Twenty-five years of open type a dissection surgery in 500 patients – Has a change in surgical technique led to a change in outcome ?

P0359 

Abstract Submission 

Paul Werner (1), Iuliana Coti (2), Beguem Sena Kuscu (3), Philipp Angleitner, Dominik Wiedemann (5), Marie-Elisabeth Stelzmueller (6), Stephane Mahr (3), Guenther Laufer (7), Daniel Zimpfer (8), Marek Ehrlich (9)

(1) General Hospital of Vienna, Vienna, Vienna, (2) General Hospital of Vienna, Austria, Vienna, Vienna, (3) Medical University of Vienna, Vienna, NA, (4) Department of Cardiac Surgery, Medical University of Vienna, Vienna, Vienna, (5) N/A, Vienna, Austria, (6) N/A, Austria, (7) Vienna General Hospital - AKH Wien, Vienna, Austria, (8) MUW/AKH Viena, Graz, IN, (9) AKH Vienna, Vienna, GA

Paul Werner    -  Contact Me
General Hospital of Vienna

Iuliana Coti    -  Contact Me
General Hospital of Vienna, Austria

Beguem Sena Kuscu    -  Contact Me
Medical University of Vienna

Philipp Angleitner    -  Contact Me
^Department of Cardiac Surgery, Medical University of Vienna

Dominik Wiedemann    -  Contact Me
N/A

Marie-Elisabeth Stelzmueller    -  Contact Me
N/A

Stephane Mahr    -  Contact Me
Medical University of Vienna

Guenther Laufer    -  Contact Me
Vienna General Hospital - AKH Wien

Daniel Zimpfer    -  Contact Me
MUW/AKH Viena

*Marek Ehrlich    -  Contact Me
AKH Vienna

Paul Werner    -  Contact Me
General Hospital of Vienna

Objective: Novel surgical techniques for acute type A aortic dissection (ATAAD) have been continuously implemented but short term outcomes have been stagnating over the last decades. We investigated operative mortality and adverse outcomes after surgery for ATAAD over the course of 25 years in an all-comer, single-center collective.
Methods: Between 1998-2022, 500 patients underwent open surgical repair for ATAAD in a tertiary reference center. Retro- and prospective follow up was conducted and patients were included when sufficient documentation was available. Short term major adverse events were classified after the International Aortic Arch Surgery Study Group consensus statement.
Results: In the overall cohort (67.4% male, age 60±14 years), an open distal/ hemiarch was performed in 82.4% of cases (n=412), a partial or total arch replacement in 6.4% (n=32) and 5.4% (n=27) respectively and an elephant- and frozen elephant trunk procedure in 0.8% (n=4) and 3.2% (n=16) patients respectively. Neurological endpoints were observed in 25.2% (n=126) of patients. Operative mortality was 14.2% (n=71), based on a 11.8% (n=59) 30-day mortality and a 14.2% (n=71) in-hospital mortality. Age (1.01, 1.00-1.03) and cardiopulmonary bypass time (1.004, 1.00-1.007) were independent predictors of operative mortality in a multivariate analysis. Surgical volume has significantly increased (46%) between surgical eras of 1998-2010 and 2011-2022 from 203 to 297 cases. There was a statistically significant difference in axillary artery cannulation (42.3% vs 85.3%, p<0.001) and cerebral perfusion (CP) mode (antegrade CP 43.2% vs 96.2%, p<0.001) between eras of 1998-2010 (n=203, age 58±14 years) and 2011-2022 (n=297, age 60±14 years), yet, no significant differences in operative mortality (15.7% vs 14.2%, p=0.66) or neurological endpoints (23.2% vs 28.3%, p=0.219) were observed between those periods.
Conclusions: Surgical technique for operative repair of ATAAD has undergone significant changes with regards to performed procedures, arterial canulation and cerebral perfusion. No statistically significant difference of operative mortality was observed between the first and second half of a 25 year period. A significant increase in surgical volume was observed between the first and the second period, which might reflect that nowadays more patients receive surgical treatment for ATAAD with steady operative outcomes

Dissection