| Abstract: | I read with great interest the article by Czerny et al. [1], which aimed to create a web-based application for the prediction of the 30-day mortality rate for patients undergoing surgery for acute type A aortic dissection (ATAAD). A total of 2537 patients undergoing surgery for ATAAD in 56 referral centres in Germany, Austria, Switzerland and Luxemburg, from July 2006 to June 2015 enrolled in the German Registry for Acute Type A Aortic Dissection (GERAADA) were analysed. Therefore, based on univariable and multivariable analyses of preoperative variables only, GERAADA score included 9 parameters (age, need for catecholamines at referral, preoperative resuscitation, need for intubation before surgery, preoperative hemiparesis, coronary malperfusion, visceral malperfusion, dissection extension to the descending aorta and previous cardiac surgery) with significant influence on the 30-day mortality rate in the final model. Furthermore, 6 other variables (sex, aortic valve regurgitation, peripheral malperfusion, extension of dissection to aortic arch or supra-aortic vessels, and location of primary entry tear within aortic arch) were added to the web-based calculator. Surprisingly, left ventricular ejection fraction has not been tested even in univariable analysis, although Thurau et al. [2] (Deutches Herzzentrum Berlin) have shown (cohort of 512 patients with ATAAD, who were operated between 2006 and 2014, thus representing 20% of patients in the GERAADA database) that preoperative left ventricular ejection fraction ≤35% (P = 0.003) and longer cardiopulmonary bypass (CPB) time (P < 0.001) were independent predictors of 30-day mortality. This leads us to the next fact, i.e. that no intraoperative variable was included in the GERAADA risk prediction model, although Thurau et al. [2] confirmed that a longer CPB time was an independent predictor of 30-day mortality. Furthermore, the manuscript originating from the GERAADA database (2137 patients with ATAAD operated on between July 2006 and June 2010), by Conzelmann et al. [3] confirmed that mortality increased with longer operating times (total, CPB, cardiac ischaemia and circulatory arrest, all P < 0.02). Can the authors explain why there are no intraoperative variables in the GERAADA score? |
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