Clinical Outcomes and Economic Burden of Zone 2 Aortic Arch Reconstruction in DeBakey Type 1 and 2 Aortic Dissections

P0082 

Abstract Submission 

Lauren Pixley (1), Omar Sharaf (2), Dan Neal (3), Kevin Reilly (4), Aidan Charles (4), John Spratt (4), Thomas Beaver (5), Tomas Martin (6), Eric Jeng (7)

(1) N/A, N/A, (2) N/A, Berlin, CT, (3) University of Florida Health, Gainesville, FL, (4) University of Florida, Gainesville, FL, (5) Shands, Gainesville, FL, (6) Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, (7) University of Florida- Shands, Gainesville, FL

Lauren Pixley    -  Contact Me
N/A

Omar Sharaf    -  Contact Me
N/A

Dan Neal    -  Contact Me
University of Florida Health

Kevin Reilly    -  Contact Me
University of Florida

Aidan Charles    -  Contact Me
University of Florida

John Spratt    -  Contact Me
University of Florida

*Thomas Beaver    -  Contact Me
Shands

*Tomas Martin    -  Contact Me
Division of Cardiovascular Surgery, Department of Surgery, University of Florida

Eric Jeng    -  Contact Me
University of Florida- Shands

Lauren Pixley    -  Contact Me
N/A

Objective: We retrospectively evaluated the clinical outcomes and economics of Zone 2 aortic arch reconstruction in DeBakey Type 1 and 2 acute and chronic aortic dissections.

Methods: Between April 2018 and June 2022, n=140 patients with DeBakey Type 1 or 2 aortic dissection underwent Zone 2 repair at the University of Florida Health. Patients were categorized into two groups; the Acute group (n=83) and the chronic group (n=57). The Kaplan-Meier (KM) method was used to evaluate longitudinal survival.

Results: The Acute group was younger (54.5±13.0 vs. 59.3±11.1 years, p=0.031) and less frequently had hypertension (83.1% vs. 98.2%, p= 0.004), cerebrovascular disease (13.3% vs. 36.8%, p=0.002), and history of prior sternotomy (21.7% vs. 64.9%, p<0.0001). The Acute group had a longer total corporeal circulatory arrest time (66.1±15.4 vs. 59.7± 8.4 minutes, p=0.023), deep hypothermic cerebral circulatory arrest (DHCA) time (22.4±7.5 vs. 19.4±8.6 minutes, p=0.007), and lower minimum temperature (16.3±3.7 vs. 18.3±2.8 °C, p=0.0003) during DHCA. Postoperatively, the Acute group had a higher rate of postoperative acute kidney injury (21.7% vs. 7.0%, p=0.020); however, there was no difference between groups in the new requirement for dialysis (3.6% vs. 1.8%, p=0.646.) Morbidity included cerebrovascular accident in 7 (5.0%) patients, respiratory failure requiring tracheostomy in 15 (10.7%) patients, pneumonia in 19 (13.6%) patients, and sepsis in 13 (9.3%) patients. Thirty-day mortality was low at 2.3% (n=3). There is no difference in longitudinal KM-estimated survival by dissection timing (log-rank p=0.1).The Acute group had a lower operating room cost ($24,900±10,900 vs. $28,200±11,500, p=0.036), anesthesia cost ($3,300±1,300 vs. $4,200±1,600, p=<0.0001), and implant device costs ($12,100±12,000 vs. $16,700±11,000, p=0.003.) However, total hospital costs did not differ between Acute and Chronic groups ($108,000±50,500 vs. $117,000±54,900, p=0.285.)

Conclusions: Patients undergoing Zone 2 arch reconstruction for aortic dissections in our center are associated with a low postoperative complication rate and excellent long-term survival. While patients with chronic dissection presented older with higher comorbidity burden, there were no differences in most postoperative outcomes, mortality, and economics of dissection repair when evaluated by dissection timing.

Dissection