Clinical Outcome of Patients Undergoing Cardiopulmonary Resuscitation Prior to Surgery for Acute Type A Aortic Dissection

M. Montagner; M. Kofler; L. Pitts; A. Falk; S. Buz; C. Starck; S. Kurz; V. Falk; J. Kempfert

doi:10.1055/s-0042-1742827

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2022; 70(S 01): S1-S61
DOI: 10.1055/s-0042-1742827

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Sunday, February 20

Aortic Diseases and Thoracic Tumor Therapies

Clinical Outcome of Patients Undergoing Cardiopulmonary Resuscitation Prior to Surgery for Acute Type A Aortic Dissection

Authors

M. Montagner

¹Duetsches Herzzentrum Berlin, Berlin, Deutschland
M. Kofler

²German Heart Institute Berlin, Berlin, Deutschland
L. Pitts

¹Duetsches Herzzentrum Berlin, Berlin, Deutschland
A. Falk

²German Heart Institute Berlin, Berlin, Deutschland
S. Buz

²German Heart Institute Berlin, Berlin, Deutschland
C. Starck

²German Heart Institute Berlin, Berlin, Deutschland
S. Kurz

³Charité, Augustenburger Platz 1, Berlin, Deutschland
V. Falk

⁴Department of Cardiovascular Surgery, German Heart Institute Berlin, Berlin, Deutschland
J. Kempfert

²German Heart Institute Berlin, Berlin, Deutschland

Abstract

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Background: Acute type A aortic dissection (ATAAD) is a severe condition that requires urgent surgical treatment. Preoperative cardiopulmonary reanimation (CPR) was related to increased mortality in this subgroup of patients. The present analysis aims to describe outcomes in patients presenting with ATAAD and preoperative CPR from a single-center experience.

Method: Between 1998 and 2021, a total of 90 patients where admitted with ATAAD and underwent preoperative CPR. Clinical data were collected and analyzed retrospectively. Endpoints of the study were 30-day mortality and the diagnosis of postoperative neurologic deficit (clinic and/or imaging based).

Results: In 13 (14.4%) cases, the patients died before surgery and in 3 (3.3%) cases, cardiopulmonary bypass was established, but surgery could not be completed due to metabolic collapse or aortic rupture. In the successfully operated patient group (n = 74), mean age was 63 years (SD: 12) and 31 (42%) patients were female. Of the CPR events, 64 (86.5%) occurred in-hospital and 38 (59.4%) at our institution. The PENN classification showed circulatory collapse (Ac class) in 30 (40.5%) patients, with associated local ischemia (ABC class) in 42 (56.8%) cases. Operative time was 487 minutes (SD: 187 minutes). Operative temperature was 22°C (SD: 7°C) and an open distal anastomosis was performed in 58 (78.4%) patients under antegrade (39.7%) or retrograde (60.3%) selective cerebral perfusion. Primary mechanical circulatory support was needed in 38 (51.4%) patients. Total length of ICU stay was 14 days (SD: 15 days). A postoperative neurologic deficit was present in 29 (34%) patients, with a CT-based diagnosis of stroke, cerebral bleeding, or edema in 19 (26%) cases. The 30-day mortality was 50%.

Conclusion: Preoperative CPR in patients presenting ATAAD correlates with extremely high mortality and morbidity rates. The choice whether to operate or not should be taken on individual basis, considering the high-risk constellation.