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Eur J Cardiothorac Surg 2001;20:1194-1198
© 2001 Elsevier Science NL

Acute type A aortic dissection: the prognostic impact of preoperative cardiac tamponade

^a Department of Emergency Medicine, University Clinics, Vienna General Hospital, 1090 Vienna, Austria
^b Department of Internal Medicine II/Division of Angiology, University Clinics, Vienna General Hospital, 1090 Vienna, Austria
^c Department of Surgery/Division of Cardio-Thoracic Surgery, University Clinics, Vienna General Hospital, 1090 Vienna, Austria

Received 21 May 2001; received in revised form 21 September 2001; accepted 25 September 2001.

Corresponding author. Tel.: +43-1-40400-1964; fax: +43-1-40400-1965
e-mail: hans.domanovits{at}akh-wien.ac.at

Objective: Acute type A aortic dissection requires emergency surgery and is associated with considerable mortality. The aim of the study was to evaluate whether occurrence of preoperative cardiac tamponade with or without palpable pulses in these patients is associated with higher incidence of multiple organ failure (MOF) and in-hospital mortality. Methods: A retrospective cohort study included 87 patients with acute type A aortic dissection, who were admitted via an emergency department between December 1991 and December 1999 for emergency surgery. Impending cardiac tamponade (with palpable pulses) and severe cardiac tamponade (without palpable pulses) were recorded and patients were followed for occurrence of MOF and/or in-hospital mortality. Results: Impending cardiac tamponade with palpable pulses was diagnosed in 33 patients (38%), signs of severe cardiac tamponade without palpable pulses were found in seven patients (8%). MOF occurred in 41 patients (47%); 32 patients (37%) died during the present stay, all of them had MOF. Preoperative severe cardiac tamponade without palpable pulses was associated with a significantly increased risk for poor outcome (odds ratio (OR)=16.1, 70% confidence interval (CI) 4.8–71.7, P=0.04), particularly preoperative death (n=6 of 7). Impending cardiac tamponade with palpable pulses (OR=1.6, 70% CI 0.8–3.3, P=0.2) was not associated with the occurrence of MOF/death. Hemodynamic shock (OR=6.5, 70% CI 3.0–13.9, P=0.01) was also associated with poor outcome. Conclusion: Patients with acute type A aortic dissection and signs of preoperative cardiac tamponade without palpable pulses had a 16-fold increased risk for poor outcome, particularly preoperative death. In contrast, cardiac tamponade with palpable pulses was not associated with increased frequency of MOF/in-hospital mortality.

Key Words: Acute aortic dissection • Cardiac tamponade • Multiple organ failure • Hospital mortality

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