• Hung-Wen Tsai, Shih-Rong Hsieh, Hao-Ji Wei, Chung-Chi Wang, Yen Chang, and Hui-Ching Ho.
• Cardiovascular Division of Surgery, Taichung Veterans General Hospital, Taichung City, Taiwan.
• J Formos Med Assoc. 2004 Jun 1; 103 (6): 428431428-31.

Background And PurposeAcute type A aortic dissection presents a formidable challenge for the cardiac surgeon, although remarkable improvements have been achieved in diagnosis, surgical techniques and perioperative management. The aim of this study was to identify the most important variables associated with in-hospital mortality in patients undergoing surgery for this condition.MethodsBetween July 1998 and June 2002, 80 patients underwent surgery for acute type A aortic dissection. Univariate and multivariate analyses were performed to identify the variables independently correlated with in-hospital mortality.ResultsThe overall in-hospital mortality rate was 20% (16/80 patients). Univariate analysis revealed 24 preoperative and operative variables, including type of surgery, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, diabetes mellitus, and postoperative (postoperative 24 hours) bleeding > or = 1500 mL, as factors associated with in-hospital death. Stepwise logistic regression analysis showed the factors independently associated with in-hospital death were CPB time, diabetes mellitus, and postoperative bleeding > or = 1500 mL (p <0.05).ConclusionsMultiple factors affect in-hospital mortality after surgery for acute type A aortic dissection. This study suggests that CPB time, diabetes mellitus and postoperative bleeding > or = 1500 mL are the main determinants of in-hospital death.

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