Thorac Cardiovasc Surg 2019; 67(S 01): S1-S100
DOI: 10.1055/s-0039-1678942
Oral Presentations
Tuesday, February 19, 2019
DGTHG: Aortenerkrankungen (Typ A Dissektion)
Georg Thieme Verlag KG Stuttgart · New York

Short- and Long-Term Outcomes after Iatrogenic Type A Aortic Dissection

L. Brendel
1   Johannes Gutenberg Universität Mainz, Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Mainz, Germany
,
D.S. Dohle
1   Johannes Gutenberg Universität Mainz, Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Mainz, Germany
,
H. El Beyrouti
1   Johannes Gutenberg Universität Mainz, Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Mainz, Germany
,
P. Pfeiffer
1   Johannes Gutenberg Universität Mainz, Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Mainz, Germany
,
M. El Mehsen
1   Johannes Gutenberg Universität Mainz, Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Mainz, Germany
,
C.-F. Vahl
1   Johannes Gutenberg Universität Mainz, Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Mainz, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
28 January 2019 (online)

 
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    Objectives: Iatrogenic Type A aortic dissection (IAD) is a rare but serious complication during interventional or operative cardiac procedures with an incidence up to 0.2%. We demonstrate short- and long-term results of surgically treated patients with iatrogenic acute Type A aortic dissection.

    Methods: Out of 587 patients operated for acute Type A aortic dissection between January 2004 and June 2017, 28 (4.8%) patients suffered from iatrogenic aortic dissection (IAD). Previous operative or interventional procedures were percutaneous coronary intervention (PCI, n = 14), transcatheter aortic valve replacement (TAVR, n = 2), thoracic endovascular aortic repair (TEVAR, n = 2), and cardiac surgery (n = 10). IAD patients were identified retrospectively and compared with patients operated for spontaneous acute Type A aortic dissection (n = 559).

    Results: Mean age was significantly higher in the IAD group compared with the control group (71 ± 11 vs. 64 ± 14 years, p < 0.001). Incidence of diabetes (p = 0.04), hypertension (p = 0.015) and coronary artery disease (p < 0.001) were significantly higher in the IAD group. Preoperative resuscitation (CPR) rate was significantly higher in IAD group compared to the control group (21 vs. 6%, p < 0.001). CPB time was longer in the IAD group (194 ± 122 vs. 166 ± 81 minutes, p = 0.075) and more concomitant CABG procedures were performed (p < 0.001). Rethoracotomy rate was higher in the IAD group (p = 0.021) and ICU stay (p = 0.042) and ventilation times (p = 0.029) were significantly longer. In-hospital mortality rate was higher in the IAD group (17.9 vs. 10.7%, p = 0.242).

    Ten-year survival rates in the IAD group were lower compared with the control group (42.5 vs. 57%, p = 0.068).

    Conclusion: IAD is a dangerous complication during cardiac interventional or operative procedures and more frequent in older patients with a higher rate of preoperative resuscitation. Nevertheless, surgically managed short- and long-term results of IAD are comparable to spontaneous type A aortic dissection results. Consequent and early surgical therapy for aortic dissection including IAD remain the gold standard.


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    No conflict of interest has been declared by the author(s).

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