Long-term outcome of aortic dissection associated with aberrant subclavian artery and Kommerell's diverticulum

P0196 

Abstract Submission 

Yangxue Sun (1), Hongwei Guo (2), Yuanrui Gu (3), Shuo dong (4), Haitao Xu (5), Chuhao Du (5), Jie Dong (6)

(1) National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, Beijing, (2) Fuwai Hospital, Beijing, Beijing, (3) Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, (4) N/A, N/A, (5) Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospit, Beijing, Beijing, (6) N/A, Baltimore, MD

Yangxue Sun    -  Contact Me
National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences

Hongwei Guo    -  Contact Me
Fuwai Hospital

Yuanrui Gu    -  Contact Me
Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Shuo dong    -  Contact Me
N/A

Haitao Xu    -  Contact Me
Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospit

Chuhao Du    -  Contact Me
Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospit

Jie Dong    -  Contact Me
N/A

Yangxue Sun    -  Contact Me
National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences

Objective: Aberrant subclavian artery (aSA) and Kommerell's diverticulum (KD) have been reported to increase the risk of aortic rupture (4%-19%) and aortic dissection. However, limited studies have investigated the treatment of aortic dissection in patients with aSA and KD. This study aims to report the clinical characteristics, surgical treatment, and through standardized data reporting. This study aims to investigate clinical characters and long-term follow-up outcomes of patients with aortic dissection associated with aSA.

Methods: Between 2011 and 2021, a total of 48 patients with aSA anomalies underwent aortic dissection intervention. Among them, 20 (41.7%) had Stanford type A dissection, 9 (18.8%) had Stanford type B dissection, and 19 (39.6%) had non-A non-B dissection.

Results: The mean age of the patient population was 48.81±9.65 years. The operative mortality rate was 12.5%. The overall mortality rate was 20.8%, with a median follow-up time of 4.5 years (IQR: 2-8.75 years). Preoperative coronary artery atherosclerotic heart disease was identified as a factor associated with operative mortality (OR=2.57, P=0.017). The adjusted variables associated with a reduced risk of overall mortality were increased BMI (HR=0.73; 95%CI 0.56-0.96). Central nervous system complications occurred in 8 patients (16.7%), subclavian steal syndrome in 6 patients (12.5%), respiratory complications in 3 patients (6.2%), and peripheral nerve injury in 2 patients(4.2%). The incidence of respiratory complications in patients with the right aortic arch was significantly higher than that in patients with the left aortic arch (P=0.01). During the follow-up period, a total of 7 cases required reintervention for cardiovascular disease. The estimated Kaplan-Meier survival rates at 1 year, 3 years, 5 years, and 7 years after surgery were 87.0%, 82.5%, 79.7%, and 75.1%, respectively.

Conclusions: In patients with aSA and KD, the presence of aortic dissection is associated with increased early and long-term mortality rates, as well as a higher incidence of postoperative complications. Early intervention should be considered for patients with aSA and KD to prevent the occurrence of aortic dissection. Once aortic dissection occurs, individualized intervention strategies should be formulated based on preoperative characteristics, including age, general condition, type of dissection, and imaging characteristics.

Dissection