Impact of symptom-to-surgery time and malperfusion on mortality in patients with acute type A aortic dissection
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0161
Submission Type:
Abstract Submission
Authors:
Xun Zhang (1), Chao Fu (1), Jun Shao (1), Bo Wang (1), Changming Niu (1), Hao Yao (1), Qing-Guo Li (1)
Institutions:
(1) The 2nd Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
Submitting Author:
Xun Zhang
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The 2nd Affiliated Hospital of Nanjing Medical University
The 2nd Affiliated Hospital of Nanjing Medical University
Co-Author(s):
Chao Fu
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The 2nd Affiliated Hospital of Nanjing Medical University
The 2nd Affiliated Hospital of Nanjing Medical University
Jun Shao
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The 2nd Affiliated Hospital of Nanjing Medical University
The 2nd Affiliated Hospital of Nanjing Medical University
Bo Wang
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The 2nd Affiliated Hospital of Nanjing Medical University
The 2nd Affiliated Hospital of Nanjing Medical University
Changming Niu
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The 2nd Affiliated Hospital of Nanjing Medical University
The 2nd Affiliated Hospital of Nanjing Medical University
Hao Yao
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The 2nd Affiliated Hospital of Nanjing Medical University
The 2nd Affiliated Hospital of Nanjing Medical University
Qing-Guo Li
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The 2nd Affiliated Hospital of Nanjing Medical University
The 2nd Affiliated Hospital of Nanjing Medical University
Presenting Author:
Xun Zhang
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Abstract:
Objective
Acute type A aortic dissection (ATAAD) is associated with significant mortality and morbidity, especially in cases complicated by malperfusion. However, the impact of symptom-to-surgery time on operative mortality in ATAAD is unclear. This study aims to determine the impact of symptom-to-surgery time on operative and mid-term mortality in ATAAD patients with and without malperfusion.
Methods:
A retrospective analysis included 288 ATAAD patients treated between January 2016 and December 2020. Patients were separated into early and late intervention groups by symptom-to-surgery time (Median: 10 hours, IQR: 6-21.25). Baseline characteristics, including malperfusion (late [n=46, 33%] vs. early [n=61, 41%], p=0.198), were comparable between groups, except for male gender (late [n=91, 66%] vs. early [n=121, 81%], p=0.005) and prior aortic dissection (late [n=11, 8%] vs. early [n=2, 1%], p=0.007). Malperfusion was further classified into specific organ systems (cerebral: n=34, 12%; cardiac: n=53, 18%; renal: n=35, 12%; mesenteric: n=5, 2%; limb: n=22, 8%; Spinal: n=1, 0%; Tamponade: n=21, 7%), number of malperfused organs (one organ: n=59, 20%; two organs: n=29, 10%; three organs: n=11, 4%), and the Penn classification system (Penn B: n=86, 30%, Penn C: n=8, 3%, Penn B-C: n=13, 5%). Follow-up data were complete for all patients (236/236) over a mean period of 4.3 ± 1.6 years, with 19 patients undergoing re-intervention at a median of 1.7 years (IQR 1.4-4.4).
Results:
Operative death (52 [18%]) and late death (14 [6%]) were not significantly different between the late and early intervention groups, along with other perioperative variables. Multivariable analysis identified age (OR 1.09, 95% CI 1.06-1.14, p<0.001), extracorporeal membrane oxygenation (ECMO) (OR 10.61, 95% CI 2.50-51.61, p=0.002), and malperfusion (OR 7.06, 95% CI 3.11-17.19, p<0.001) as predictors for operative death, when malperfusion was used as a binary variable (model 1). When stratified by organ systems (model 2), cerebral (OR 3.18, 95% CI 1.08-9.11, p=0.032), cardiac (OR 6.13, 95% CI 1.33-27.43, p=0.018), limb (OR 6.41, 95% CI 1.79-22.76, p=0.004) malperfusion were significant predictors for operative mortality. When divided into malperfused organ numbers, one organ (OR 6.48, 95% CI 2.51-17.58, p<0.001), two organs (OR 13.46, 95% CI 3.08-67.22, p=0.001), and three organs (OR 49.09, 95% CI 8.23-322.71, p<0.001) were all significant predictors for operative mortality (model 3). When using the Penn classification system for malperfusion (model 4), Penn B (OR 8.26, 95% CI 3.28-22.32, p<0.001) and Penn B-C (OR 13.26, 95% CI 2.81-63.75, p=0.001) significantly predicted operative mortality. Survival comparison revealed significant differences between the malperfusion and without malperfusion groups (Log-rank p<0.001), but not between the late and early groups (Log-rank p=0.187). Within late and early surgery groups, malperfusion still significantly increased both operative (late: OR 12.54, 95% CI 3.07-70.85, p=0.001; early: OR 5.40, 95% CI 1.77-18.31, p=0.004; p=0.189 for interaction) and mid-term mortality (late: HR 4.16, 95% CI 1.77-9.81, p=0.001; early: HR 4.07, 95% CI 1.84-8.98, p<0.001; p=0.342 for interaction), after adjusting for covariates.
Conclusions:
In this series of ATAAD patients, preoperative malperfusion status rather than symptom-to-surgery time determines both operative and mid-term mortality.
Acute type A aortic dissection (ATAAD) is associated with significant mortality and morbidity, especially in cases complicated by malperfusion. However, the impact of symptom-to-surgery time on operative mortality in ATAAD is unclear. This study aims to determine the impact of symptom-to-surgery time on operative and mid-term mortality in ATAAD patients with and without malperfusion.
Methods:
A retrospective analysis included 288 ATAAD patients treated between January 2016 and December 2020. Patients were separated into early and late intervention groups by symptom-to-surgery time (Median: 10 hours, IQR: 6-21.25). Baseline characteristics, including malperfusion (late [n=46, 33%] vs. early [n=61, 41%], p=0.198), were comparable between groups, except for male gender (late [n=91, 66%] vs. early [n=121, 81%], p=0.005) and prior aortic dissection (late [n=11, 8%] vs. early [n=2, 1%], p=0.007). Malperfusion was further classified into specific organ systems (cerebral: n=34, 12%; cardiac: n=53, 18%; renal: n=35, 12%; mesenteric: n=5, 2%; limb: n=22, 8%; Spinal: n=1, 0%; Tamponade: n=21, 7%), number of malperfused organs (one organ: n=59, 20%; two organs: n=29, 10%; three organs: n=11, 4%), and the Penn classification system (Penn B: n=86, 30%, Penn C: n=8, 3%, Penn B-C: n=13, 5%). Follow-up data were complete for all patients (236/236) over a mean period of 4.3 ± 1.6 years, with 19 patients undergoing re-intervention at a median of 1.7 years (IQR 1.4-4.4).
Results:
Operative death (52 [18%]) and late death (14 [6%]) were not significantly different between the late and early intervention groups, along with other perioperative variables. Multivariable analysis identified age (OR 1.09, 95% CI 1.06-1.14, p<0.001), extracorporeal membrane oxygenation (ECMO) (OR 10.61, 95% CI 2.50-51.61, p=0.002), and malperfusion (OR 7.06, 95% CI 3.11-17.19, p<0.001) as predictors for operative death, when malperfusion was used as a binary variable (model 1). When stratified by organ systems (model 2), cerebral (OR 3.18, 95% CI 1.08-9.11, p=0.032), cardiac (OR 6.13, 95% CI 1.33-27.43, p=0.018), limb (OR 6.41, 95% CI 1.79-22.76, p=0.004) malperfusion were significant predictors for operative mortality. When divided into malperfused organ numbers, one organ (OR 6.48, 95% CI 2.51-17.58, p<0.001), two organs (OR 13.46, 95% CI 3.08-67.22, p=0.001), and three organs (OR 49.09, 95% CI 8.23-322.71, p<0.001) were all significant predictors for operative mortality (model 3). When using the Penn classification system for malperfusion (model 4), Penn B (OR 8.26, 95% CI 3.28-22.32, p<0.001) and Penn B-C (OR 13.26, 95% CI 2.81-63.75, p=0.001) significantly predicted operative mortality. Survival comparison revealed significant differences between the malperfusion and without malperfusion groups (Log-rank p<0.001), but not between the late and early groups (Log-rank p=0.187). Within late and early surgery groups, malperfusion still significantly increased both operative (late: OR 12.54, 95% CI 3.07-70.85, p=0.001; early: OR 5.40, 95% CI 1.77-18.31, p=0.004; p=0.189 for interaction) and mid-term mortality (late: HR 4.16, 95% CI 1.77-9.81, p=0.001; early: HR 4.07, 95% CI 1.84-8.98, p<0.001; p=0.342 for interaction), after adjusting for covariates.
Conclusions:
In this series of ATAAD patients, preoperative malperfusion status rather than symptom-to-surgery time determines both operative and mid-term mortality.
Aortic Symposium:
Dissection
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