Outcome after type A aortic dissection repair in patients with preoperative cardiac arrest

Pan, Emily; Wallinder, Andreas; Peterström, Eric; Geirsson, Arnar; Olsson, Christian; Ahlsson, Anders; Fuglsang, Simon; Gunn, Jarmo; Hansson, Emma C.; Hjortdal, Vibeke E.; Mennander, Ari; Nozohoor, Shahab; Wickbom, Anders; Zindovic, Igor; Guðbjartsson, Tómas; Jeppsson, Anders

doi:10.1016/j.resuscitation.2019.08.039

Cited by 26 publications

(18 citation statements)

References 14 publications

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“…Reports from a retrospective analysis of 1159 patients from the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database showed that 44 patients (3.8%) needed preoperative CPR. 14,15 Although 30-day mortality rate was 43.2%, a survival rate of 50% at 3.3 years of follow-up was reported, which is similar to our findings with 40.9% survival rate at a mean follow-up of 46 months (median 35, 7-149).…”

Section: Follow-upsupporting

confidence: 90%

Outcomes of patients operated for acute type A aortic dissection requiring preoperative cardiopulmonary resuscitation

et al. 2020

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Background and Aim Acute type A aortic dissection (AAAD) is a life‐threatening condition. The emergency operation usually results in 20% perioperative mortality. If preoperative cardiopulmonary resuscitation (CPR) is necessary, there is an increase in the rate of mortality. The aim of the present study was to report the outcomes of AAAD surgery in patients requiring preoperative CPR in a high‐volume center. Methods A retrospective analysis of preoperative, intraoperative, postoperative, and follow‐up data in patients requiring preoperative CPR in the setting of AAAD surgery was performed. Results Between January 2006 and December 2018, 637 patients underwent emergency surgery for AAAD. In total, 26 (4%) patients received CPR; the mean age was 63 ± 13 years; and 18 were male (69%). The reason for CPR was acute tamponade (N = 14, 54%), pulseless electrical activity (N = 5, 19%), asystole or ventricular fibrillation (N = 7, 27%), and four (15%) patients were not operated due to prolonged CPR and severe initial neurological impairment. There was no intraoperative mortality. The in‐hospital mortality rate was 50% (N = 11), due to severe cerebral damage confirmed by computed tomography, and six patients (55%) were older than 70 years. The median follow‐up was 35 months (7‐149), which was 100% complete; two patients had permanent hemiplegia, one had anterior spinal syndrome, and other two died during the follow‐up. The overall survival rate was 41% (n = 9). Conclusion Surgery outcomes were still reasonable in AAAD patients requiring preoperative CPR in a high‐volume center.

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Section: Follow-upsupporting

confidence: 90%

Outcomes of patients operated for acute type A aortic dissection requiring preoperative cardiopulmonary resuscitation

et al. 2020

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“…These risks may be more significant for patients with ATAAD due to the occurrence of cardiac tamponade, frank aortic rupture, and severe end-organ malperfusion. Approximately 3.8–6.3% of ATAAD patients presented with a critical hemodynamic status and required CPR to maintain systemic circulation until surgery [ 1 – 3 ]. During this study, 22 patients who underwent ATAAD repair surgeries and preoperative CPR were analyzed.…”

Section: Discussionmentioning

confidence: 99%

“…ATAAD is also a challenge for cardiothoracic surgeons because of the complex anatomy of the aorta and possibility of preoperative complications, including hemodynamic collapse requiring cardiopulmonary resuscitation (CPR). Previous studies reported that the incidence of preoperative CPR ranges from 3.8% to 6.3% [ 1 – 3 ]. Among these patients, the in-hospital mortality rates ranged from 50% to 95% [ 1 , 4 , 5 ], which was approximately five-times to six-times higher than that of the general ATAAD population [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies reported that the incidence of preoperative CPR ranges from 3.8% to 6.3% [ 1 – 3 ]. Among these patients, the in-hospital mortality rates ranged from 50% to 95% [ 1 , 4 , 5 ], which was approximately five-times to six-times higher than that of the general ATAAD population [ 6 , 7 ]. However, even though they comprise an extremely high-risk subgroup, the clinical characteristics and surgical results of patients with ATAAD undergoing preoperative CPR may be under-reported.…”

Section: Introductionmentioning

confidence: 99%

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Surgical results in acute type A aortic dissection with preoperative cardiopulmonary resuscitation: Survival and neurological outcome

Lin

Tseng

et al. 2020

PLoS ONE

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Background Acute type A aortic dissection (ATAAD) is a life-threatening disease that requires emergent surgical intervention. This retrospective study aimed to clarify the individual characteristics, short-term and mid-term outcomes, and prognostic factors of patients who underwent surgical repair of ATAAD with preoperative cardiopulmonary resuscitation (CPR). Methods Between January 2007 and January 2020, 656 consecutive patients underwent ATAAD repair at our institution; 22 (3.4%) of these patients underwent CPR prior to surgery. Patients who underwent preoperative CPR were classified as the survivor group (n = 9) and non-survivor group (n = 13), according to whether they survived to hospital discharge. Clinical features, surgical information, and postoperative complications were analyzed and compared. Three-year cumulative survival rates and cerebral performance categories (CPC) scores are presented. Results In patients undergoing CPR prior to ATAAD surgery, the in-hospital mortality rate was 59.1%. A total of 72.7% of patients underwent concomitant surgical resuscitation procedures during CPR such as emergent subxiphoid pericardiotomy and/or emergent cardiopulmonary bypass. The survivor group had a higher rate of return of spontaneous heartbeat (ROSB) compared to the non-survivor group (100% versus 53.8%; P = 0.017). The 3-year cumulative survival rates were 35.1% (95% confidence interval [CI], 27.6%–42.6%) and 85.7% (95% CI, 81.9%–88.8%) for overall patients and for survivors, respectively. As for the neurological outcome, 77.8% (7/9) of patients had full cerebral performance (CPC-1) at the 3-month follow-up examination after discharge. Conclusions Patients with ATAAD undergoing preoperative CPR, especially those without ROSB after CPR, are at high risk for in-hospital mortality. However, the short-term and mid-term outcomes, including the cerebral performance after discharge and 3-year survival rate, are promising for patients who survived to discharge.

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“…In the previous literature, ATAAD with preoperative complications was associated with disastrous outcomes [1][2][3][4] . However, the characteristics and surgical results of uncomplicated ATAAD remain to be clarified.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

Lin

See

Tseng

et al. 2020

Sci Rep

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This retrospective study aimed to clarify the short-term and mid-term outcomes of and prognostic factors for patients who underwent surgical repair for uncomplicated acute type A aortic dissection (ATAAD). Between January 2007 and June 2019, 603 consecutive patients underwent ATAAD repair at our institution. According to patients’ preoperative presentations and imaging studies, uncomplicated ATAAD was found in 276 (45.8%) patients by excluding preoperative complicated factors. Patients with uncomplicated ATAAD were classified into the survivor (n = 243) and non-survivor (n = 33) groups. Clinical features, surgical information, and postoperative complications were compared. Three-year survival and freedom from reoperation rates for survivors were analyzed using the Kaplan–Meier actuarial method. The in-hospital surgical mortality rate of uncomplicated ATAAD patients was 11.9%. The non-survivor group had a higher rate of postoperative malperfusion-related complications, and a multivariate analysis revealed that repeat surgery, retrograde cerebral perfusion, and intraoperative extracorporeal membrane oxygenation support were predictors of in-hospital mortality. In the survivor group, 3-year cumulative survival and freedom from aortic reoperation rates were 89.6% (95% confidence interval [CI] 84.8–92.9%) and 83.1% (95% CI 76.8–87.7%), respectively. In conclusion, uncomplicated and complicated ATAAD rates were similar; the short-term and mid-term surgical outcomes in patients with uncomplicated ATAAD were generally acceptable.

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Outcome after type A aortic dissection repair in patients with preoperative cardiac arrest

Cited by 26 publications

References 14 publications

Outcomes of patients operated for acute type A aortic dissection requiring preoperative cardiopulmonary resuscitation

Outcomes of patients operated for acute type A aortic dissection requiring preoperative cardiopulmonary resuscitation

Surgical results in acute type A aortic dissection with preoperative cardiopulmonary resuscitation: Survival and neurological outcome

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

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