P183. Is Prior Cardiac Surgery a Risk Factor in Patients with Acute Type A Aortic Dissection
Weill Cornell Medical College, Cornell University
Manhasset, NY
United States - Contact Me
Dr. Charles Mack is an Attending Cardiothoracic Surgeon, Associate Professor of Cardiothoracic Surgery and Vice Chair for Quality in the Department of Cardiothoracic Surgery at The New York Presbyterian Hospital-Weill Cornell Medicine and also the Associate Program Director of The New York Presbyterian-Weill Cornell Thoracic Surgery Residency Program. He is the Director of Cardiovascular Services, Director of the Cardiothoracic Intensive Care Unit and Surgical Director of Structural Heart Disease at New York Presbyterian-Queens. Dr. Mack completed his undergraduate studies at Fordham University in 1987 and graduated from Tufts University School of Medicine in 1992. He completed his general surgery residency at New York Presbyterian Hospital-Weill Cornell Medicine in 1999. During this time, he also completed a 2-year research fellowship studying gene therapy applications for cardiovascular disease in collaboration with the Division of Pulmonary and Critical Care Medicine and Department of Cardiothoracic Surgery. This preclinical work laid the foundation for the first clinical trial evaluating human gene therapy as a potential treatment for coronary artery disease. He then completed a cardiothoracic surgery fellowship at New York Presbyterian Hospital-Weill Cornell Medicine/Memorial Sloan Kettering Cancer Center and has served the Department of Cardiothoracic Surgery at Weill Cornell Medicine in various roles since 2001
Dr. Mack interests include all aspects of adult cardiac surgery. His primary areas of focus are outcomes and quality in adult cardiac surgery, critical care and perioperative management, mechanical support, TAVR and resident education. He has also been involved in the launch of the AATS Quality Gateway.
Description
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.
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