{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:44:46Z","timestamp":1777679086648,"version":"3.51.4"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T00:00:00Z","timestamp":1635984000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> Acute type A aortic dissection (ATAAD) is a fatal condition that requires emergency surgery. The aim of the present study was to determine pre- and intra-operative risk factors for in-hospital mortality in patients with ATAAD.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Consecutive 313 patients with ATAAD who underwent emergency surgery at our hospital from February 2012 to February 2017 were enrolled in our study. Univariate and multivariate logistic regression analysis were performed to identify the pre-operative and intra-operative risk factors for in-hospital mortality.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Of the 313 patients, 32 patients (10.2%) died. Compared with survivors, non-survivors had higher heart rate, serum potassium level and EuroSCORE II, and higher incidence of moderate to severe pericardial effusion, supra-aortic vessels involvement, myocardial ischemia and lower-extremity ischemia. As for surgery-related factors, the duration of surgery and cardiopulmonary bypass time were longer in non-survivors than survivors. In addition, non-survivors were more likely to undergo coronary-artery bypass graft compared with survivors. On multivariate analysis, elevated plasma potassium level (OR: 43.0, 95% CI: 3.8\u201351.5, <jats:italic>p<\/jats:italic> &amp;lt; 0.001), high incidence of supra-aortic vessels involvement (OR: 4.4, 95% CI: 1.5\u20137.0, <jats:italic>p<\/jats:italic> = 0.008) and lower-extremity ischemia (OR: 4.9, 95% CI: 1.6\u20136.9; <jats:italic>p<\/jats:italic> = 0.009), and longer duration of surgery (OR 6.0, 95% CI: 1.8\u201318.7, <jats:italic>p<\/jats:italic> = 0.000) and cardiopulmonary bypass time (OR: 3.7, 95% CI: 1.3\u20139.3, <jats:italic>p<\/jats:italic> = 0.001) were independently predictive of higher mortality in patients with ATAAD.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Supra-aortic vessels involvement, lower-extremity ischemia and elevated plasma potassium level are independent predictors of mortality in patients with ATAAD. A significant decrease in duration of surgery and cardiopulmonary bypass time is helpful to improve survival of patients.<\/jats:p>","DOI":"10.3389\/fcvm.2021.728568","type":"journal-article","created":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T06:26:20Z","timestamp":1636007180000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Clinical Analysis of Risk Factors for Mortality in Type A Acute Aortic Dissection: A Single Study From China"],"prefix":"10.3389","volume":"8","author":[{"given":"Hongliang","family":"Yuan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenxing","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongxing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenqian","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manwei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yali","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing","family":"Lv","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuman","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingxing","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1093\/ejcts\/ezs025","article-title":"Analysis of risk factors for neurological dysfunction in patients with acute aortic dissection type A: data from the German registry for acute aortic dissection type a (geraada)","volume":"42","author":"Conzelmann","year":"2012","journal-title":"Eur J Cardiothorac Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1016\/j.jacc.2015.05.029","article-title":"Presentation, diagnosis, and outcomes of acute aortic dissection: 17- year trends from the international registry of acute aortic dissection","volume":"66","author":"Pape","year":"2015","journal-title":"J Am Coll Cardiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/jocs.13511","article-title":"Contemporary management and outcomes of acute type A aortic dissection: an analysis of the STS adult cardiac surgery database","volume":"33","author":"Lee","year":"2018","journal-title":"J Card Surg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1093\/ejcts\/ezx056","article-title":"Management of cerebral malperfusion in surgical repair of acute type A aortic dissection","volume":"52","author":"Furukawa","year":"2017","journal-title":"Eur J Cardiothorac Surg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1016\/j.jtcvs.2017.02.053","article-title":"Bilateral versus unilateral antegrade cerebral perfusion in total arch replacement for type A aortic dissection","volume":"154","author":"Tong","year":"2017","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1502","DOI":"10.1016\/j.athoracsur.2012.01.106","article-title":"What is the best strategy for brain protection in patients undergoing aortic arch surgery? A single center experience of 636 patients","volume":"93","author":"Misfeld","year":"2012","journal-title":"Ann Thorac Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1016\/j.jtcvs.2012.07.063","article-title":"Selective antegrade cerebral perfusion and mild (28\u00b0C-30\u00b0C) systemic hypothermic circulatory arrest for aortic arch replacement: results from 1002 patients","volume":"144","author":"Zierer","year":"2012","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.jtcvs.2004.09.005","article-title":"Contemporary results of surgery in acute type A aortic dissection: the international registry of acute aortic dissection experience","volume":"129","author":"Trimarchi","year":"2005","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1016\/j.athoracsur.2010.05.069","article-title":"Risk analysis for hospital mortality in patients with acute type A aortic dissection","volume":"90","author":"Goda","year":"2010","journal-title":"Ann Thoracic Surg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1016\/S0002-9149(02)02198-7","article-title":"Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection","volume":"89","author":"Bossone","year":"2002","journal-title":"Am J Cardiol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.jtcvs.2018.02.007","article-title":"Early reperfusion strategy improves the outcomes of surgery for type A acute aortic dissection with malperfusion","volume":"156","author":"Uchida","year":"2018","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1093\/icvts\/ivx169","article-title":"Should limb revascularization take priority over dissection repair in type A aortic dissection presenting as isolated acute limb ischaemia","volume":"25","author":"Preece","year":"2017","journal-title":"Interact Cardiovasc Thorac Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1016\/j.clinbiochem.2017.05.008","article-title":"The effect of admission serum potassium levels on in-hospital and long-term mortality in type A acute aortic dissection","volume":"50","author":"Chen","year":"2017","journal-title":"Clin Biochem."},{"key":"B14","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1001\/jama.2011.1967","article-title":"Serum potassium levels and mortality in acute myocardial infarction","volume":"307","author":"Goyal","year":"2012","journal-title":"JAMA."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1001\/jama.1965.03080130009002","article-title":"Increase of ventricular excitability threshold by hyperpotassemia: possible cause of internal pacemaker failure","volume":"191","author":"Surawicz","year":"1965","journal-title":"JAMA."},{"key":"B16","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1111\/j.1749-6632.1969.tb34130.x","article-title":"Effect of changes in potassium and calcium concentrations on diastolic threshold and strength-interval relationships of the human heart","volume":"167","author":"Gettes","year":"1969","journal-title":"Ann N Y Acad Sci."},{"key":"B17","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1093\/eurheartj\/ehw129","article-title":"Short-term mortality risk of serum potassium levels in hypertension: a retrospective analysis of nationwide registry data","volume":"38","author":"Krogager","year":"2017","journal-title":"Eur Heart J."},{"key":"B18","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1007\/s11739-015-1253-1","article-title":"Relation between admission serum potassium levels and long-term mortality in acute coronary syndrome","volume":"10","author":"Peng","year":"2015","journal-title":"Intern Emerg Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1161\/CIRCULATIONAHA.108.778811","article-title":"Serum potassium and clinical outcomes in the eplerenone post-acute myocardial infarction heart failure efficacy and survival study (EPHESUS)","volume":"118","author":"Pitt","year":"2008","journal-title":"Circulation."},{"key":"B20","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1002\/ejhf.688","article-title":"Impact of eplerenone on cardiovascular outcomes in heart failure patients with hypokalaemia","volume":"19","author":"Rossignol","year":"2017","journal-title":"Eur J Heart Fail."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.1161\/CIR.0b013e3181d4739e","article-title":"2010 ACCF\/AHA\/AATS\/ACR\/ASA\/SCA\/ SCAI\/SIR\/STS\/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J","volume":"55","author":"Hiratzka","year":"2010","journal-title":"Am. Coll. Cardiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur Heart J."},{"key":"B23","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/S0967-2109(03)00057-7","article-title":"Operative risk factors of type a aortic dissection: analysis of 252 consecutive patients","volume":"11","author":"Tan","year":"2003","journal-title":"Cardiovasc Surg."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.728568\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T06:26:22Z","timestamp":1636007182000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.728568\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,4]]},"references-count":23,"alternative-id":["10.3389\/fcvm.2021.728568"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2021.728568","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,4]]},"article-number":"728568"}}