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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2025-06-01
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| author | 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 |
| author_facet | 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 |
| author_sort | Angelo M. Dell’Aquila |
| collection | DOAJ |
| description | 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. |
| format | Article |
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| institution | Kabale University |
| issn | 2308-3425 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-9eaab61fa15c4cf7b8e29de403507ac02025-08-20T03:32:14ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252025-06-0112723910.3390/jcdd12070239Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and OutcomesAngelo M. Dell’Aquila0Konrad Wisniewski1Adrian-Iustin Georgevici2Gábor Szabó3Francesco Onorati4Till J. Demal5Andreas Rukosujew6Sven Peterss7Caroline Radner8Joscha Buech9Antonio Fiore10Andrea Perrotti11Angel G. Pinto12Javier Rodriguez Lega13Marek Pol14Petr Kacer15Enzo Mazzaro16Giuseppe Gatti17Igor Vendramin18Daniela Piani19Luisa Ferrante20Mauro Rinaldi21Eduard Quintana22Robert Pruna-Guillen23Dario Di Perna24Zein El-Dean25Hiwa Sherzad26Giovanni Mariscalco27Mark Field28Amer Harky29Manoj Kuduvalli30Matteo Pettinari31Stefano Rosato32Tatu Juvonen33Timo Mäkikallio34Lenard Conradi35Giorgio Mastroiacovo36Fausto Biancari37Department of Cardiac Surgery, University Hospital Halle, 06120 Halle, GermanyDepartment of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, GermanySt. Josef-Hospital, University Hospital of Ruhr-University of Bochum, 44791 Bochum, GermanyDepartment of Cardiac Surgery, University Hospital Halle, 06120 Halle, GermanyDivision of Cardiac Surgery, University of Verona Medical School, 37129 Verona, ItalyDepartment of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, GermanyDepartment of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, GermanyDepartment of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 81337 Munich, GermanyDepartment of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 81337 Munich, GermanyDepartment of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 81337 Munich, GermanyDepartment of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, FranceDepartment of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, FranceCardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, SpainCardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, SpainDepartment of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech RepublicDepartment of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech RepublicDivision of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34149 Trieste, ItalyDivision of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34149 Trieste, ItalyCardiothoracic Department, University Hospital of Udine, 33100 Udine, ItalyCardiothoracic Department, University Hospital of Udine, 33100 Udine, ItalyCardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, ItalyCardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, ItalyDepartment of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Cardiac Surgery, Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, FranceDepartment of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UKDepartment of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UKDepartment of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UKLiverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UKLiverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UKLiverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UKDepartment of Cardiac Surgery, Ziekenhuis Oost Limburg, 3600 Genk, BelgiumNational Center for Global Health, Istituto Superiore di Sanitá, 00161 Rome, ItalyResearch Unit of Surgery, Anesthesia and Critical Care, University of Oulu, 90570 Oulu, FinlandDepartment of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, FinlandDepartment of Cardiac Surgery, Cologne University Hospital, 50937 Cologne, GermanyDepartment of Cardiovascular Surgery, Centro Cardioologico Monzino IRCCS, 20138 Milan, ItalyDepartment of Cardiovascular Surgery, Centro Cardioologico Monzino IRCCS, 20138 Milan, ItalyObjectives: 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.https://www.mdpi.com/2308-3425/12/7/239type a aortic dissectioninvasive mechanical ventilationintubation |
| spellingShingle | 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 Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes Journal of Cardiovascular Development and Disease type a aortic dissection invasive mechanical ventilation intubation |
| title | Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes |
| title_full | Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes |
| title_fullStr | Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes |
| title_full_unstemmed | Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes |
| title_short | Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes |
| title_sort | preoperative mechanical ventilation prior to surgical repair for type a aortic dissection incidence risk and outcomes |
| topic | type a aortic dissection invasive mechanical ventilation intubation |
| url | https://www.mdpi.com/2308-3425/12/7/239 |
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