Outcome after type A aortic dissection repair in patients with preoperative cardiac arrest
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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; Mennander, Ari; Nozohoor, Shahab; Wickbom, Anders; Zindovic, Igor; Gudbjartsson, Tomas; Jeppsson, Anders.
I: Resuscitation, Bind 144, 11.2019, s. 1-5.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Outcome after type A aortic dissection repair in patients with preoperative cardiac arrest
AU - Pan, Emily
AU - Wallinder, Andreas
AU - Peterström, Eric
AU - Geirsson, Arnar
AU - Olsson, Christian
AU - Ahlsson, Anders
AU - Fuglsang, Simon
AU - Gunn, Jarmo
AU - Hansson, Emma C
AU - Hjortdal, Vibeke
AU - Mennander, Ari
AU - Nozohoor, Shahab
AU - Wickbom, Anders
AU - Zindovic, Igor
AU - Gudbjartsson, Tomas
AU - Jeppsson, Anders
N1 - Copyright © 2019 Elsevier B.V. All rights reserved.
PY - 2019/11
Y1 - 2019/11
N2 - AIM OF THE STUDY: Patients presenting with acute type A aortic dissection (ATAAD) and cardiac arrest before surgery are considered to have very poor prognosis, but limited data is available. We used a large database to evaluate the outcome of ATAAD patients with a cardiac arrest before surgery.METHODS: We evaluated 1154 surgically treated ATAAD patients from the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database between 2005 and 2014. Patients with (n = 44, 3.8%) and without preoperative cardiac arrest were compared and variables univariably associated with mortality in the cardiac arrest group were identified. Median follow-up time was 2.7 years (interquartile range 0.5-5.5).RESULTS: Thirty-day mortality in the arrest and non-arrest group was 43.2% and 16.6%, respectively (odds ratio [OR] 3.83, CI 2.06-7.09; P < 0.001). In the nine patients with ongoing cardiopulmonary resuscitation when cardiopulmonary bypass was initiated, five died intraoperatively and one died after 65 days. In patients surviving the operation, stroke was significantly more common in the arrest group (48.4% vs 18.2%; OR 4.21, CI 2.05-8.67; P < 0.001). In total, 50.0% (22/44) of the arrest patients survived to the end of follow-up. Non-survivors in the arrest group more often had DeBakey type I dissection, cardiac tamponade, cardiac malperfusion and higher preoperative serum lactate (all P < 0.05).CONCLUSIONS: Early mortality and complications after ATAAD surgery in patients with a preoperative cardiac arrest are high, but mid-term outcome after surviving the initial period is acceptable. Preoperative cardiac arrest should not be considered an absolute contraindication for a surgical ATAAD repair.
AB - AIM OF THE STUDY: Patients presenting with acute type A aortic dissection (ATAAD) and cardiac arrest before surgery are considered to have very poor prognosis, but limited data is available. We used a large database to evaluate the outcome of ATAAD patients with a cardiac arrest before surgery.METHODS: We evaluated 1154 surgically treated ATAAD patients from the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database between 2005 and 2014. Patients with (n = 44, 3.8%) and without preoperative cardiac arrest were compared and variables univariably associated with mortality in the cardiac arrest group were identified. Median follow-up time was 2.7 years (interquartile range 0.5-5.5).RESULTS: Thirty-day mortality in the arrest and non-arrest group was 43.2% and 16.6%, respectively (odds ratio [OR] 3.83, CI 2.06-7.09; P < 0.001). In the nine patients with ongoing cardiopulmonary resuscitation when cardiopulmonary bypass was initiated, five died intraoperatively and one died after 65 days. In patients surviving the operation, stroke was significantly more common in the arrest group (48.4% vs 18.2%; OR 4.21, CI 2.05-8.67; P < 0.001). In total, 50.0% (22/44) of the arrest patients survived to the end of follow-up. Non-survivors in the arrest group more often had DeBakey type I dissection, cardiac tamponade, cardiac malperfusion and higher preoperative serum lactate (all P < 0.05).CONCLUSIONS: Early mortality and complications after ATAAD surgery in patients with a preoperative cardiac arrest are high, but mid-term outcome after surviving the initial period is acceptable. Preoperative cardiac arrest should not be considered an absolute contraindication for a surgical ATAAD repair.
U2 - 10.1016/j.resuscitation.2019.08.039
DO - 10.1016/j.resuscitation.2019.08.039
M3 - Journal article
C2 - 31505231
VL - 144
SP - 1
EP - 5
JO - Resuscitation
JF - Resuscitation
SN - 0300-9572
ER -
ID: 244371115