The Impact of Preoperative Anemia on Outcomes of 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:
P0337
Submission Type:
Abstract Submission
Authors:
Danial Ahmad (1), James Brown (1), Sarah Yousef (2), Derek Serna-Gallegos (3), Yisi Wang (1), Floyd Thoma (1), Julie Phillippi (4), David Kaczorowski (5), David West (1), Pyongsoo Yoon (1), Johannes Bonatti (6), Danny Chu (7), Francis Ferdinand (8), Ibrahim Sultan (3)
Institutions:
(1) UPMC, Pittsburgh, PA, (2) University of Pittsburgh, Pittsburgh, PA, (3) University of Pittsburgh Medical Center, Pittsburgh, PA, (4) N/A, Pittsburgh, PA, (5) University of Pittsburgh Medical Center, Venetia, PA, (6) UPMC Heart and Vascular Institute, Pittsburgh, PA, (7) Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, (8) UPMC, Erie, PA
Submitting Author:
Danial Ahmad
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UPMC
UPMC
Co-Author(s):
James Brown
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UPMC
UPMC
Sarah Yousef
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University of Pittsburgh
University of Pittsburgh
Derek Serna-Gallegos
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Yisi Wang
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UPMC
UPMC
Floyd Thoma
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UPMC
UPMC
*Julie Phillippi
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N/A
N/A
*David Kaczorowski
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
David West
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UPMC
UPMC
Pyongsoo Yoon
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UPMC
UPMC
♦Johannes Bonatti
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UPMC Heart and Vascular Institute
UPMC Heart and Vascular Institute
*Danny Chu
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Veterans Affairs Pittsburgh Healthcare System
Veterans Affairs Pittsburgh Healthcare System
Francis Ferdinand
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UPMC
UPMC
*Ibrahim Sultan
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Presenting Author:
Danial Ahmad
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UPMC
UPMC
Abstract:
Objectives:
Preoperative anemia is associated with increased morbidity and mortality after cardiac surgery. We sought to evaluate the impact of preoperative anemia in patients undergoing surgery for acute type A aortic dissection (ATAAD).
Methods:
This was a retrospective institutional study from 2010-2023 of patients undergoing treatment for ATAAD. Patients were stratified into propensity matched anemia (+) and anemia (-) groups based on standard gender-based cutoffs for anemia using hemoglobin (Hb) or hematocrit if Hb was unavailable.
Results:
A total of 579 patients were identified. Of those, 454 were included with 273 patients in the anemia (-) and 181 in the anemia (+) group. Patients with no Hb data, or those with aortic rupture, traumatic dissection/trauma, previous dissection, cancer, heart failure (NYHA 3-4), or no follow-up were excluded to avoid including secondary causes of anemia. Among women, more patients were non-anemic (44.7% vs.32.6%, p=0.01). Anemic patients were older at presentation (63 vs. 61 years, p=0.04) and had a higher incidence of diabetes (15.5% vs. 8.1%, p=0.0135). Further, these patients had lower total albumin (3.5 g/dL (3.1-3.8) vs. 3.8 (3.5-4), p<0.001) along with longer cardiopulmonary bypass (195 mins (158-229) vs. 178 mins (149-218), p=0.02) and cross clamp (128 mins (92.5-170) vs. 113 mins (92-151), p=0.05) times. Circulatory arrest times were however comparable among the groups (24.0 mins (20.0-33.0) vs.25.0 mins (19.0-32.0), p=0.672).
At a follow up of 4.8 years (1.6-8), overall mortality was comparable between the anemia (+) and (-) cohort (29.8% vs 22.7%, p=0.088). There was also no difference in operative mortality, 30-day readmission, and one-year survival between the groups.
Postoperative blood product utilization (60.8% vs. 46.5%, p=0.003) was higher in the anemia (+) group who also had a longer length of hospital stay (9 days (6-15) vs. 8 (6-14), = 0.04). On multivariable Cox proportional hazards regression for overall mortality, anemia was not associated with the outcome of mortality (HR: 1.11 (95%CI: 0.615-2.006), p=0.727). However, chronic obstructive pulmonary disease (HR:2.27 (1.48-3.51), p<0.0001) and perfusion time (HR: 1.013 (1.009-1.017), p<0.0001) were associated with overall mortality.
Unadjusted Kaplan-Meier survival analysis (Panel A) and the cumulative incidence of readmission or reintervention (Panel B) showed no significant difference between the groups. The nonlinear relationship between baseline Hb and overall survival for men (Panel C) and women (Panel D) is depicted in the figure.
Conclusions:
Preoperative anemia did not directly predispose ATAAD patients to worse survival. Anemia appears to be a bystander with other comorbidities that impact survival and outcomes after surgery for acute type A aortic dissection.
Preoperative anemia is associated with increased morbidity and mortality after cardiac surgery. We sought to evaluate the impact of preoperative anemia in patients undergoing surgery for acute type A aortic dissection (ATAAD).
Methods:
This was a retrospective institutional study from 2010-2023 of patients undergoing treatment for ATAAD. Patients were stratified into propensity matched anemia (+) and anemia (-) groups based on standard gender-based cutoffs for anemia using hemoglobin (Hb) or hematocrit if Hb was unavailable.
Results:
A total of 579 patients were identified. Of those, 454 were included with 273 patients in the anemia (-) and 181 in the anemia (+) group. Patients with no Hb data, or those with aortic rupture, traumatic dissection/trauma, previous dissection, cancer, heart failure (NYHA 3-4), or no follow-up were excluded to avoid including secondary causes of anemia. Among women, more patients were non-anemic (44.7% vs.32.6%, p=0.01). Anemic patients were older at presentation (63 vs. 61 years, p=0.04) and had a higher incidence of diabetes (15.5% vs. 8.1%, p=0.0135). Further, these patients had lower total albumin (3.5 g/dL (3.1-3.8) vs. 3.8 (3.5-4), p<0.001) along with longer cardiopulmonary bypass (195 mins (158-229) vs. 178 mins (149-218), p=0.02) and cross clamp (128 mins (92.5-170) vs. 113 mins (92-151), p=0.05) times. Circulatory arrest times were however comparable among the groups (24.0 mins (20.0-33.0) vs.25.0 mins (19.0-32.0), p=0.672).
At a follow up of 4.8 years (1.6-8), overall mortality was comparable between the anemia (+) and (-) cohort (29.8% vs 22.7%, p=0.088). There was also no difference in operative mortality, 30-day readmission, and one-year survival between the groups.
Postoperative blood product utilization (60.8% vs. 46.5%, p=0.003) was higher in the anemia (+) group who also had a longer length of hospital stay (9 days (6-15) vs. 8 (6-14), = 0.04). On multivariable Cox proportional hazards regression for overall mortality, anemia was not associated with the outcome of mortality (HR: 1.11 (95%CI: 0.615-2.006), p=0.727). However, chronic obstructive pulmonary disease (HR:2.27 (1.48-3.51), p<0.0001) and perfusion time (HR: 1.013 (1.009-1.017), p<0.0001) were associated with overall mortality.
Unadjusted Kaplan-Meier survival analysis (Panel A) and the cumulative incidence of readmission or reintervention (Panel B) showed no significant difference between the groups. The nonlinear relationship between baseline Hb and overall survival for men (Panel C) and women (Panel D) is depicted in the figure.
Conclusions:
Preoperative anemia did not directly predispose ATAAD patients to worse survival. Anemia appears to be a bystander with other comorbidities that impact survival and outcomes after surgery for acute type A aortic dissection.
Aortic Symposium:
Other - Type A Aortic Dissection
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