EP17 IMPACT OF A MODIFIED INTRAOPERATIVE SETTING FOR THE MANAGEMENT OF CIRCULATORY ARREST IN TYPE A ACUTE AORTIC DISSECTION

Abstract

Background-aim: Despite several recent reports show a trend towards a more extensive arch surgery for patients presenting with type A acute aortic dissection (TA-AAD), in-hospital mortality from IRAD remains high (13–17%). Our study aimed to evaluate the impact of a modified intraoperative setting for the management of circulatory arrest on short and mid-term outcomes in limited repair and complete arch surgery. Methods: From 1997 to 2017, 335 patients with TA-AAD were admitted at our Institution and divided into 3 groups according to the surgical strategy. GROUP-A: retrograde femoral artery perfusion- deep hypothermia (1977–2004;n = 144), GROUP-B: standard anterograde right axillary artery perfusion- moderate hypothermia (2005–2012;n = 102), GROUP-C: right axillary artery with modified monitoring and perfusion lines setting- moderate hypothermia (2013–2017;n = 89). Data was collected and analysed retrospectively. Results: Overall in-hospital mortality: 34.7% in Group-A (mean-age 61.5 ± 12.5years), 13.7% in Group-B (mean-age 63.8 ± 12.8years) and 5.6% in Group-C (mean-age 64.2 ± 11.1years) (p = 0.001). Concerning total-arch replacement, in-hospital mortality was 37% in Group-B vs 0% in Group-C (p = 0.001). Overall 1-year and 5-years survival: 56.3 ± 4.1% and 47.9 ± 4.2% in Group-A, 79.4 ± 4% and 69.6 ± 4.6% in Group-B, 89.5 ± 3.3% and 87.5 ± 3.8% in Group-C (p = 0.001). Group (p = 0.001), CEC-time (p = 0.003), re-exploration (p = 0.001), AKD (p = 0.049) and CVVH (p = 0.007) were predictors for in-hospital mortality in a univariate analysis, re-exploration (HR 4.2) and CVVH (HR 2.1) in a multivariate analysis, Group was a protective factor (HR = 0.25). Conclusions: In our experience current modified approach for the management of circulatory arrest seems to improve overall survival and decrease the risk of in-hospital mortality, showing excellent results especially in total arch replacement.