Functional Outcome of Patients after Surgery for Acute Stanford Type A Aortic Dissection
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0140
Submission Type:
Abstract Submission
Authors:
Murat Yildiz (1), Maria Nucera (1), Selim Mosbahi (1), Cem Kapkin (1), Silvan Jungi (1), Matthias Siepe (1), Florian Schoenhoff (1)
Institutions:
(1) Inselspital, Bern, Switzerland
Submitting Author:
Murat Yildiz
-
Contact Me
Inselspital
Inselspital
Co-Author(s):
Maria Nucera
-
Contact Me
Inselspital
Inselspital
Selim Mosbahi
-
Contact Me
Inselspital
Inselspital
Cem Kapkin
-
Contact Me
Inselspital
Inselspital
Silvan Jungi
-
Contact Me
Inselspital
Inselspital
*Matthias Siepe
-
Contact Me
Inselspital
Inselspital
*Florian Schoenhoff
-
Contact Me
Inselspital
Inselspital
Presenting Author:
Murat Yildiz
-
Contact Me
Inselspital
Inselspital
Abstract:
Objective
To report functional outcome of type A aortic dissection (TAAD) after 1 year as well as morbidity and mortality.
Methods
Retrospective analysis including 642 patients with TAAD from 01/2005 –12/2021. Patients were followed in the aortic disease clinic at 3, 6, and 12 months after the event. Permission was sought to contact health care providers outside of our institution. Stroke was defined as any impairment of neurological function. Follow-up at 12 months was 90% complete.
Results
Mean age at TAAD was 62y (95% CI: 61-63y) and 30% of the population was female. One year after surgery for TAAD, 75% of patients were living at home in NYHA functional class I. No patients were observed with NYHA stage IV. Less than 2% were residing in an assisted living facility. 85% of non-retired patients had returned to work. 212 (33%) patients were retired after 1 year at a mean age of 73y (95% CI: 72-74y). Stroke occurred in 148 (23%) patients and was the cause of death in 33 patients. Among the 148 patients, 66 (45%) exhibited preoperative neurological disabilities, while four patients (3%), initially without any neurological impairments postoperatively, experienced a postoperative stroke. Of the remaining (alive) patients with stroke (115) 30% had no residual limitations 1 year after TAAD. Pericardial effusion in the patients with neurological disability was present in 60 patients (41%) of which 25 were hemodynamically impaired (17%).
The cross-clamp time was significantly higher in patients with stroke (98min 95% CI: 94.0-101.1 in patients without stroke vs. 106min 95% CI: 98.5-114.1 in patients with stroke, p-value: 0.026). 69% of patients with stroke live at home, 28% at home with support and 3% in an assisted living facility. One year after stroke, 77% of the patients achieved a Rankin Scale ≤2, while no patient had a Rankin Scale of 5. There was no significant correlation between gender and recovery rate (p-value: 0.48). However, experiencing a stroke significantly increased the likelihood of residing in an assisted living facility or receiving support at home one year after TAAD (OR = 9.44, 95% CI: 4.85-18.77, p-value:<0.001). Thirty-day mortality was 11.8% and 92 patients (14%) died within 1st year after TAAD. There was no significant gender difference in mortality (p-value: 0.101).
Conclusions
After surgery for acute type A aortic dissection, 3 out of 4 patients live at home unassisted 1 year after surgery. Stroke survivors have a favorable outcome with the majority having mild or no residual neurological deficits at 1 year. Nevertheless, experiencing stroke is a risk factor for living in an assisted living facility 1 year after the event. There were no gender differences in suffering from a stroke, living in an assisted living facility, or mortality.
To report functional outcome of type A aortic dissection (TAAD) after 1 year as well as morbidity and mortality.
Methods
Retrospective analysis including 642 patients with TAAD from 01/2005 –12/2021. Patients were followed in the aortic disease clinic at 3, 6, and 12 months after the event. Permission was sought to contact health care providers outside of our institution. Stroke was defined as any impairment of neurological function. Follow-up at 12 months was 90% complete.
Results
Mean age at TAAD was 62y (95% CI: 61-63y) and 30% of the population was female. One year after surgery for TAAD, 75% of patients were living at home in NYHA functional class I. No patients were observed with NYHA stage IV. Less than 2% were residing in an assisted living facility. 85% of non-retired patients had returned to work. 212 (33%) patients were retired after 1 year at a mean age of 73y (95% CI: 72-74y). Stroke occurred in 148 (23%) patients and was the cause of death in 33 patients. Among the 148 patients, 66 (45%) exhibited preoperative neurological disabilities, while four patients (3%), initially without any neurological impairments postoperatively, experienced a postoperative stroke. Of the remaining (alive) patients with stroke (115) 30% had no residual limitations 1 year after TAAD. Pericardial effusion in the patients with neurological disability was present in 60 patients (41%) of which 25 were hemodynamically impaired (17%).
The cross-clamp time was significantly higher in patients with stroke (98min 95% CI: 94.0-101.1 in patients without stroke vs. 106min 95% CI: 98.5-114.1 in patients with stroke, p-value: 0.026). 69% of patients with stroke live at home, 28% at home with support and 3% in an assisted living facility. One year after stroke, 77% of the patients achieved a Rankin Scale ≤2, while no patient had a Rankin Scale of 5. There was no significant correlation between gender and recovery rate (p-value: 0.48). However, experiencing a stroke significantly increased the likelihood of residing in an assisted living facility or receiving support at home one year after TAAD (OR = 9.44, 95% CI: 4.85-18.77, p-value:<0.001). Thirty-day mortality was 11.8% and 92 patients (14%) died within 1st year after TAAD. There was no significant gender difference in mortality (p-value: 0.101).
Conclusions
After surgery for acute type A aortic dissection, 3 out of 4 patients live at home unassisted 1 year after surgery. Stroke survivors have a favorable outcome with the majority having mild or no residual neurological deficits at 1 year. Nevertheless, experiencing stroke is a risk factor for living in an assisted living facility 1 year after the event. There were no gender differences in suffering from a stroke, living in an assisted living facility, or mortality.
Aortic Symposium:
Dissection
Image or Table
