1-Sear Survival after Surgery for Acute Type-A Aortic Dissection in Patients with Previous Cardiac Surgery

Objectives: “Previous cardiac surgery” is an independent risk factor for mortality after surgery for acute type-A aortic dissection. Factors that create this increased risk are unknown. Aim of this study is to report long-term mortality rates after surgery for acute type A aortic dissection (ATAAD) in patients who had previous cardiac surgery (PCS).

Methods: We retrospectively screened a single-center aortic dissection database. The inclusion criteria were (1) ATAAD (Stanford) between 01/2000 and 12/2019, (2) surgery for ATAAD, and (3) previous conventional cardiac surgery with median sternotomy and central cannulation before the onset of the ATAAD.

Result: After the screening of the database, 79 patients received cardiac surgery with median sternotomy before they received surgery for ATAAD (PCS group). This cohort of patients is older (mean age PCS group: 68 ± 12 versus no PCS group: 62 ± 14 years, p < 0.001), the incidence of cardiac risk factors were sig. more common and they had less cardio/ pulmonary reserve (CAD 45 [57%] vs. 226 (17%); LVEF 53 ± 10 vs. 56 ± 10, p < 0.001 for both). Total operation time (566 ± 330 vs. 432± 158 minutes, p < 0.001) and time on cardiopulmonary bypass (291 ± 154 vs. 230 ± 89 minutes, p < 0.001) were significantly longer in patients with PCS, which was associated with longer preparation times. There was no significant difference in cross-clamp time (112 ± 50 vs. 106 ± 38 minutes, p = 0.16) between the two groups. Significantly more fresh frozen plasma (18 ± 20 vs. 13 ± 10 units, p < 0.001) and red blood cell (8 ± 8 vs. 6 ± 5 units, p < 0.001) units were given in the PCS group. The postoperative parameters “need for open chest therapy” (16 [23%] vs. 120 [9%], p < 0.001), intensive unit stay (15 ± 20 vs. 12 ± 15 days, p < 0.001) and ventilation time (13 ± 20 vs. 9 ± 12 days, p < 0.001) were significantly higher in the PCS group. Thirty-day (19 vs. 26%) and 1-year (25 vs. 35%) mortality were significantly higher in the PCS group. The increased risk for death during a 1-year follow-up period is described with an HR of 2.099 ([1.603, 2.749], p < 0.001).

Conclusion: One-year mortality of this small subgroup of previously operated patients is significantly higher than in patients without PCS. Patients with PCS are older, show more comorbidities with less cardio/pulmonary reserve. The re-do setting is associated with significantly higher requirements of blood products.

Publikationsverlauf

Artikel online veröffentlicht:
19. Februar 2021