Is Prior Cardiac Surgery a Risk Factor 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:
P0183
Submission Type:
Abstract Submission
Authors:
Charles Mack (1), Gianmarco Cancelli (1), Lamia Harik (1), Mohamed Rahouma (1), Giovanni Jr Soletti (1), Camilla Rossi (1), Michele Dell'Aquila (1), Kevin R. An (1), Jordan Leith (1), Tulio Caldonazo (1), Christopher Lau (1), Mario Gaudino (1), Leonard Girardi (1)
Institutions:
(1) Weill Cornell Medicine, New York, NY
Submitting Author:
♦Charles Mack
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Co-Author(s):
Gianmarco Cancelli
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Weill Cornell Medicine
Lamia Harik
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Weill Cornell Medicine
Mohamed Rahouma
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Weill Cornell Medicine
Giovanni Jr Soletti
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Weill Cornell Medicine
Camilla Rossi
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Weill Cornell Medicine
Michele Dell'Aquila
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Weill Cornell Medicine
Kevin R. An
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Weill Cornell Medicine
Jordan Leith
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Weill Cornell Medicine
Tulio Caldonazo
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Weill Cornell Medicine
*Christopher Lau
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Weill Cornell Medicine
*Mario Gaudino
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Weill Cornell Medicine
*Leonard Girardi
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Weill Cornell Medicine
Presenting Author:
♦Charles Mack
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Weill Cornell Medicine
Abstract:
Objective: To evaluate the impact of prior cardiac surgery on outcomes in patients undergoing repair of acute type A aortic dissection (ATAAD).
Methods: Retrospective, single-center center cohort study of patients undergoing surgery for ATAAD from January 1997 to August 2023. The primary outcome was operative mortality. The secondary outcome was major postoperative adverse events (MAE), defined as the composite outcome of perioperative mortality, myocardial infarction, stroke, tracheostomy, and dialysis.
Results: Of 403 patients included in our database, 69 (17.1%) had a prior cardiac surgery. Patients with prior cardiac surgery had a higher preoperative incidence of diabetes (26.1% vs 13.2%; P=0.012), previous myocardial infarction (33.3% vs 12.3%; P<0.001), connective tissue disorders (17.4% vs 4.2%; P<0.001) and a reduced ejection fraction (median 45.00, interquartile range (IQR) [40.00, 50.00] vs median 50.00, IQR [45.00, 50.00]; P<0.001) when compared with patients with no prior cardiac surgery. Intraoperatively, patients with prior cardiac surgery had longer cardiopulmonary bypass time (median 162.00 min, IQR [138.00, 190.00] vs median 140.00 min, IQR [127.00, 163.00]; P<0.001). Circulatory arrest time (CA) was the same in both groups (24.00 [20.00, 30.00] vs 25.00 [20.00, 33.75]; P=0.285). When stratified by the type of previous surgery, patients who had previous ascending aorta interventions had a significantly longer circulatory arrest time (49.50 [23.75, 59.00]; P=0.048) compared to patients who had other previous cardiac surgery procedures. Also, patients with a prior history of ascending aorta interventions were more likely to undergo to total arch repair during ATAAD surgery compared to the other groups (44.4%; P=0.017) Overall, patients with prior cardiac surgery had significantly higher operative mortality (13.0% vs 3.6%; P=0.004) compared with patients with no previous cardiac surgery. Mortality was 11.1% (1/9) in patients with previous ascending aorta interventions, 17.4% (4/23) in patients with previous valve surgery, 12% (3/25) in patients with previous CABG and 16.7% (1/6) for patients who had combined valve surgery and CABG. There was a significantly higher incidence of MAE in the reoperation group (21.7% vs 10.5%; P=0.017). However, on multivariable analysis, prior cardiac surgery was not associated with MAE (odds ratio 1.48, 95% confidence interval [0.76-2.8]; P= 0.25).
Conclusions: Patients with prior cardiac surgery undergoing ATAAD repair had higher operative mortality and incidence of MAE than those patients with no prior cardiac surgery, although in the fully adjusted analysis the difference did not reach statistical significance. Future research focusing on new strategies and techniques to improve outcomes in these high-risk patients is warranted.
Methods: Retrospective, single-center center cohort study of patients undergoing surgery for ATAAD from January 1997 to August 2023. The primary outcome was operative mortality. The secondary outcome was major postoperative adverse events (MAE), defined as the composite outcome of perioperative mortality, myocardial infarction, stroke, tracheostomy, and dialysis.
Results: Of 403 patients included in our database, 69 (17.1%) had a prior cardiac surgery. Patients with prior cardiac surgery had a higher preoperative incidence of diabetes (26.1% vs 13.2%; P=0.012), previous myocardial infarction (33.3% vs 12.3%; P<0.001), connective tissue disorders (17.4% vs 4.2%; P<0.001) and a reduced ejection fraction (median 45.00, interquartile range (IQR) [40.00, 50.00] vs median 50.00, IQR [45.00, 50.00]; P<0.001) when compared with patients with no prior cardiac surgery. Intraoperatively, patients with prior cardiac surgery had longer cardiopulmonary bypass time (median 162.00 min, IQR [138.00, 190.00] vs median 140.00 min, IQR [127.00, 163.00]; P<0.001). Circulatory arrest time (CA) was the same in both groups (24.00 [20.00, 30.00] vs 25.00 [20.00, 33.75]; P=0.285). When stratified by the type of previous surgery, patients who had previous ascending aorta interventions had a significantly longer circulatory arrest time (49.50 [23.75, 59.00]; P=0.048) compared to patients who had other previous cardiac surgery procedures. Also, patients with a prior history of ascending aorta interventions were more likely to undergo to total arch repair during ATAAD surgery compared to the other groups (44.4%; P=0.017) Overall, patients with prior cardiac surgery had significantly higher operative mortality (13.0% vs 3.6%; P=0.004) compared with patients with no previous cardiac surgery. Mortality was 11.1% (1/9) in patients with previous ascending aorta interventions, 17.4% (4/23) in patients with previous valve surgery, 12% (3/25) in patients with previous CABG and 16.7% (1/6) for patients who had combined valve surgery and CABG. There was a significantly higher incidence of MAE in the reoperation group (21.7% vs 10.5%; P=0.017). However, on multivariable analysis, prior cardiac surgery was not associated with MAE (odds ratio 1.48, 95% confidence interval [0.76-2.8]; P= 0.25).
Conclusions: Patients with prior cardiac surgery undergoing ATAAD repair had higher operative mortality and incidence of MAE than those patients with no prior cardiac surgery, although in the fully adjusted analysis the difference did not reach statistical significance. Future research focusing on new strategies and techniques to improve outcomes in these high-risk patients is warranted.
Aortic Symposium:
Dissection
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