P315. Surgical Outcome of Acute Type A Aortic Dissection Requiring Preoperative Cardiopulmonary Resuscitation without Patient Selection
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I am Dr. Mihee Lim, an independent thoracic surgeon with over a year of experience since embarking on my surgical career. Having graduated from Pusan National University with a degree in nanomedical engineering and completed my master's and doctoral studies in medicine, I have dedicated my professional journey to the pursuit of excellence and innovation in the field of cardiac surgery.
Over the past year, my focus has been on establishing myself as a skilled and compassionate practitioner, particularly in the realm of minimally invasive cardiac surgery. Specializing in the least invasive techniques, I aim to provide patients with the benefits of reduced postoperative pain, shorter recovery times, and improved overall outcomes. One of my main areas of interest is the field of artificial heart surgeries and heart transplantation. Recognizing the critical importance of these procedures as the primary therapeutic options for end-stage heart failure, I want to do my best to lead advances in this field.
Because my area of greatest interest was minimally invasive cardaic surgery, my doctoral research, centered on the intersection of minimally invasive techniques and sarcopenia, has provided valuable insights into the safety and efficacy of performing minimally invasive cardiac surgeries in patients with sarcopenia. Through a rigorous investigation, I have demonstrated that, contrary to initial concerns, minimally invasive cardiac surgeries can be safely conducted in patients with sarcopenia.
As an independent practitioner, I am continually seeking opportunities to expand my knowledge, refine my skills, and contribute to the collective knowledge of the thoracic surgery community. My journey has been marked by a deep passion for delivering high-quality patient care.
Description
Acute type A aortic dissection (ATAAD) is a life-threatening disease that requires emergent surgery. However, the surgical indication for ATAAD with preoperative cardiopulmonary resuscitation (CPR) remain controversial. This retrospective study aimed to compare the individual characteristics and short-term outcomes between survivors and deceased patients who underwent preoperative in-hospital CPR.
Methods
From Jan 2019 to Aug 2023, 174 consecutive patients underwent ATAAD repair; 22 (12.6%) of these patients underwent preoperative in-hospital CPR. Patients who underwent preoperative CPR were classified into the survival group (n=13) and non-survival group (n=9), based on whether they survived to hospital discharge. Clinical features, surgical information, and postoperative complications were analyzed. Cerebral performance category (CPC) scores at discharge are presented.
Results
The major cause of cardiovascular collapse requiring CPR was aortic rupture/cardiac tamponade (n = 13, [59%]), followed by coronary mal-perfusion (n =7, [32%]). When patients who had been planned for surgery requiring CPR without return of spontaneous circulation, ECMO was actively applied. There were 5 (38.5%) patients in the survivors group and 2 (22.2%) in the non-survivors group who required preoperative ECMO at the beginning of surgery (P= .735). Overall duration of CPR was similar in survivors (5.0 minutes [range, 4.0-6.5 minutes] vs 7.0 minutes [range, 4.5-10 minutes]; P= .453). There were no significant inter-group differences in preoperative demographics and intra-operative procedures. Among patients in the survival group, 61.5% (8/13) of patients were discharged home, and 92.3% (12/13) of patients had full cerebral performance at discharge.
Conclusion
Patients with ATAAD undergoing preoperative in-hospital CPR, a significant proportion of these patients survived and discharged home with full cerebral performance. The prognosis of patients could not be predicted based solely on the preoperative situation. Therefore, a transient in-hospital CPR issue with active treatment might not be an obstacle to aortic surgery.
Authors
MIHEE LIM (1), Chee-hoon Lee (2), Minho Ju (3), Hyung Gon Je (4)
Institutions
(1) Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedic, Yangsan, South Korea, (2) Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedic, Seoul, South Korea, (3) N/A, Seoul, South Korea, (4) N/A, Yangsan, Korea