P140. Functional Outcome of Patients after Surgery for Acute Stanford Type A Aortic Dissection
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Hopsital of the University of Pennsylvania
Philadelphia, PA
United States - Contact Me
Dr. Murat Yildiz is a cardiac surgeon with a particular interest in aortic surgery. Graduating from the University of Bern in November 2014, he achieved the European Board of Cardiothoracic Surgery (EBCTS) certification in September 2022, followed by Swiss Board Certification in May 2023. Currently based at Inselspital Bern, Dr. Yildiz is involved in a postdoctoral research fellowship at the University of Pennsylvania.
He was honored to receive the first prize of the Aortic Association Scientific Award in 2023, acknowledging his contributions to the field. This recognition fuels his dedication to advancing aortic surgery and contributes to ongoing advancements in cardiovascular medicine
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective
To report functional outcome of type A aortic dissection (TAAD) after 1 year as well as morbidity and mortality.
Methods
Retrospective analysis including 642 patients with TAAD from 01/2005 –12/2021. Patients were followed in the aortic disease clinic at 3, 6, and 12 months after the event. Permission was sought to contact health care providers outside of our institution. Stroke was defined as any impairment of neurological function. Follow-up at 12 months was 90% complete.
Results
Mean age at TAAD was 62y (95% CI: 61-63y) and 30% of the population was female. One year after surgery for TAAD, 75% of patients were living at home in NYHA functional class I. No patients were observed with NYHA stage IV. Less than 2% were residing in an assisted living facility. 85% of non-retired patients had returned to work. 212 (33%) patients were retired after 1 year at a mean age of 73y (95% CI: 72-74y). Stroke occurred in 148 (23%) patients and was the cause of death in 33 patients. Among the 148 patients, 66 (45%) exhibited preoperative neurological disabilities, while four patients (3%), initially without any neurological impairments postoperatively, experienced a postoperative stroke. Of the remaining (alive) patients with stroke (115) 30% had no residual limitations 1 year after TAAD. Pericardial effusion in the patients with neurological disability was present in 60 patients (41%) of which 25 were hemodynamically impaired (17%).
The cross-clamp time was significantly higher in patients with stroke (98min 95% CI: 94.0-101.1 in patients without stroke vs. 106min 95% CI: 98.5-114.1 in patients with stroke, p-value: 0.026). 69% of patients with stroke live at home, 28% at home with support and 3% in an assisted living facility. One year after stroke, 77% of the patients achieved a Rankin Scale ≤2, while no patient had a Rankin Scale of 5. There was no significant correlation between gender and recovery rate (p-value: 0.48). However, experiencing a stroke significantly increased the likelihood of residing in an assisted living facility or receiving support at home one year after TAAD (OR = 9.44, 95% CI: 4.85-18.77, p-value:<0.001). Thirty-day mortality was 11.8% and 92 patients (14%) died within 1st year after TAAD. There was no significant gender difference in mortality (p-value: 0.101).
Conclusions
After surgery for acute type A aortic dissection, 3 out of 4 patients live at home unassisted 1 year after surgery. Stroke survivors have a favorable outcome with the majority having mild or no residual neurological deficits at 1 year. Nevertheless, experiencing stroke is a risk factor for living in an assisted living facility 1 year after the event. There were no gender differences in suffering from a stroke, living in an assisted living facility, or mortality.
Authors
Murat Yildiz (1), Maria Nucera (1), Selim Mosbahi (1), Cem Kapkin (1), Silvan Jungi (1), Matthias Siepe (1), Florian Schoenhoff (1)
Institutions
(1) Inselspital, Bern, Switzerland
To report functional outcome of type A aortic dissection (TAAD) after 1 year as well as morbidity and mortality.
Methods
Retrospective analysis including 642 patients with TAAD from 01/2005 –12/2021. Patients were followed in the aortic disease clinic at 3, 6, and 12 months after the event. Permission was sought to contact health care providers outside of our institution. Stroke was defined as any impairment of neurological function. Follow-up at 12 months was 90% complete.
Results
Mean age at TAAD was 62y (95% CI: 61-63y) and 30% of the population was female. One year after surgery for TAAD, 75% of patients were living at home in NYHA functional class I. No patients were observed with NYHA stage IV. Less than 2% were residing in an assisted living facility. 85% of non-retired patients had returned to work. 212 (33%) patients were retired after 1 year at a mean age of 73y (95% CI: 72-74y). Stroke occurred in 148 (23%) patients and was the cause of death in 33 patients. Among the 148 patients, 66 (45%) exhibited preoperative neurological disabilities, while four patients (3%), initially without any neurological impairments postoperatively, experienced a postoperative stroke. Of the remaining (alive) patients with stroke (115) 30% had no residual limitations 1 year after TAAD. Pericardial effusion in the patients with neurological disability was present in 60 patients (41%) of which 25 were hemodynamically impaired (17%).
The cross-clamp time was significantly higher in patients with stroke (98min 95% CI: 94.0-101.1 in patients without stroke vs. 106min 95% CI: 98.5-114.1 in patients with stroke, p-value: 0.026). 69% of patients with stroke live at home, 28% at home with support and 3% in an assisted living facility. One year after stroke, 77% of the patients achieved a Rankin Scale ≤2, while no patient had a Rankin Scale of 5. There was no significant correlation between gender and recovery rate (p-value: 0.48). However, experiencing a stroke significantly increased the likelihood of residing in an assisted living facility or receiving support at home one year after TAAD (OR = 9.44, 95% CI: 4.85-18.77, p-value:<0.001). Thirty-day mortality was 11.8% and 92 patients (14%) died within 1st year after TAAD. There was no significant gender difference in mortality (p-value: 0.101).
Conclusions
After surgery for acute type A aortic dissection, 3 out of 4 patients live at home unassisted 1 year after surgery. Stroke survivors have a favorable outcome with the majority having mild or no residual neurological deficits at 1 year. Nevertheless, experiencing stroke is a risk factor for living in an assisted living facility 1 year after the event. There were no gender differences in suffering from a stroke, living in an assisted living facility, or mortality.
Authors
Murat Yildiz (1), Maria Nucera (1), Selim Mosbahi (1), Cem Kapkin (1), Silvan Jungi (1), Matthias Siepe (1), Florian Schoenhoff (1)
Institutions
(1) Inselspital, Bern, Switzerland
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.