P186. Late Aortic Reinterventions after Surgery for Acute Type A Aortic Dissection
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Karolinska Institute
Stockholm
Sweden - Contact Me
Markus Bjurbom is a cardiac surgeon at Karolinska University Hospital, Stockholm, Sweden. He is also working on his PhD at the Karolinska Institute with focus on outcomes after acute type A aortic dissection and establishing a registry for patients with type A aortic dissection in the Nordic countries (NORCAAD).
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective
To outline patterns, prevalence and outcomes of aortic reinterventions at least 10 years after surgical repair for acute type A aortic dissection (ATAAD) and to identify factors associated with aortic reinterventions.
Methods
All patients who underwent surgical repair for ATAAD at a single center between January 1 2005 and December 31 2013 were included. All aortic reinterventions were reported. Cox regression analysis, including a Fine-Gray model treating death as a competing risk to reintervention, was used to investigate factors associated with aortic reintervention and mortality.
Results
225 patients underwent surgical repair for ATAAD. 195 patients (87%) underwent surgery with an open distal anastomosis, 33 patients (15%) had a root replacement, and 18 patients (8.0%) underwent an arch repair at the time of the index repair, with 30-day mortality of 13.0%. 37 patients (16%) underwent an aortic reintervention at a median time of 8 years (range up to 15 years) after the index procedure. The most common indications for aortic reintervention were aortic dilatation (84%) and aortic regurgitation (27%). 30-day mortality after aortic reintervention was 0%. Factors associated with proximal aortic reintervention was root diameter >45 mm at the time of initial ATAAD repair if no root replacement was performed (SHR 5.4, 95% CI 1.3-22, p=0.02) and age (SHR 0.9, 95% CI 0.9-0.96, p=0.001). Factors associated with distal aortic reintervention were descending aortic diameter at the time of index repair (per mm increase) (SHR 1.1, 95% CI 1.0-1.2, p=0.005), dissection of the right renal artery (SHR 2.9, 95% CI 1.7-2.3, p=0.03) and failure to completely resect the primary tear (SHR 2.3, 95% CI 1.0-5.5, p=0.05). With a mean follow-up of 9 years (median 10 years), event-free survival at 1, 5, 10 and 15 years was 82% (95% CI 77-87), 72% (65-77), 48% (41-54) and 33% (26-40), respectively.
Conclusion
Aortic reoperations are not uncommon after surgery for ATAAD, predominantly due to progressive aortic dilatation which may develop very late after the original repair. This warrants lifelong aortic imaging surveillance for most patients who have undergone a surgical repair for ATAAD and should be reflected properly in reporting long-term outcomes. In selected patients, aortic reinterventions can be done with limited surgical risk. At the time of the index repair, replacing a moderately dilated aortic root and ensuring complete resection of the primary tear may decrease the need for future aortic reinterventions.
Authors
Markus Bjurbom (1), Kristina Ma (1), Magnus Dalén (1), Anders Franco-Cereceda (1), Christian Olsson (1)
Institutions
(1) Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
To outline patterns, prevalence and outcomes of aortic reinterventions at least 10 years after surgical repair for acute type A aortic dissection (ATAAD) and to identify factors associated with aortic reinterventions.
Methods
All patients who underwent surgical repair for ATAAD at a single center between January 1 2005 and December 31 2013 were included. All aortic reinterventions were reported. Cox regression analysis, including a Fine-Gray model treating death as a competing risk to reintervention, was used to investigate factors associated with aortic reintervention and mortality.
Results
225 patients underwent surgical repair for ATAAD. 195 patients (87%) underwent surgery with an open distal anastomosis, 33 patients (15%) had a root replacement, and 18 patients (8.0%) underwent an arch repair at the time of the index repair, with 30-day mortality of 13.0%. 37 patients (16%) underwent an aortic reintervention at a median time of 8 years (range up to 15 years) after the index procedure. The most common indications for aortic reintervention were aortic dilatation (84%) and aortic regurgitation (27%). 30-day mortality after aortic reintervention was 0%. Factors associated with proximal aortic reintervention was root diameter >45 mm at the time of initial ATAAD repair if no root replacement was performed (SHR 5.4, 95% CI 1.3-22, p=0.02) and age (SHR 0.9, 95% CI 0.9-0.96, p=0.001). Factors associated with distal aortic reintervention were descending aortic diameter at the time of index repair (per mm increase) (SHR 1.1, 95% CI 1.0-1.2, p=0.005), dissection of the right renal artery (SHR 2.9, 95% CI 1.7-2.3, p=0.03) and failure to completely resect the primary tear (SHR 2.3, 95% CI 1.0-5.5, p=0.05). With a mean follow-up of 9 years (median 10 years), event-free survival at 1, 5, 10 and 15 years was 82% (95% CI 77-87), 72% (65-77), 48% (41-54) and 33% (26-40), respectively.
Conclusion
Aortic reoperations are not uncommon after surgery for ATAAD, predominantly due to progressive aortic dilatation which may develop very late after the original repair. This warrants lifelong aortic imaging surveillance for most patients who have undergone a surgical repair for ATAAD and should be reflected properly in reporting long-term outcomes. In selected patients, aortic reinterventions can be done with limited surgical risk. At the time of the index repair, replacing a moderately dilated aortic root and ensuring complete resection of the primary tear may decrease the need for future aortic reinterventions.
Authors
Markus Bjurbom (1), Kristina Ma (1), Magnus Dalén (1), Anders Franco-Cereceda (1), Christian Olsson (1)
Institutions
(1) Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.