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E-pub ahead of print

Type-A Aortic Dissection Repair in Patients With Prior Cardiac Surgery

Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review

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  • Markus Bjurbom
  • Christian Olsson
  • Arnar Geirsson
  • Tomas Gudbjartsson
  • Jarmo Gunn
  • Emma C Hansson
  • Vibeke Hjortdal
  • Anders Jeppsson
  • Ari Mennander
  • Jacob Ede
  • Igor Zindovic
  • Anders Ahlsson
  • Anders Wickbom
  • Magnus Dalén
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BACKGROUND: Emergency surgery for acute type A aortic dissection in patients with previous cardiac surgery is controversial. This study aimed to evaluate the association between previous cardiac surgery and outcomes after surgery for acute type A aortic dissection, to appreciate whether emergency surgery can be offered with acceptable risks.

METHODS: All patients operated on for acute type A aortic dissection between 2005 and 2014 from the Nordic Consortium for Acute Type A Aortic Dissection database were eligible. Patients with previous cardiac surgery were compared with patients without previous cardiac surgery. Univariable and multivariable statistical analyses were performed to identify predictors of 30-day mortality and early major adverse events (a secondary composite endpoint comprising 30-day mortality, perioperative stroke, postoperative cardiac arrest, or de novo dialysis).

RESULTS: In all, 1159 patients were included, 40 (3.5%) with previous cardiac surgery. Patients with previous cardiac surgery had higher 30-day mortality (30% vs 17.8%, P = .049), worse medium-term survival (51.7% vs 71.2% at 5 years, log rank P = .020), and higher unadjusted prevalence of major adverse events (52.5% vs 35.7%, P = .030). In multivariable analysis, previous cardiac surgery was not associated with 30-day mortality (odds ratio 0.78; 95% CI, 0.30-2.07; P = .624) or major adverse events (odds ratio 1.07; 95% CI, 0.45-2.55, P = .879).

CONCLUSIONS: Major adverse events after surgery for acute type A aortic dissection were more frequent in patients with previous cardiac surgery. Previous cardiac surgery itself was not an independent predictor for adverse events, although the small sample size precludes definite conclusions. Previous cardiac surgery should not deter from emergency surgery.

OriginalsprogEngelsk
TidsskriftThe Annals of thoracic surgery
ISSN0003-4975
DOI
StatusE-pub ahead of print - 7 jun. 2022

Bibliografisk note

Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

ID: 78744099