An Examination of Long-Term Outcomes in Patients Who Follow Up After Emergent Repair of Type A Dissections with Post-Operative CT Angiogram.

M. Grasty¹, J. J. Kelly², N. Agrawal³, W. Lutfi⁴, M. Berezowski², S. Mosbahi⁵, Y. Zhao², J. Bavaria⁶, W. Szeto², N. D. Desai^2
1Hospital of the University of Pennsylvania, Phialdelphia, Pennsylvania ²University of Pennsylvania, Philadelphia, Pennsylvania ³UPHS, Phiadelphia, Pennsylvania ⁴upenn, philadelphia, Pennsylvania ⁵University of Pennsylvania Health System, Philadelphia, Pennsylvania ⁶Hospital of the University of Pennsylvania, Dept. of Cardiovascular S, Philadelphia, Pennsylvania

Purpose: Acute type A aortic dissections (ATAAD) typically require emergent surgery. Black patients with ATAAD historically have higher mortality. In patients who survive, quality follow-up with imaging is imperative and improves long-term survival. We examined the quality of long-term follow-up in ATAAD patients and evaluated the role of race.

Methods: From January 1 2011 to December 31 2022, 828 patients underwent repair for ATAAD at a single institution. Patients with chronic (N=81) or subacute (N=16) dissection and those who did not identify as black or white were excluded; the total study sampling was 541 patients (Black N=169 , White N=372). The primary outcome was follow-up, defined as the presence of a CT Angiography (CTA) at any time in the post operative period. Survival, reintervention, re-admission rate and perioperative complications were the secondary outcomes. Lastly, Kaplan-Meier estimates were determined to evaluate long-term survival.

Results: In this cohort black patients were younger (56.1 vs 64.45, p< 0.001) and were more likely to have hypertension (95.9% [162/169] vs 85.5% [318/372], p=0.001). 30-day mortality and readmission rates were similar amongst the two groups. Within the first post-operative year less than half of all patients received a CTA (36.7% vs 44.9%, p=0.09), but over the eleven year follow up period this number improved, as 41% of black patients and 45.4% of white patients ultimately underwent CTA. Long-term survival in terms of freedom from death was similar amongst black and white patients in the first five post operative years, but at 8 years – black patients tended to a higher probability for survival, however this finding was not significant.

Conclusion: Long-term follow up with imaging is critical for patients who undergo repair for ATAAD and in this single institution review, we saw no difference in short term outcomes and long-term survival in black and white patients who had a post-operative CTA. This finding is unexpected given recent studies which describe that black patients tend to have higher mortality when compared to other ethnic groups. These findings suggest that at this large tertiary referral center, no disparity exists in the outcomes in black and white patients who follow up with CTA.

Identify the source of the funding for this research project: None