Evaluation of the GERAADA score for prediction of 30-day mortality in patients with acute type A aortic dissection. (29th December 2020)

• Record Type: Journal Article
• Authors: Luehr, Maximilian; Merkle-Storms, Julia; Gerfer, Stephen; Li, Yupeng; Krasivskyi, Ihor; Vehrenberg, Johannes; Rahmanian, Parwis; Kuhn-Régnier, Ferdinand; Mader, Navid; Wahlers, Thorsten
• Is Part Of: European journal of cardio-thoracic surgery. Volume 59:Number 5(2021)
• Page Start: 1109
• Page End: 1114
• Publication Date: 2020-12-29
• Subjects: Acute type A aortic dissection -- Risk score -- Aortic surgery; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezaa455
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: : OBJECTIVES: The German Registry of Acute Aortic Dissection Type A (GERAADA) score to predict 30-day mortality in patients suffering from acute aortic dissection type A (AADA) was recently introduced. The aim of this study was to evaluate if the GERAADA score's prediction corresponds with the authors' institutional results. METHODS: All consecutive AADA patients between 2010 and 2020 were included. Retrospective data collection comprised 11 preoperative parameters: age, sex, previous cardiac surgery, inotropic support at referral, resuscitation before surgery, aortic regurgitation, preoperative hemiparesis, intubation/ventilation at referral, preoperative organ malperfusion, extension of aortic dissection and location of primary entry site. Calculations of the GERAADA score were individually performed by a cardiac surgeon blinded to the study for all patients via a web-based application (https://www.dgthg.de/de/GERAADA_Score ). RESULTS: A total of 371 AADA patients were operated at the authors' institution. The mean age was 62.7 ± 13.5 years and 233 (63%) were males. Prediction of 30-day mortality was accurate for the entire study cohort (actual vs predicted 30-day mortality: 15.1% vs 15.7%; P = 0.776) as well as for all 26 subgroups. In addition, preoperative resuscitation ( P < 0.001), advanced age ( P = 0.042) and other/unknown malperfusion ( P = 0.032) were identified as independent risk factors. CONCLUSIONS: The GERAADA score prediction of 30-day mortality after surgery is accurate, easily accessible due to its web-based platform and can be calculated with very basic preoperative clinical parameters. A prospective clinical trial is required to further evaluate the new GERAADA score as a useful tool to allow for improved decision-making in the emergency setting of AADA.