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Acute Stanford type A Aortic Dissections - The Experience of an Ultra-Peripheral Center
Session:
Sessão de Posters 15 - Patologias diversas em Cardiologia
Speaker:
Inês Coutinho Dos Santos
Congress:
CPC 2024
Topic:
P. Other
Theme:
37. Miscellanea
Subtheme:
22.4 Aortic Disease - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Inês Coutinho Dos Santos; Fabiana Duarte; Maria Inês Barradas; André Monteiro; Luís Oliveira; Emília Santos; Santos Serena; António Fontes; Carina Machado; Nuno Pelicano; Anabela Tavares; Dinis Martins
Abstract
<p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Introduction</strong>: Acute aortic dissections (AAD) are catastrophic life-threatening events that require emergent surgical care. We aim to describe the experience of an ultra-peripheral center without cardiac surgery in managing patients with AAD.</span></span></span></p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Methods</strong>: In this retrospective single-center study, we characterize all consecutive patients admitted to our hospital from 2007 to 2023 with diagnosis of Stanford type A AAD. </span></span></span></p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Results</strong>: A total of 20 patients were included (mean age 58,4±14,1years, 65% male), the majority presenting with DeBakey type I aortic dissection (95%). 75% of patients had overweight/obesity, 60% hypertension, 55% dyslipidemia, 20% known aortopathy (2 Marfan syndrome and 2 aortic aneurysm), and 5% family history of aortic dissection. At presentation, the most frequent signs and symptoms were chest pain (65%), abdominal pain (30%), hypertension (50%) and pericardial effusion (50%). 35% were hemodynamically unstable, with 15% presenting in cardiac arrest and 10% in shock. 25% had at least moderate to severe aortic regurgitation, there was 1 case of cardiac tamponade and 1 of acute myocardial infarction. All patients had chest CT for diagnosis and assessment of AAD’s extension: the origin was in the aortic root (85%) or ascending aorta (15%), and it propagated to the aortic arch (25%), descending aorta (15%), abdominal aorta (10%) or iliac arteries or beyond (50%). Involvement of the aortic valve was found in 25%. The dissection reached all supra-aortic trunks in 65% and the renal arteries in 50%. 85% of patients were transferred to central hospitals with cardiac surgery. Average time admission-diagnosis was 12,7±8,1h, admission-transfer 24,0±9,6h and diagnosis-surgery 24,9±26,7h. Cardiac surgery was conducted in 75% and the most frequent procedures were ascending aorta replacement (60%) and Bentall procedure (33%). Of these, 27% needed partial arch replacement and 13% coronary revascularization. Mean hospitalization duration was 14,9±15,4 days. Postoperatively, there was 1 case of significant bleeding requiring surgical exploration. In-hospital mortality was 40% (3 deaths before transfer (15%), 2 before surgery, 1 intraoperatively and 2 postoperatively) and AAD was the cause of death in 87%. Post-surgical complications requiring additional intervention occurred in 33% (mediastinitis in 13%, aortic disease progression in 20%) at 4,0±5,7meses. There were no cases of post-discharge 30-day mortality. </span></span></span><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">At a mean follow-up of 66,1±59,7 months, all-cause mortality occurred in 2 patients, there were no cases of cardiovascular mortality and 50% of patients were still alive.</span></span></span></p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Conclusion</strong>: Management of AAD at ultra-peripheral centers is a challenge. Its success depends on multidisciplinary teamwork to timely diagnose, refer and transfer these patients. Despite geographical limitations, our study suggests that cardiovascular mortality may be similar to other realities.</span></span></span></p>
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