Peri-operative risk factors for in-hospital mortality in acute type A aortic dissection

Acute type A aortic dissection (TAAD) is cardiovascular emergency that is often fatal. American Heart Association guidelines recommend that surgical interventions should be given to TAAD patients to resect all aneurysmal aorta and the proximal extent of the dissection (1). TAAD surgical managements had been increased and improved in recent years. In 2015, international registry of acute aortic dissection (IRAD) reported that in-hospital mortality of surgical treated TAAD patients has decreased over time, but the rate remained high (from 25% to 18% over 17 years, P=0.003) (2). Identifying patients with high-risk feature is clinically relevant. IRAD researchers reported that the principal independent pre-operative predictors of mortality were history of aortic valve replacement, migrating chest pain, hypotension as sign of TAAD, shock or tamponade, preoperative cardiac tamponade, and preoperative limb ischemia (3). Age greater than 70 years, prior cardiac surgery, intraoperative hypotension, a right ventricle dysfunction at surgery, a necessity to perform coronary revascularization, pre-existing cardiac disease, and cardiopulmonary resuscitation were also reported as risk factors for TAAD in-hospital mortality in other studies (4,5)