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Type A Aortic Dissection Repair in Patients With Prior Cardiac Surgery

Bjurbom, Markus ; Olsson, Christian LU ; Geirsson, Arnar ; Gudbjartsson, Tomas ; Gunn, Jarmo ; Hansson, Emma C. ; Hjortdal, Vibeke ; Jeppsson, Anders ; Mennander, Ari and Ede, Jacob LU orcid , et al. (2023) In Annals of Thoracic Surgery 115(3). p.591-598
Abstract

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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Thoracic Surgery
volume
115
issue
3
pages
591 - 598
publisher
Elsevier
external identifiers
  • scopus:85134746664
  • pmid:35688205
ISSN
0003-4975
DOI
10.1016/j.athoracsur.2022.05.033
language
English
LU publication?
yes
id
d26c5c96-15bd-4996-bb6a-caa442753dbd
date added to LUP
2022-09-30 14:35:13
date last changed
2024-04-28 14:52:23
@article{d26c5c96-15bd-4996-bb6a-caa442753dbd,
  abstract     = {{<p>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.</p>}},
  author       = {{Bjurbom, Markus and Olsson, Christian and Geirsson, Arnar and Gudbjartsson, Tomas and Gunn, Jarmo and Hansson, Emma C. and Hjortdal, Vibeke and Jeppsson, Anders and Mennander, Ari and Ede, Jacob and Zindovic, Igor and Ahlsson, Anders and Wickbom, Anders and Dalén, Magnus}},
  issn         = {{0003-4975}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{591--598}},
  publisher    = {{Elsevier}},
  series       = {{Annals of Thoracic Surgery}},
  title        = {{Type A Aortic Dissection Repair in Patients With Prior Cardiac Surgery}},
  url          = {{http://dx.doi.org/10.1016/j.athoracsur.2022.05.033}},
  doi          = {{10.1016/j.athoracsur.2022.05.033}},
  volume       = {{115}},
  year         = {{2023}},
}