Outcomes After Acute Type A Aortic Dissection in Patients With Prior Cardiac Surgery

Krebs, Elizabeth D.; Mehaffey, J. Hunter; Hawkins, Robert B.; Beller, Jared P.; Fonner, Clifford E.; Kiser, Andy C.; Quader, Mohammed; Kern, John A.; Yarboro, Leora T.; Teman, Nicholas R.; Ailawadi, Gorav

doi:10.1016/j.athoracsur.2019.02.065

Cited by 12 publications

(14 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…44 In contrast, in a more recent, much larger study using the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database from 2002 to 2017, ATAAD repair in patients with previous cardiac surgery was associated with a greater than 2-fold higher risk of mortality compared with patients without previous cardiac surgery (odds ratio, 2.1; P < .01). 45 There was a trend toward decreased operative mortality for patients with previous cardiac surgery who underwent ATAAD repair at high-volume centers (25.7% vs 37.9%; P ¼ .19). In summary, the currently available evidence suggests that patients with ATAAD and a history of previous cardiac surgery require careful deliberation, adequate preoperative planning, and potential consideration for transfer to highvolume centers.…”

Section: Previous Cardiac Surgerymentioning

confidence: 86%

When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A Review

Sabe

Percy

Kaneko

et al. 2021

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

Background Acute type A aortic dissection (ATAAD) is a surgical emergency with an operative mortality of up to 30%, a rate which has not changed meaningfully in over two decades. A growing body of research has highlighted several comorbidities and presenting factors in which delay or permanent deferral of surgery may be considered; however, modern comprehensive summative reviews are lacking. The urgency and timing of this review are underscored by significant challenges in resource utilization posed by the COVID-19 pandemic. This review provides an update on the current understanding of risk assessment, surgical candidacy, and operative timing in patients with ATAAD. Methods A literature search was conducted through PubMed and Embase databases to identify relevant studies relating to risk assessment in ATAAD. Articles were selected via group consensus based on quality and relevance. Results Several patient factors have been identified which increase risk in ATAAD repair. In particular, frailty, advanced age, prior cardiac surgery, and use of novel anticoagulant medications have been studied. The understanding of malperfusion syndromes has also expanded significantly, including recommendations for surgical delay. Finally, approaches to triage have been significantly influenced by resource limitations related to the ongoing COVID-19 pandemic. While medical management remains a reasonable option in carefully selected patients at prohibitive risk for open surgery, endovascular therapies for treatment of ATAAD are rapidly evolving. Conclusions Early surgical repair remains the preferred treatment for most patients with ATAAD, however, improvements in risk stratification should guide appropriate delay or permanent deferral of surgery in select individuals.

show abstract

Section: Previous Cardiac Surgerymentioning

confidence: 86%

When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A Review

Sabe

Percy

Kaneko

et al. 2021

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…The increased risk is likely explained by the higher rate of redo and urgent procedures compared to first time and elective operations in 2019. Redo procedures are normally associated with worse outcomes 12 however the gap appears to be closing, particularly in higher volume centres 13 .…”

Section: Discussionmentioning

confidence: 99%

Dissecting the Management and Outcomes of Thoracic Aortovascular Disease During the COVID-19 Pandemic

McPherson

Chilvers

Freystaetter

et al. 2021

Annals of Vascular Surgery

View full text Add to dashboard Cite

Objective The COVID-19 pandemic has forced the cancellation of planned surgery and led to significant surgical service reductions. Early intervention in aortovascular disease is often critical and cannot be deferred despite these reductions. There is urgent need to evaluate the provision and outcomes of thoracic aortovascular intervention during the peak of the pandemic. Methods Prospective data was collected for patients receiving open and endovascular thoracic aortovascular intervention over two-time points; January-May 2020 and January-May 2019 at three tertiary cardiovascular centres. Baseline demographics, cardiovascular risk and COVID-19 screening results were noted. Primary outcomes were median length of intensive care unit and hospital stay, intra-operative mortality, 30-day mortality, post-operative stroke, and spinal cord injury. Results Patients operated in 2020 (41) had significantly higher median EuroSCORE II than 2019 (53) (7.44 vs. 5.86, P = 0.032) and rates of previous cardiac (19.5% vs. 3.8%, P = 0.019), aortic (14.6% vs. 1.9%, P = 0.041), and endovascular (22.0% vs. 3.8%, P = 0.009) intervention. There was an increase in proportion of urgent cases in 2020 (31.7% vs. 18.9%). There were no intra-operative deaths in 2020 and 1 in 2019 ( P = 1.00). There were no significant differences ( P ≥ 0.05) in 30-day mortality (4.9% vs. 13.2%), median intensive care unit length of stay (72 vs. 70 hr), median hospital length of stay (8 vs. 9 days), post-operative stroke (3 vs. 6), or spinal cord injury (2 vs. 1) between 2020 and 2019 respectively. Conclusions Despite the increased mortality risk of patients and urgency of cases during COVID-19, complicated by the introduction of cohorting and screening regimens, thoracic aortovascular intervention remained safe with comparable in outcomes to pre-COVID-19.

show abstract

“…1 While the authors recently demonstrated that prior cardiac surgery was not a risk factor for mortality in non-MPS patients, larger multi-institutional experience has demonstrated the contrary. 2,3 In this issue of The Annals of Thoracic Surgery, Norton and colleagues 4 investigated these relationships between prior cardiac surgery and MPS (managed with endovascular fenestration). They demonstrate that although patients with both MPS and prior cardiac surgery had extremely poor results (inhospital mortality of 40%), the former was the major determinant of outcomes.…”

Section: Invited Commentarymentioning

confidence: 99%

“…1,2 In ATAAD 9% to 16% of patients have had previous cardiac surgery (PCS), which is associated with an increased operative mortality (12-37%). [3][4][5][6][7] Open aortic repair is often more complex and challenging in patients with PCS because of the added risks of sternal reentry and presence of adhesions. ATAAD complicated by malperfusion syndrome (MPS), which is end tissue/organ necrosis and dysfunction due to end-organ malperfusion, is also traditionally treated with emergent open aortic repair and associated with an increased operative mortality (25%-44%).…”

mentioning

confidence: 99%

Managing Malperfusion Syndrome in Acute Type A Aortic Dissection With Previous Cardiac Surgery

Norton

Farhat

et al. 2021

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

Outcomes After Acute Type A Aortic Dissection in Patients With Prior Cardiac Surgery

Cited by 12 publications

References 22 publications

When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A Review

When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A Review

Dissecting the Management and Outcomes of Thoracic Aortovascular Disease During the COVID-19 Pandemic

Managing Malperfusion Syndrome in Acute Type A Aortic Dissection With Previous Cardiac Surgery

Contact Info

Product

Resources

About