P160. Impact of Re-sternotomy in Acute Type A Aortic Dissection Repair
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Memorial Hermann Heart and Vascular Institute
Houston, TX
United States - Contact Me
Cardiovascular surgeon at Memorial Hermann Hospital and McGovern Medical School at UTHealth
Integrated vascular surgery residency 2017-2022
Aortic & Structural Heart Fellowship 2015-2017
Board-certified for Japanese cardiovascular surgery and general surgery
Board-certified for Vascular Surgery in US
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective:
We reviewed our near two-decade experience to evaluate for the impact of resternotomy in acute type A aortic dissection (ATAD).
Methods:
All open ATAD repairs performed at our institution from December 1999 to December 2022 were reviewed. Perioperative data were reviewed. Patients who had re-sternotomy was compared with first time sternotomy group.
Results:
Total of 697 patients had type A aortic repair during the study period. 49 patients had previous sternotomy procedures. Patients with re-sternotomy were older (67 yo vs. 57 yo, P<0.001) and had frequently had hypertension (82% vs. 64%, P=0.011), advanced chronic kidney disease (greater than stage IIIb), and previous infrarenal abdominal aortic aneurysm repair (10% vs. 1%, <0.001). Re-sternotomy patients required larger amount of transfusion including, cell saved units, packed red blood cell, and platelet (all P<0.001). Aortic clamp time (100 min vs. 96 min, P=0.137) and circulatory arrest time (27 min vs. 26 min, P=0.294) were similar in two groups, and performed concomitant procedures, but cardiopulmonary bypass time (178 min vs. 153 min, P=0.002) were longer in the re-sternotomy group. Postoperative complications were more frequently observed in re-sternotomy group, including ARDS (27% vs. 13%, P=0.008), postoperative dialysis (24% vs. 14%, P<0.001), and operative mortality (39% vs. 12%, P<0.001).
Conclusions:
ATAD patients with previous sternotomy had more comorbidities compared to first time sternotomy patients. Outcomes after ATAD patients remain challenging despite the advancement of perioperative care in ATAD.
Authors
Yuki Ikeno (1), Akiko Tanaka (1), Alexander Mills (1), Lucas Ribe (1), Harleen Sandhu (1), Charles Miller (1), steven eisenberg (1), Anthony Estrera (1)
Institutions
(1) McGovern Medical School at UTHealth, Houston, TX
We reviewed our near two-decade experience to evaluate for the impact of resternotomy in acute type A aortic dissection (ATAD).
Methods:
All open ATAD repairs performed at our institution from December 1999 to December 2022 were reviewed. Perioperative data were reviewed. Patients who had re-sternotomy was compared with first time sternotomy group.
Results:
Total of 697 patients had type A aortic repair during the study period. 49 patients had previous sternotomy procedures. Patients with re-sternotomy were older (67 yo vs. 57 yo, P<0.001) and had frequently had hypertension (82% vs. 64%, P=0.011), advanced chronic kidney disease (greater than stage IIIb), and previous infrarenal abdominal aortic aneurysm repair (10% vs. 1%, <0.001). Re-sternotomy patients required larger amount of transfusion including, cell saved units, packed red blood cell, and platelet (all P<0.001). Aortic clamp time (100 min vs. 96 min, P=0.137) and circulatory arrest time (27 min vs. 26 min, P=0.294) were similar in two groups, and performed concomitant procedures, but cardiopulmonary bypass time (178 min vs. 153 min, P=0.002) were longer in the re-sternotomy group. Postoperative complications were more frequently observed in re-sternotomy group, including ARDS (27% vs. 13%, P=0.008), postoperative dialysis (24% vs. 14%, P<0.001), and operative mortality (39% vs. 12%, P<0.001).
Conclusions:
ATAD patients with previous sternotomy had more comorbidities compared to first time sternotomy patients. Outcomes after ATAD patients remain challenging despite the advancement of perioperative care in ATAD.
Authors
Yuki Ikeno (1), Akiko Tanaka (1), Alexander Mills (1), Lucas Ribe (1), Harleen Sandhu (1), Charles Miller (1), steven eisenberg (1), Anthony Estrera (1)
Institutions
(1) McGovern Medical School at UTHealth, Houston, TX
Presentation Duration
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