305: Early results from an emergency center dedicated for acute aortic syndromes with round-the-clock access

Abstract

Acute aortic syndromes (AAS) represent a wide range of life-threatening pathologies. We assessed the feasibility and early results of an immediate, round-the-clock, protocolized management of patients with AAS. In January 2009, we set up the SOS-Aorta program regrouping intensivists, cardio-vascular and endovascular surgeons available around the clock. All patients admitted via SOS-aorta were included in a prospective registry. We compared the early results of this registry to the one of a retrospective cohort of patients admitted for AAS before the creation of this program. From January 2006 to December 2011, a total of 451 patients were admitted for AAS (174 before and 287 after SOS-Aorta). The average number of patients treated annually was 58±6.6 in the 3-years before SOS-Aorta. It increased significantly to 96±17 (p<0.05) after SOS-Aorta. The overall in-hospital mortality in the early period was 36.4±1.84%. It decreased significantly to 21.6% (p<0.01) after SOS-Aorta. The first 122 patients from the SOS-aorta registry were reviewed: mean age 66 (56-78), 70% men. Chest or abdominal pain were present in 68,8%. Typical migrating pain suggestive of aortic dissection was present in only 4%. Final diagnosis xas: acute Type A dissection in 52%, type B in 19% and ruptured aneurysm in 25%. Patients were frequently in critical condition: 25% with shock, 8,2% cardiac arrest, 11% acute coronary syndrom and 8% tamponade. The mean SAPS2 score (New Simplified Acute Physiology Score) was 30 [24–37]. 79% of the patients underwent emergent surgery in a mean time frame of 1,27 hours (0,24-7,63). Multivariate analysis showed that SAPS2 score was the only significant predictor of mortality OR:1,12 (IC95%:1,05–1,18), p<0,001. Setting-up the SOS-Aorta program has increased significantly the number of patients admitted for AAS. It resulted in a significant improvement of in-hospital mortality for these patients with otherwise immediate severe prognosis.