. the independent risk factor of surgical mortality in patients with acute type a aortic dissection is preoperative renal insufficiency.2. preoperative renal insufficiency may be complication of renal ischemia caused by involvement of renal artery by dissection.3. treatment for preoperative renal insufficiency may improve prognosis,we suggest that without delay of salvage, correction of renal function before surgery in patients with acute type a aortic dissection complicated by renal insufficiency.