Prediction of mortality rate in acute type A dissection: the German Registry for Acute Type A Aortic Dissection score

Author:

Czerny Martin12,Siepe Matthias12ORCID,Beyersdorf Friedhelm12ORCID,Feisst Manuel3,Gabel Michael3,Pilz Maximilian3ORCID,Pöling Jochen4,Dohle Daniel-Sebastian5,Sarvanakis Konstantinos6,Luehr Maximilian7,Hagl Christian7,Rawa Arif8,Schneider Wilke9,Detter Christian10,Holubec Tomas11ORCID,Borger Michael12,Böning Andreas13,Rylski Bartosz12

Affiliation:

1. Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany

2. Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany

3. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany

4. Department of Cardiac Surgery, Schuechtermann Clinic, Bad Rothenfelde, Germany

5. Department of Cardiothoracic and Vascular Surgery, University Hospital, Johannes Gutenberg University, Mainz, Germany

6. Clinic of Cardiothoracic Surgery, Klinikum Augsburg, Augsburg, Germany

7. Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany

8. Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany

9. Department for Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany

10. Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany

11. Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany

12. Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany

13. Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany

Abstract

Abstract OBJECTIVES The goal was to develop a scoring system to predict the 30-day mortality rate for patients undergoing surgery for acute type A aortic dissection on the basis of the German Registry for Acute Type A Aortic Dissection (GERAADA) data set and to provide a Web-based application for standard use. METHODS A total of 2537 patients enrolled in GERAADA who underwent surgery between 2006 and 2015 were analysed. Variable selection was performed using the R-package FAMoS. The robustness of the results was confirmed via the bootstrap procedure. The coefficients of the final model were used to calculate the risk score in a Web-based application. RESULTS Age [odds ratio (OR) 1.018, 95% confidence interval (CI) 1.009–1.026; P < 0.001; 5-year OR: 1.093], need for catecholamines at referral (OR 1.732, 95% CI 1.340–2.232; P < 0.001), preoperative resuscitation (OR 3.051, 95% CI 2.099–4.441; P < 0.001), need for intubation before surgery (OR 1.949, 95% CI 1.465–2.585; P < 0.001), preoperative hemiparesis (OR 1.442, 95% CI 0.996–2.065; P = 0.049), coronary malperfusion (OR 1.870, 95% CI 1.386–2.509; P < 0.001), visceral malperfusion (OR 1.748, 95% CI 1.198–2.530; P = 0.003), dissection extension to the descending aorta (OR 1.443, 95% CI 1.120–1.864; P = 0.005) and previous cardiac surgery (OR 1.772, 95% CI 1.048–2.903; P = 0.027) were independent predictors of the 30-day mortality rate. The Web application based on the final model can be found at https://www.dgthg.de/de/GERAADA_Score. CONCLUSIONS The GERAADA score is a simple, effective tool to predict the 30-day mortality rate for patients undergoing surgery for acute type A aortic dissection. We recommend the widespread use of this Web-based application for standard use.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,General Medicine,Surgery

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