Impact of Re-sternotomy in Acute Type A Aortic Dissection Repair

P0160 

Abstract Submission 

Yuki Ikeno (1), Akiko Tanaka (1), Alexander Mills (1), Lucas Ribe (1), Harleen Sandhu (1), Charles Miller (1), steven eisenberg (1), Anthony Estrera (1)

(1) McGovern Medical School at UTHealth, Houston, TX

Yuki Ikeno    -  Contact Me
McGovern Medical School at UTHealth

Akiko Tanaka    -  Contact Me
McGovern Medical School at UTHealth

Alexander Mills    -  Contact Me
McGovern Medical School at UTHealth

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

Harleen Sandhu    -  Contact Me
McGovern Medical School at UTHealth

Charles Miller    -  Contact Me
McGovern Medical School at UTHealth

steven eisenberg    -  Contact Me
McGovern Medical School at UTHealth

*Anthony Estrera    -  Contact Me
McGovern Medical School at UTHealth

Akiko Tanaka    -  Contact Me
Memorial Hermann Heart and Vascular Institute

Objective:
We reviewed our near two-decade experience to evaluate for the impact of resternotomy in acute type A aortic dissection (ATAD).

Methods:
All open ATAD repairs performed at our institution from December 1999 to December 2022 were reviewed. Perioperative data were reviewed. Patients who had re-sternotomy was compared with first time sternotomy group.

Results:
Total of 697 patients had type A aortic repair during the study period. 49 patients had previous sternotomy procedures. Patients with re-sternotomy were older (67 yo vs. 57 yo, P<0.001) and had frequently had hypertension (82% vs. 64%, P=0.011), advanced chronic kidney disease (greater than stage IIIb), and previous infrarenal abdominal aortic aneurysm repair (10% vs. 1%, <0.001). Re-sternotomy patients required larger amount of transfusion including, cell saved units, packed red blood cell, and platelet (all P<0.001). Aortic clamp time (100 min vs. 96 min, P=0.137) and circulatory arrest time (27 min vs. 26 min, P=0.294) were similar in two groups, and performed concomitant procedures, but cardiopulmonary bypass time (178 min vs. 153 min, P=0.002) were longer in the re-sternotomy group. Postoperative complications were more frequently observed in re-sternotomy group, including ARDS (27% vs. 13%, P=0.008), postoperative dialysis (24% vs. 14%, P<0.001), and operative mortality (39% vs. 12%, P<0.001).

Conclusions:
ATAD patients with previous sternotomy had more comorbidities compared to first time sternotomy patients. Outcomes after ATAD patients remain challenging despite the advancement of perioperative care in ATAD.

Dissection