Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes

Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes

Objectives: Several conditions associated with type A aortic dissection may require preoperative invasive mechanical ventilation (IMV). The current literature lacks data on this subset of patients’ prevalence and postoperative outcomes. This study aims to investigate this unexplored issue in a multi...

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Main Authors: Angelo M. Dell’Aquila, Konrad Wisniewski, Adrian-Iustin Georgevici, Gábor Szabó, Francesco Onorati, Till J. Demal, Andreas Rukosujew, Sven Peterss, Caroline Radner, Joscha Buech, Antonio Fiore, Andrea Perrotti, Angel G. Pinto, Javier Rodriguez Lega, Marek Pol, Petr Kacer, Enzo Mazzaro, Giuseppe Gatti, Igor Vendramin, Daniela Piani, Luisa Ferrante, Mauro Rinaldi, Eduard Quintana, Robert Pruna-Guillen, Dario Di Perna, Zein El-Dean, Hiwa Sherzad, Giovanni Mariscalco, Mark Field, Amer Harky, Manoj Kuduvalli, Matteo Pettinari, Stefano Rosato, Tatu Juvonen, Timo Mäkikallio, Lenard Conradi, Giorgio Mastroiacovo, Fausto Biancari
Format: Article
Language:English
Published: MDPI AG 2025-06-01
Series:Journal of Cardiovascular Development and Disease
Subjects:
type a aortic dissection
invasive mechanical ventilation
intubation
Online Access:https://www.mdpi.com/2308-3425/12/7/239
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Summary:Objectives: Several conditions associated with type A aortic dissection may require preoperative invasive mechanical ventilation (IMV). The current literature lacks data on this subset of patients’ prevalence and postoperative outcomes. This study aims to investigate this unexplored issue in a multicenter European registry. Methods: Data from 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD) were the subject of this analysis. Bootstrapped Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was performed for variable selection to identify key predictors of hospital death. In the second step, a multilevel multivariable logistic regression (MMLR) was carried out, given the clustered structure of the data. Results: A total of 346 (9.3%) out of 3735 patients required preoperative IMV. Compared to the non-IMV patients, patients requiring IMV had a significantly higher rate of organ malperfusion (52% vs. 35%, <i>p</i> < 0.001) and a higher proportion of tears in the aortic root (<i>p</i> = 0.048). The in-hospital mortality rate among IMV patients was 38% vs. 15% in non-IMV patients (<i>p</i> < 0.001), without a difference in post-discharge survival (<i>p</i> = 0.84). At the MMLR, patients who required IMV had 135% higher odds of in-hospital death compared to the remaining patients. IMV yielded the second highest odds in the prediction model for in-hospital mortality (OR 2.13, CI 1.60 to 2.85, <i>p</i> < 0.001). Among IMV patients, the extension of surgery to the aortic arch was significantly associated with increased in-hospital mortality (<i>p</i> < 0.001, OR 2.98). In multivariable analysis, preoperative IMV was independently associated with increased odds of in-hospital mortality. Conclusions: The need for invasive mechanical ventilation before surgical repair for type A aortic dissection is not infrequent. In this subpopulation, the in-hospital mortality rate was twofold compared to patients who did not require IMV. The awareness of the preoperative risk profile and outcomes of this subset of patients should urge surgeons to tailor the surgical strategy more appropriately to improve the immediate postoperative results.
ISSN:2308-3425

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