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Article

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

by
Angelo M. Dell’Aquila
1,2,*,†,
Konrad Wisniewski
2,†,
Adrian-Iustin Georgevici
3,
Gábor Szabó
1,
Francesco Onorati
4,
Till J. Demal
5,
Andreas Rukosujew
2,
Sven Peterss
6,
Caroline Radner
6,7,
Joscha Buech
6,7,
Antonio Fiore
8,
Andrea Perrotti
9,
Angel G. Pinto
10,
Javier Rodriguez Lega
10,
Marek Pol
11,
Petr Kacer
11,
Enzo Mazzaro
12,
Giuseppe Gatti
12,
Igor Vendramin
13,
Daniela Piani
13,
Luisa Ferrante
14,
Mauro Rinaldi
14,
Eduard Quintana
15,
Robert Pruna-Guillen
15,
Dario Di Perna
16,
Zein El-Dean
17,
Hiwa Sherzad
17,
Giovanni Mariscalco
17,
Mark Field
18,
Amer Harky
18,
Manoj Kuduvalli
18,
Matteo Pettinari
19,
Stefano Rosato
20,
Tatu Juvonen
21,22,
Timo Mäkikallio
23,
Lenard Conradi
24,
Giorgio Mastroiacovo
25 and
Fausto Biancari
25add Show full author list remove Hide full author list
1
Department of Cardiac Surgery, University Hospital Halle, 06120 Halle, Germany
2
Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany
3
St. Josef-Hospital, University Hospital of Ruhr-University of Bochum,44791Bochum, Germany
4
Division of Cardiac Surgery, University of Verona Medical School, 37129 Verona, Italy
5
Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
6
Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 81337 Munich, Germany
7
German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, 80802 Munich, Germany
8
Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France
9
Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, France
10
Cardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, Spain
11
Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic
12
Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34149 Trieste, Italy
13
Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy
14
Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy
15
Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
16
Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France
17
Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK
18
Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
19
Department of Cardiac Surgery, Ziekenhuis Oost Limburg, 3600 Genk, Belgium
20
National Center for Global Health, Istituto Superiore di Sanitá, 00161 Rome, Italy
21
Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, 90570 Oulu, Finland
22
Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
23
Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland
24
Department of Cardiac Surgery, Cologne University Hospital, 50937 Cologne, Germany
25
Department of Cardiovascular Surgery, Centro Cardioologico Monzino IRCCS, 20138 Milan, Italy
 
add Show full affiliation list
 
remove Hide full affiliation list
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Cardiovasc. Dev. Dis. 2025, 12(7), 239; https://doi.org/10.3390/jcdd12070239
Submission received: 14 April 2025 / Revised: 4 June 2025 / Accepted: 18 June 2025 / Published: 23 June 2025
Versions Notes

Abstract

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%, p < 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 < 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 < 0.001). Among IMV patients, the extension of surgery to the aortic arch was significantly associated with increased in-hospital mortality (p < 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.
Keywords: type a aortic dissection; invasive mechanical ventilation; intubation type a aortic dissection; invasive mechanical ventilation; intubation

Share and Cite

MDPI and ACS Style

Dell’Aquila, A.M.; Wisniewski, K.; Georgevici, A.-I.; Szabó, G.; Onorati, F.; Demal, T.J.; Rukosujew, A.; Peterss, S.; Radner, C.; Buech, J.; et al. Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes. J. Cardiovasc. Dev. Dis. 2025, 12, 239. https://doi.org/10.3390/jcdd12070239

AMA Style

Dell’Aquila AM, Wisniewski K, Georgevici A-I, Szabó G, Onorati F, Demal TJ, Rukosujew A, Peterss S, Radner C, Buech J, et al. Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes. Journal of Cardiovascular Development and Disease. 2025; 12(7):239. https://doi.org/10.3390/jcdd12070239

Chicago/Turabian Style

Dell’Aquila, Angelo M., Konrad Wisniewski, Adrian-Iustin Georgevici, Gábor Szabó, Francesco Onorati, Till J. Demal, Andreas Rukosujew, Sven Peterss, Caroline Radner, Joscha Buech, and et al. 2025. "Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes" Journal of Cardiovascular Development and Disease 12, no. 7: 239. https://doi.org/10.3390/jcdd12070239

APA Style

Dell’Aquila, A. M., Wisniewski, K., Georgevici, A.-I., Szabó, G., Onorati, F., Demal, T. J., Rukosujew, A., Peterss, S., Radner, C., Buech, J., Fiore, A., Perrotti, A., Pinto, A. G., Rodriguez Lega, J., Pol, M., Kacer, P., Mazzaro, E., Gatti, G., Vendramin, I., ... Biancari, F. (2025). Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes. Journal of Cardiovascular Development and Disease, 12(7), 239. https://doi.org/10.3390/jcdd12070239

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