Survival after acute type A aortic dissection is mainly determined by cerebral malperfusion: results from a Belgian referral center
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0325
Submission Type:
Abstract Submission
Authors:
Thomas Martens (1), Joke Verlinden (2), Isabelle Claus (3), Jens Czapla (2), Tine Philipsen (2), Katrien François (4), Thierry Bové (5)
Institutions:
(1) Ghent University Hospital, Belgium, (2) Department of Cardiac Surgery, Ghent University Hospital, Belgium, Ghent, NA, (3) Ghent University Hospital, Department of Cardiac Surgery, Ghent, NA, (4) University Hospital Ghent, Gent, NA, (5) Ghent University Hospital, Ghent, East Flanders
Submitting Author:
Thomas Martens
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Ghent University Hospital
Ghent University Hospital
Co-Author(s):
Joke Verlinden
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Department of Cardiac Surgery, Ghent University Hospital, Belgium
Department of Cardiac Surgery, Ghent University Hospital, Belgium
Isabelle Claus
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Ghent University Hospital, Department of Cardiac Surgery
Ghent University Hospital, Department of Cardiac Surgery
Jens Czapla
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Department of Cardiac Surgery, Ghent University Hospital, Belgium
Department of Cardiac Surgery, Ghent University Hospital, Belgium
Tine Philipsen
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Department of Cardiac Surgery, Ghent University Hospital, Belgium
Department of Cardiac Surgery, Ghent University Hospital, Belgium
*Katrien François
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University Hospital Ghent
University Hospital Ghent
Thierry Bové
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Ghent University Hospital
Ghent University Hospital
Presenting Author:
Thomas Martens
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Ghent University Hospital
Ghent University Hospital
Abstract:
Objective
Acute type A aortic dissection (ATAAD) still carries a significant risk for mortality, despite evolutions in operative management and organ protection. During the last decade, preoperative malperfusion has been identified as a risk factor for mortality, and some centers even advocate treatment of the malperfusion as a first step. Therefore, we wanted to analyze whether the various types of malperfusion carry comparable operative risks and a sternotomy-first strategy is defendable.
Methods
A retrospective review of all ATAAD patients treated at a Belgian aortic referral center was performed. Preoperative malperfusion was categorized as cerebral, abdominal, limb or cardiac. Primary endpoints were in-hospital and overall mortality. All patients were treated as per protocol, with central open aortic surgery as the index procedure. Statistical analysis was achieved with SPSS version 29.
Results
Between 2016 and 2023, a total of 95 patients underwent aortic surgery for ATAAD. Sixty patients (63%) were male. The treated aortic segment varied in this cohort, with the majority of patients having hemi-arch or full arch replacement (n=47 or 49.5% ; n=28 or 29.5%) respectively. Malperfusion of any kind was seen in more than one third of patients (n=35 , 36.8%). Cerebral malperfusion was observed in 17 (17.9%), followed by limb (n=14 , 14.7%) , abdominal (n=6 , 6.3%) and cardiac (n=6 , 6.3%) ischemia. Seven patients (7.3%) were diagnosed with multi-organ involvement. Hospital survival was 80% (n=76), and overall survival 75.8% (n=72) at latest follow-up. In this cohort, age at presentation was not associated with survival. Cerebral malperfusion was significantly associated with mortality (p=0.002). Other types of malperfusion however were not identified as risk factors (limb p=0.385 , abdominal p=0.833 , cardiac p=0.058). Only two of 7 patients with malperfusion in 2 or more organs survived. In 6 of them there was cerebral malperfusion. One patient had abdominal and limb ischemia, and survived.
Conclusions
More than one third of patients with ATAAD present with some form of organ malperfusion. Int his cohort, cerebral malperfusion was a significant risk factor for mortality. Whether other forms of malperfusion are as equally a burden, has to be delineated in further research.
Acute type A aortic dissection (ATAAD) still carries a significant risk for mortality, despite evolutions in operative management and organ protection. During the last decade, preoperative malperfusion has been identified as a risk factor for mortality, and some centers even advocate treatment of the malperfusion as a first step. Therefore, we wanted to analyze whether the various types of malperfusion carry comparable operative risks and a sternotomy-first strategy is defendable.
Methods
A retrospective review of all ATAAD patients treated at a Belgian aortic referral center was performed. Preoperative malperfusion was categorized as cerebral, abdominal, limb or cardiac. Primary endpoints were in-hospital and overall mortality. All patients were treated as per protocol, with central open aortic surgery as the index procedure. Statistical analysis was achieved with SPSS version 29.
Results
Between 2016 and 2023, a total of 95 patients underwent aortic surgery for ATAAD. Sixty patients (63%) were male. The treated aortic segment varied in this cohort, with the majority of patients having hemi-arch or full arch replacement (n=47 or 49.5% ; n=28 or 29.5%) respectively. Malperfusion of any kind was seen in more than one third of patients (n=35 , 36.8%). Cerebral malperfusion was observed in 17 (17.9%), followed by limb (n=14 , 14.7%) , abdominal (n=6 , 6.3%) and cardiac (n=6 , 6.3%) ischemia. Seven patients (7.3%) were diagnosed with multi-organ involvement. Hospital survival was 80% (n=76), and overall survival 75.8% (n=72) at latest follow-up. In this cohort, age at presentation was not associated with survival. Cerebral malperfusion was significantly associated with mortality (p=0.002). Other types of malperfusion however were not identified as risk factors (limb p=0.385 , abdominal p=0.833 , cardiac p=0.058). Only two of 7 patients with malperfusion in 2 or more organs survived. In 6 of them there was cerebral malperfusion. One patient had abdominal and limb ischemia, and survived.
Conclusions
More than one third of patients with ATAAD present with some form of organ malperfusion. Int his cohort, cerebral malperfusion was a significant risk factor for mortality. Whether other forms of malperfusion are as equally a burden, has to be delineated in further research.
Aortic Symposium:
Dissection
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