{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T19:40:05Z","timestamp":1777405205804,"version":"3.51.4"},"reference-count":16,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>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\u2019 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%, p &lt; 0.001) and a higher proportion of tears in the aortic root (p = 0.048). The in-hospital mortality rate among IMV patients was 38% vs. 15% in non-IMV patients (p &lt; 0.001), without a difference in post-discharge survival (p = 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, p &lt; 0.001). Among IMV patients, the extension of surgery to the aortic arch was significantly associated with increased in-hospital mortality (p &lt; 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.<\/jats:p>","DOI":"10.3390\/jcdd12070239","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T09:08:44Z","timestamp":1750669724000},"page":"239","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5748-4275","authenticated-orcid":false,"given":"Angelo M.","family":"Dell\u2019Aquila","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Halle, 06120 Halle, Germany"},{"name":"Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5784-5747","authenticated-orcid":false,"given":"Konrad","family":"Wisniewski","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian-Iustin","family":"Georgevici","sequence":"additional","affiliation":[{"name":"St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, 44791 Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00e1bor","family":"Szab\u00f3","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Halle, 06120 Halle, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0879-3557","authenticated-orcid":false,"given":"Francesco","family":"Onorati","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, University of Verona Medical School, 37129 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8978-9914","authenticated-orcid":false,"given":"Till J.","family":"Demal","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0869-1630","authenticated-orcid":false,"given":"Andreas","family":"Rukosujew","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1880-152X","authenticated-orcid":false,"given":"Sven","family":"Peterss","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 81337 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0782-1456","authenticated-orcid":false,"given":"Caroline","family":"Radner","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 81337 Munich, Germany"},{"name":"German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, 80802 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8749-2962","authenticated-orcid":false,"given":"Joscha","family":"Buech","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 81337 Munich, Germany"},{"name":"German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, 80802 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7962-7276","authenticated-orcid":false,"given":"Antonio","family":"Fiore","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, H\u00f4pitaux Universitaires Henri Mondor, Assistance Publique-H\u00f4pitaux de Paris, 94000 Creteil, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Perrotti","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angel G.","family":"Pinto","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Department, University Hospital Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8740-2090","authenticated-orcid":false,"given":"Javier","family":"Rodriguez Lega","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Department, University Hospital Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marek","family":"Pol","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1662-5828","authenticated-orcid":false,"given":"Petr","family":"Kacer","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enzo","family":"Mazzaro","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9996-6133","authenticated-orcid":false,"given":"Giuseppe","family":"Gatti","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Igor","family":"Vendramin","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9959-167X","authenticated-orcid":false,"given":"Daniela","family":"Piani","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3722-1718","authenticated-orcid":false,"given":"Luisa","family":"Ferrante","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduard","family":"Quintana","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Hospital Cl\u00ednic de Barcelona, University of Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1872-6275","authenticated-orcid":false,"given":"Robert","family":"Pruna-Guillen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Hospital Cl\u00ednic de Barcelona, University of Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8134-0231","authenticated-orcid":false,"given":"Dario","family":"Di Perna","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zein","family":"El-Dean","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiwa","family":"Sherzad","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Mariscalco","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Field","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amer","family":"Harky","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manoj","family":"Kuduvalli","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2611-9566","authenticated-orcid":false,"given":"Matteo","family":"Pettinari","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Ziekenhuis Oost Limburg, 3600 Genk, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6690-5537","authenticated-orcid":false,"given":"Stefano","family":"Rosato","sequence":"additional","affiliation":[{"name":"National Center for Global Health, Istituto Superiore di Sanit\u00e1, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatu","family":"Juvonen","sequence":"additional","affiliation":[{"name":"Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, 90570 Oulu, Finland"},{"name":"Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo","family":"M\u00e4kikallio","sequence":"additional","affiliation":[{"name":"Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2237-9050","authenticated-orcid":false,"given":"Lenard","family":"Conradi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Cologne University Hospital, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9839-8728","authenticated-orcid":false,"given":"Giorgio","family":"Mastroiacovo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Centro Cardioologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fausto","family":"Biancari","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Centro Cardioologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e885","DOI":"10.1097\/SLA.0000000000005840","article-title":"Current Outcome After Surgery for Type A Aortic Dissection","volume":"278","author":"Biancari","year":"2023","journal-title":"Ann. 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Surg."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/7\/239\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:57:12Z","timestamp":1760032632000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/7\/239"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":16,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcdd12070239"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12070239","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,23]]}}}