Nighttime and Weekend Surgery in Frozen Elephant Trunk Procedures for Acute Aortic Dissections

P0225 

Abstract Submission 

Lennart Bax (1), Till Demal (2), Jens Brickwedel (1), Hermann Reichenspurner (1), Christian Detter (3)

(1) University Heart & Vascular Center Hamburg, Hamburg, Hamburg, (2) University Heart & Vascular Center Hamburg, Hamburg, Germany, (3) University Heart and Vascular Center Hamburg, Hamburg, Hamburg

Lennart Bax    -  Contact Me
University Heart & Vascular Center Hamburg

Till Demal    -  Contact Me
University Heart & Vascular Center Hamburg

Jens Brickwedel    -  Contact Me
University Heart & Vascular Center Hamburg

Hermann Reichenspurner    -  Contact Me
University Heart & Vascular Center Hamburg

Christian Detter    -  Contact Me
University Heart and Vascular Center Hamburg

Lennart Bax    -  Contact Me
University Heart & Vascular Center Hamburg

Objective: Aortic arch surgery using the frozen elephant trunk (FET) procedures is still a complex procedure and is associated with increased early mortality, especially when used in acute aortic dissections (AAD). Outcome after surgery may be dependent on the experience of the medical staff participating intra- as well as perioperatively. Thus, we aimed to evaluate the influence of nighttime and weekend surgery, where medical staff may not be the core aortic team.

Methods: Between 01/2010 and 11/2022, 222 consecutive patients underwent FET surgery at our center. Of these 76 underwent FET for AAD and were thus included in this analysis. We used a multivariable regression analysis to test whether surgery during normal working hours (group 1) vs nighttime and/or weekend (group 2) was associated with better 30-day survival rates.

Results: Mean age was 59.515.5 years (n=20 >70 years) with 73.7% (n=56/76) male patients. EuroSCORE II was 21.0±15.9. Nighttime and/or weekend surgery (group 2) was performed in 42.1% (n=32/76).
In group 1 vs group 2, 20.5% (n=9/44) vs 15.6% (n=5/32) suffered from heritable thoracic aortic disease (HTAD), respectively. Prior cardiac surgery had been performed in 9.1% (n=4/44) vs 0% (n=0/32). Surgery on the aortic root was necessary in 18.2% (n=8/44) vs 25.0% (n=8/32) and concomitant coronary artery bypass grafting (CABG) was necessary in 18.2% (n=8/44) vs 6.3% (n=2/32) of patients. Aortic cross clamp and selective antegrade cerebral perfusion times were 144±59 vs 151±60 and 81±32 vs 82±34 minutes, respectively.
30-day mortality was 15.9% (n=7/44) vs 31.3% (n=10/32) in group 1 vs group 2. In multivariable regression analysis, including 9 covariables (nighttime and /or weekend surgery, prior cardiac/aortic surgery, hereditable thoracic aortic disease, age >70y, surgery on the aortic root, distal landing zone 2 vs. 3, concomitant CABG, cerebral perfusion time >75 minutes and aortic cross clamp >140 minutes) surgery during nighttime and/or weekend was found to be an independent risk factor for 30-day mortality (OR 4.1; CI 1.1–15.8; p=0.037).

Conclusions: In our patient cohort FET surgery for AAD during nighttime and/or weekend was independently associated with an elevated 30-day mortality. Since the core aortic team, consisting of specialized surgeons, anaesthesiologists and ICU personnel are usually not present during these hours we suggest either reducing the complexity of the surgical procedure, or having a dedicated FET-team on call at all hours.

Aortic Arch