Outcome of Patients undergoing Surgery for Acute Type A Aortic Dissection after Cardiopulmonary Resuscitation

Background: Patients with acute type A aortic dissection (ATAD) are known to have limited prognosis. Surgical risk amplifies with complicating factors. This study explored outcomes in ATAD patients undergoing surgery following preoperative CPR.

Methods: Retrospective analysis was performed using data from the European registry of type A aortic dissection (ERTAAD). Between 2005 and 2021, 2,266 ATAD patients were included from 19 European centers receiving surgery. Patients were stratified by need for preoperative CPR (group 1) versus no need for CPR (group 2) for comparative analyses. Multiple regression analysis was conducted to identify predictors for 30-day mortality.

Results: Prior to surgery, 72 (3.2%) ATAD patients (age 64.2 (54.0–73.8) years, 77.8% male) required CPR. There were no significant differences between groups regarding important procedural parameters such as frequency of root repair, arch repair, myocardial ischemic time, or circulatory arrest time.

Patients in group 1 had significantly higher rates of the following complications compared with group 2: postoperative stroke (n = 23 (31.9%) vs. n = 421 (19.2%); p = 0.011), acute heart failure (n = 27 (37.5%) vs. n = 332 (15.1%); p < 0.001), need for dialysis (n = 16 (22.2%) vs. n = 287 (13.1%); p = 0.039), and 30-day mortality (n = 38 (52.8%) vs. n = 363 (16.5%); p < 0.001).

Multivariable regression analysis identified the following parameters as independent risk factors for 30-day mortality: preoperative CPR (OR 3.2, p < 0.001), age >70 years (OR 1.9, p < 0.001), poor mobility (OR 2.0, p = 0.006), ejection fraction <50% (OR 1.7, p < 0.001), and myocardial ischemia (OR 1.5, p = 0.017).

In a multivariable regression analysis, incorporating CPR and stepwise addition of independent variables (CPR: OR 3.4, p < 0.001; step 1: CPR + age >70 years, OR 1.7, p = 0.007; step 2: CPR + age >70 years + reduced LVEF, OR 0.6, p = 0.138; step 3: CPR + age >70 years + reduced LVEF + myocardial ischemia, OR 2.5, p < 0.001), no substantial increase in odds ratios for combined predictors was observed compared with CPR alone.

Conclusion: Preoperative CPR in ATAD surgery led to higher postoperative complications, including 30-day mortality. However, for patients with CPR and additional risk factors (i.e., low ejection fraction, advanced age, myocardial ischemia) the analysis did not indicate a significant rise in mortality, thus suggesting that surgery remains a viable option for these patients.

Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2024