PREDICTORS FOR IN HOSPITAL MORTALITY IN PATIENTS WITH TYPE A AORTIC DISSECTION FROM A TWO CENTRE EXPERIENCE S Leontyev, J Légaré, MA Borger, K Buth, AK Funkat, J Gerhard, S Lehmann, J Seeburger, FW Mohr Department of Cardiac Surgery, Heart Center, University of Leipzig, Germany. Department of Cardiac Surgery, Heart Center, University of Leipzig, Germany.

Background Acute type A aortic dissection a cardiovascular emergency with a high potential for death.  worldwide prevalence 0.5 to 2.95 per 100,000 per year; the prevalence ranges from 0.2 to 0.8 per 100,000 per year in the U.S new cases per year (1).  Surgical mortality rates 9% to 36% (2,3) 3-year survival - 86% (4) and 5-year survival to 50-80% (3). 1 Cohn et all Trimarchi et all 2005; 3 Thiappini et all Tsai et all 2006

Aim / Methods  Analysis of all patients (n=465)undergoing aortic surgery for acute Type A dissection in Leipzig (Germany)(n=374) and Halifax (Canada) (n=91) over the same period between 1996 and  To evaluate predictors for in hospital mortality after surgical treatment in patients with type A aortic dissection

Total n=465 Age (years) 61  13 Female 36 % NYHA III-IV 38% Coronary artery disease 20% Diabetes 12 % Peripheral vascular disease 13 % Marfan Syndrome 4 % Demographics

Total (n=465) Critical preoperative state 31 % CPR 11 % Preoperative intubation 19 % Preoperative inotropic support 19 % Preoperative pericardial tamponade 38 % Preoperative state

Total (n=465) Preoperative malperfision syndrome 35 % Coronary malperfusion 14 % Cerebral malperfusion 10 % Malperfusion of extremities 12 % Visceral malperfusion 8 % Preoperative malperfision

Total (n=465) Ascending aorta 94 % Aortic arch 87 % Descending aorta 59 % Abdominal aorta 48 % Operative data Total n=465 Cardio-pulmonary bypass [min] 202 ± 77 X-clamp time [min] 104 ± 52 Circulatory arrest 90% Circulatory arrest time [min] 29 ± 20

Total (n = 465) Modified Bental procedure 32 % Aortic valve sparing procedure (modified Yacoub or David) 23 % Isolated supracoronare aorta ascending replacement 25 % Partial or total aortic arch replacement 75 % Aortic arch replacement with elephant trunk17% Concomitant procedure - MV surgery or CABG16% Operation

Odds ratioCIp critical preoperative state <0.01 visceral malperfusion <0.01 malperfusion of extremities Multivariate analysis all patients ( Preoperative risk factors ) Critical preoperative state - preoperative ventilation, inotropic support, cardiopulmonary resuscitation and unstable preoperative status

Mortality Total (n=465) 30 day mortality 23 % (n=107) Mortality without critical preoperative state and malperfusion syndrom (n=217) 10% (n=22)

Mortality The reasons of death low cardiac output 50.5% neurological complication 13.7% multi-organ failure 7.5% aortic rupture 5.3% other20% 107 patients died during first 30 days

Conclusion This represents one of the largest series of patients with Type A aortic dissection in which a risk model could be created The surgical treatment of patients with acute aortic Type A Dissection is associated with high operative mortality. We identified the following independent predictors of poor outcome: The critical preoperative state The presence of malperfusion