CONGRESS ABSTRACT

Objective: Acute aortic dissection of the ascending aorta carries a very high early mortality up to1% to 2% per hour in untreated symptomatic patients. Immediate surgical treatment, therefore,has been considered so far the gold standard in such conditions. The relevance of preoperativeperipheral malperfusion in postoperative outcome, however, has been recently pointed outsuggesting the option for a primary stabilization of peripheral (especially visceral) malperfusionbefore the complete treatment of ascending aorta dissection in hemodynamic stable patients.Signifi cant clinical visceral malperfusion, however, is still underdiagnosed and no clearparameters have been defi ned for a defi nitive defi nition. Here we evaluate the potential of usingMELD and MELD-based scores, as marker of signifi cant malperfusion, in preoperative predictionof postoperative in-hospital mortality Materials and Methods: Out of 326 overall patients undergoing emergent surgical repair of acuteaortic dissection, over a 10-year period, a tour Division, 160 had a complete preoperative bloodanalysis recorded in our system and were, therefore, retrospectively enrolled in this study.Preoperative MELD (Model for End stage Liver Disease) a simple preoperative score, calculatedfrom 3 biochemical variable (serum creatinine, serum bilirubin, prothombin time), and MELD-based scores (subsequent modifi cations of the original score, integrated with the introduction ofserum-Na and Albumin and without considering INR) were calculated and a potential correlationwith postoperative mortality was analyzed. Results: Out of 160 patients enrolled, 149 (89%) presented with diagnosis of acute type A aorticdissection, and 119 (73%) received ascending aorta/hemiarch replacement. Overall in-hospitalMortality was 16,8%. MELD Score ranged between 6 and 26. Overall MELD score was signifi cantlyhigher in patients who died postoperatively especially in male patients (p=0.0132). Furthermore,as shown in fi gure 1, Meld >9 was signifi cant predictive risk factor for in-hospital postoperativemortality. Discussion: In conclusion MELD score could represent a simple method to detecting early signsof visceral malperfusion and, therefore, to predicting postoperative mortality in case of acuteaortic syndrome. In such conditions the potential advantages of an "abdomen fi rst" and/or fl apstabilization treatment could be considered.