Matteo Montagner, Markus Kofler, Leonard Pitts, Simone Gasser, Lukas Stastny, Stephan D Kurz, Michael Grimm, Volkmar Falk, Jörg Kempfert, Julia Dumfarth

Analysis of Factors Affecting Outcome in Acute Type A Aortic Dissection Complicated by preoperative Cardio-pulmonary Resuscitation

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • General Medicine
  • Surgery

Abstract OBJECTIVES Cardiopulmonary resuscitation (CPR) aggravates the pre-existing dismal prognosis of patients suffering from acute type A aortic dissection (ATAAD). We aimed to identify factors affecting survival and outcome in ATAAD patients requiring CPR at presentation at two European aortic centers. METHODS Data on 112 surgical candidates and undergoing preoperative CPR were retrospectively evaluated. Patients were divided into two groups according to 30-day mortality. A multivariable model identified predictors for 30-day mortality. RESULTS Preoperative death occurred in 23 patients (20.5%). In the remaining 89 surgical patients (79.5%) circulatory arrest time (41 ± 20 min in 30-day non-survivors vs 30 ± 13 min in 30-day survivor, p = 0.003) as well as cardiopulmonary bypass time (320 ± 132 min in 30-day non-survivors vs 252 ± 140 min in 30-day survivor, p = 0.020) time was significantly longer in patients with worse outcome. 30-day mortality of the total cohort was 61.6% (n = 69) with cardiac failure in 48% and aortic rupture or haemorrhagic shock (28%) as predominant reasons of death. Age (OR 1.04, 95% CI 1.01–1.09, p = 0.034), preoperative coronary (OR 3.42, 95% CI 1.34–9.26, p = 0.012) and spinal malperfusion (OR 12.49, 95% CI 1.83–225.02, p = 0.028) emerged as independent predictors for 30-day mortality while CPR due to tamponade was associated with improved early survival (OR 0.29, 95% CI 0.091–0.81, p = 0.023). CONCLUSIONS Assessment of underlying cause for CPR is mandatory. Pericardial tamponade, rapidly resolved with pericardial drainage, is a predictor for improved survival, while age and presence of coronary and spinal malperfusion are associated with dismal outcome in this high-risk patient group.

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