SPC365

Long-term Outcome of Acute Type A Aortic Dissections: a 20-year single-center casuistic

Session: Prémio Manuel Machado Macedo em Cirurgia Cardíaca
Speaker: António Canotilho

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 26. Cardiovascular Surgery
Subtheme: 26.11 Cardiovascular Surgery - Other
Session Type: Prémios, Registos e Sessões Especiais
FP Number: ---
Authors: António Canotilho; André Soeiro; Carlos Branco; Pedro Correia; Gonçalo F. Coutinho; Pedro E. Antunes; David Prieto
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">INTRODUCTION: Acute type A aortic dissection is a life-threatening disease that develops suddenly and requires emergency surgery. However, a number of problems remain during the postoperative course. One problem is the wide age range of the patients. </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">OBJECTIVES: The aim of this study was to evaluate the 20-year results of emergency operations for acute type A aortic dissection of one single center.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">METHODS: We reviewed 194 patients who underwent surgical aortic repair of an acute type A aortic dissection from January 2000 to December 2020. Two patients were excluded. We analyzed the early and late outcomes, in-hospital death and difficulty of direct discharge to home. </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">RESULTS: We collected 67%(n=129) males on our study. <span style="color:#222222">Mean age of group was 61,3&plusmn;12,4 years, 26 of them older than 75 years. The preoperative data showed 80,7% of patients on NYHA III-IV(n=155), 81,3% with stroke(n=16), 16,1% with peripheral vascular disease(n=31), 14,1% with COPD(n=27), 9,4% on atrial fibrillation(n=18), 33,9%(n=65) with severe aortic regurgitation and a mean of LVEF of 52,4&plusmn;7,6%. Six patients with Marfan Syndrome and 1 patient with Turner Syndrome. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="color:#222222">Two exploratory sternotomy was performed with no need for ascending Aorta replacement. During surgery, central cannulation was performed in 24%(n=46), 4 of them in brachiocephalic trunk, and femoral cannulation in 74%(n=142). Isolated ascending Aorta replacement was performed in 56,8%(n=109), associated with aortic valve replacement in 16,7%(n=32), 8 biological and 24 mechanical prosthesis. We performed 14 <em>Bentall-De Bono</em> procedures(7,3%) and 16 aortic valve repair (8,3%). Combined with Aorto-coronary bypass 21 patients(10,9%). The mean extra-corporal circulation time was 116,5&plusmn;48,4min, aortic cross-clamping time 58,1&plusmn;21,6min </span><span style="color:black">and <span style="background-color:#e2f2fc">Circulatory arrest time 21,4&plusmn;7,1min. The mean cooling temperature during </span>extra-corporal </span><span style="color:#222222">circulation was 24,6&plusmn;2,4 &ordm;C</span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">About postoperative data, inotropic support &gt;12 hours was needed in 30,7%(n=59), V-A ECMO in 2,1%(n=4), ventilation time &gt;12 hours in 21,9%(n=42), atrial fibrillation in 24,5%(n=47), 3<sup>rd</sup> degree AV block with need of permanent pacemaker implantation in 3,6%(n=7), pneumoniae in 8,9%(n=17), acute kidney disease in 36,5% (n=70) and stroke in 8,3%(n=16).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The mean timing to discharge was 16,2&plusmn;12,8 days.</span></span> The 30-day mortality was 7,3%(n=14): 4 of them during surgery and 4 before discharging. In the late follow-up period, the 5-year, 10-year and 15-year survivals rates were 85,2%&plusmn;2,6%, 74&plusmn;3,6% and 63,7&plusmn;4,6%, respectively. The 5-year, 10-year and 15-year survivals rates free of MACCE events were 87,2&plusmn;2,7%, 83,1&plusmn;3,2% and 66,6&plusmn;4,8%, respectively.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">CONCLUSIONS: From the perspective of saving lives, the results of single centre casuistic emergency surgery were very acceptable and showed the way we should adopt even in selected older patients. </span></span></span></p>