Assessing Patient Outcomes in Type-A Aortic Dissection: Identifying Factors Affecting Outcomes

P0061 

Abstract Submission 

Kathy Nguyen (1), Bryan Mouser (1), Arun Singhal (2), Anthony Panos (2), Kalpaj Parekh (2), Mohammad Bashir (2)

(1) University of Iowa Carver College of Medicine, Iowa City, IA, (2) University of Iowa Hospitals and Clinics, Iowa City, IA

Kathy Nguyen    -  Contact Me
University of Iowa Carver College of Medicine

Bryan Mouser    -  Contact Me
University of Iowa Carver College of Medicine

Arun Singhal    -  Contact Me
University of Iowa Hospitals and Clinics

Anthony Panos    -  Contact Me
University of Iowa Hospitals and Clinics

*Kalpaj Parekh    -  Contact Me
University of Iowa Hospitals and Clinics

Mohammad Bashir    -  Contact Me
University of Iowa Hospitals and Clinics

Kathy Nguyen    -  Contact Me
N/A

Objective: To evaluate outcomes of patients presenting with Type-A aortic dissection and identify patient characteristics associated with better or worse outcomes.

Methods: Cases over the past 10 years in our database of all patients who presented with Type-A aortic dissection were reviewed and stratified by treatment: Surgical vs non-surgical. Comorbidities, presenting symptoms, and treatment outcomes were assessed. Data are hazard ratio (HR) and 95% confidence interval (CI), mean±SEM, or count[%]. P-values were determined by Chi-squared or Fischer's exact, 2-way independent T-tests, 2-way ANOVA with Tukey's post-hoc tests, and uni- and multivariable regression modeling with propensity-matched analysis.

Results: 242 (157 Males/85 Females) patients presented with Type-A aortic dissection. Of these, 50 patients had prohibitive risks, and surgery was not offered. 192 patients underwent surgery and 174[91%] patients achieved 30-day survival (9% mortality). Within the surgical cohort, patient's age ≥72 years, history of prior cardiac surgery, chronic kidney disease, anticoagulant use, and myocardial infarction at time of presentation were all associated with increased mortality. Intraoperatively, shorter X-clamp time (≤121±4.3min) and cerebral perfusion time (≤36.4±1.7min) promoted better survival. Conversely, intraoperative transfusion of >2units pRBC carried a 44% increased risk of mortality. Post-operatively, patients experiencing bleeding had worse outcomes, and patients experiencing cardiogenic shock carried a 2.4 times increased risk of mortality. Within the non-surgical cohort, 14[28%] patients achieved 30-day survival (72% mortality). Non-surgical patients presenting with a stroke or history of heart failure demonstrated greater 30-day mortality. Notably, male sex was protective as males had lower mortality (36% mortality) vs female patients (64% mortality, p=0.053).

Conclusions: Emergent surgery is a life-saving treatment for Type-A aortic dissection in select patients, decreasing risk of mortality with excellent outcomes. Pre-operative comorbidities and post-operative complications of bleeding and cardiogenic shock increase the risk of mortality. Overall, mortality without surgery remains very high.

Dissection