Thorac Cardiovasc Surg 2024; 72(S 01): S1-S68
DOI: 10.1055/s-0044-1780685
Monday, 19 February
Kurz- und Langzeitergebnisse Nach Chirurgischer Therapie der Typ A Dissektion

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

Authors

  • B. Al-Hafez

    1   University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland

  • T.J. Demal

    2   Universitätsklinikum Hamburg-Eppendorf, Martinistraße, Hamburg, Germany, Hamburg, Deutschland

  • C. Detter

    1   University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland

  • G. Mariscalco

    3   University of Leicester, Leicester, United Kingdom

  • G. Gatti

    4   University Hospitals of Leicester NHS Trust, Trieste, Italy

  • E. Mazzaro

    5   Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy

  • M. Acharya

    6   University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

  • S. Peterss

    7   LMU Munich, Munich, Deutschland

  • J. Buech

    8   Deparment of Cardiac Surgery, LMU University Hospital, Munich, Deutschland

  • A. Herve

    9   University Heart & Vascular Center Hamburg, Hamburg, Deutschland

  • T. Folliguet

    10   Henri-Mondor University Hospital, Créteil, France

  • M. Pettinari

    11   Ziekenhuis Oost-Limburg, Genk, Belgium

  • A. A. Dell

    12   Universitätsklinikum Münster - Klinik für Herzchirurgie Münster, Münster, Deutschland

  • K. Wisniewski

    13   Münster, Deutschland

  • M. Pol

    14   Faculty of Medicine UK, Prague, Czech Republic

  • D. Piani

    9   University Heart & Vascular Center Hamburg, Hamburg, Deutschland

  • M. Jormalainen

    15   Helsinki University Hospital, Helsinki, Finland

  • L. J. Rodriguez

    16   Gregorio Marañón General University Hospital, Madrid, Spain

  • AG. Pinto

    16   Gregorio Marañón General University Hospital, Madrid, Spain

  • E. Quintana

    17   University of Barcelona, Barcelona, Spain

  • R. Pruna-Guillen

    17   University of Barcelona, Barcelona, Spain

  • F. Nappi

    18   Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint-Denis, Paris, France

  • S. Gerelli

    19   Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France

  • D. Di Perna

    20   University of Reims Champagne-Ardenne, Reims, France

  • A. Vento

    21   University of Helsinki, Main Building, Helsinki, Finland

  • P. Raivio

    22   HUS, Helsinki, Finland

  • T. Juvonen

    23   University of Helsinki, Helsinki, Finland

  • H. Reichenspurner

    24   Hamburg, Deutschland

  • F. Biancari

    25   University of Turku, Turku, Finland

  • L. Conradi

    24   Hamburg, Deutschland
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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.



Publication History

Article published online:
13 February 2024

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