Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up.

Miriam Freundt,Jochen Cremer,Thomas Pühler,Gunnar Elke,Christine Friedrich,Assad Haneya,Matthias Gruenewald,Philipp Kolat,Mohamed Salem

doi:10.3390/jcm10225370

Abstract

Background: Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predictive of undesirable outcome to help guide perioperative management. Methods: We performed retrospective analysis of 394 cases of AAAD who underwent repair in our institution between 2001 and 2018. A combined endpoint of parameters was defined as (1) 30-day versus hospital mortality, (2) new neurological deficit, (3) new acute renal insufficiency requiring postoperative renal replacement, and (4) prolonged mechanical ventilation with need for tracheostomy. Results: Total survival/ follow-up time averaged 3.2 years with follow-up completeness of 94%. Endpoint was reached by 52.8%. Those had higher EuroSCORE II (7.5 versus 5.5), higher incidence of coronary artery disease (CAD) (9.2% versus 3.2%), neurological deficit (ND) upon presentation (26.4% versus 11.8%), cardiopulmonary resuscitation (CPR) (14.4% versus 1.6%) and intubation (RF) before surgery (16.9% versus 4.8%). 7-day mortality was 21.6% versus 0%. Hospital mortality 30.8% versus 0%. Conclusions: This 15-year follow up shows, that unfavorable postoperative clinical outcome is related to ND, CAD, CPR and RF on arrival.

Highlights

Acute type A aortic dissection (AAAD) is a catastrophic event in which the inner layer of the ascending aorta tears and separates from the middle layer
We performed a retrospective analysis of our Aortic Dissection Register, which included all consecutive 394 cases of AAAD who underwent emergent repair in moderate hypothermic cardiac arrest (MHCA) in our institution between 2001 and 2018
Follow-up was conducted in May 2020 and long-term survival was evaluated by information given by the registry office

Summary

Introduction

Acute type A aortic dissection (AAAD) is a catastrophic event in which the inner layer of the ascending aorta tears and separates from the middle layer. Due to acuity of the illness preoperative evaluation is limited, immediate decisions have to be made by surgeons and postoperative adverse clinical outcome remains oftentimes of concern [1,2,3,4,5,6,7,8]. Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. A combined endpoint of parameters was defined as (1) 30-day versus hospital mortality, (2) new neurological deficit, (3) new acute renal insufficiency requiring postoperative renal replacement, and (4) prolonged mechanical ventilation with need for tracheostomy. Those had higher EuroSCORE II (7.5 versus 5.5), higher incidence of coronary artery disease (CAD) (9.2% versus 3.2%), neurological deficit (ND) upon presentation

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