Surgical Outcome of Acute Type A Aortic Dissection Requiring Preoperative Cardiopulmonary Resuscitation without Patient Selection

P0315 

Abstract Submission 

MIHEE LIM (1), Chee-hoon Lee (2), Minho Ju (3), Hyung Gon Je (4)

(1) Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedic, Yangsan, South Korea, (2) Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedic, Seoul, South Korea, (3) N/A, Seoul, South Korea, (4) N/A, Yangsan, Korea

MIHEE LIM    -  Contact Me
Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedic

Chee-hoon Lee    -  Contact Me
Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedic

Minho Ju    -  Contact Me
N/A

Hyung Gon Je    -  Contact Me
N/A

MIHEE LIM    -  Contact Me
N/A

Objective
Acute type A aortic dissection (ATAAD) is a life-threatening disease that requires emergent surgery. However, the surgical indication for ATAAD with preoperative cardiopulmonary resuscitation (CPR) remain controversial. This retrospective study aimed to compare the individual characteristics and short-term outcomes between survivors and deceased patients who underwent preoperative in-hospital CPR.
Methods
From Jan 2019 to Aug 2023, 174 consecutive patients underwent ATAAD repair; 22 (12.6%) of these patients underwent preoperative in-hospital CPR. Patients who underwent preoperative CPR were classified into the survival group (n=13) and non-survival group (n=9), based on whether they survived to hospital discharge. Clinical features, surgical information, and postoperative complications were analyzed. Cerebral performance category (CPC) scores at discharge are presented.
Results
The major cause of cardiovascular collapse requiring CPR was aortic rupture/cardiac tamponade (n = 13, [59%]), followed by coronary mal-perfusion (n =7, [32%]). When patients who had been planned for surgery requiring CPR without return of spontaneous circulation, ECMO was actively applied. There were 5 (38.5%) patients in the survivors group and 2 (22.2%) in the non-survivors group who required preoperative ECMO at the beginning of surgery (P= .735). Overall duration of CPR was similar in survivors (5.0 minutes [range, 4.0-6.5 minutes] vs 7.0 minutes [range, 4.5-10 minutes]; P= .453). There were no significant inter-group differences in preoperative demographics and intra-operative procedures. Among patients in the survival group, 61.5% (8/13) of patients were discharged home, and 92.3% (12/13) of patients had full cerebral performance at discharge.
Conclusion
Patients with ATAAD undergoing preoperative in-hospital CPR, a significant proportion of these patients survived and discharged home with full cerebral performance. The prognosis of patients could not be predicted based solely on the preoperative situation. Therefore, a transient in-hospital CPR issue with active treatment might not be an obstacle to aortic surgery.

Dissection