Impact of Previous Cardiac Surgery on Outcomes of Acute Type A Aortic Dissection

M. Berezowski¹, J. J. Kelly¹, J. Bavaria², S. Mosbahi³, Y. Zhao¹, W. Patrick¹, W. Szeto¹, N. D. Desai^1
1University of Pennsylvania, Philadelphia, Pennsylvania ²Hospital of the University of Pennsylvania, Dept. of Cardiovascular S, Philadelphia, Pennsylvania ³University of Pennsylvania Health System, Philadelphia, Pennsylvania

Purpose: Patients with previous cardiac surgery (PCS) who subsequently develop an acute Type A aortic dissection have not been well studied. Our objective was to assess the short- and long-term outcomes of surgical repair for acute Type A aortic dissection in patients with and without PCS at a large referral center.

Methods: From January 2002 and June 2022, 1066 consecutive patients were operated on for acute Type A aortic dissection at a single institution. Of those, 83 (7.8%) had PCS. Five PCS patients had their previous cardiac surgery less than one month before dissection onset and were excluded. Data were extracted from a prospectively updated institutional registry and reviewed retrospectively.

Results: Of 78 patients with PCS, 41 (53%) had prior coronary artery bypass grafting (CABG). They were significantly older than non-CABG PCS patients [70 (±12) vs. 60 (±14) years, P< 0.001]. The mean time between cardiac surgery and dissection onset was 7.3 (±7.6) years and ranged from 1 month to 34 years.

Overall, patients with PCS were older, more often male, and they were less likely to present with cardiac tamponade (P=0.006) or moderate to severe aortic regurgitation (P=0.011, Table 1).

Intraoperatively, PCS patients more often required aortic root replacement and had longer cardiopulmonary bypass and cross-clamp times (P < 0.001), while they also more often required re-exploration for bleeding and stayed longer at the ICU. Thirty-day mortality was significantly higher in PCS group (24% vs. 12%, P=0.004).

Of the 41 patients with prior CABG, 30-day mortality was 14 (34%) compared to 5 of 37 (14%) patients with non-CABG PCS (P=0.063). In multivariable logistic regression modeling, prior CABG (OR 4.08, P< 0.001) was identified as an independent 30-day mortality risk factor, while PCS other than CABG (OR 1.62, P=0.370) was not.

Overall ten-year survival was 53.5% (95% CI, 49.7 – 57.6) and was significantly lower in PCS patients (Figure 1, Log-rank P< 0.0001).

Conclusion: In patients undergoing surgery for acute Type A aortic dissection, PCS is associated with increased 30-day mortality and decreased long-term survival compared to those without PCS. Prior CABG was identified as a significant predictor of early mortality, whereas non-CABG PCS was not.

Identify the source of the funding for this research project: There was no funding of this procject.