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Outcomes of Patients Presenting With Acute Type A Aortic Dissection in the Setting of Prior Cardiac Surgery: An Analysis From the International Registry of Acute Aortic Dissection
Study Questions:
What is the impact of prior cardiac surgery (PCS) on the presentation and outcomes of patients with type A acute aortic dissection (TAAD)?
Methods:
This was a retrospective cohort analysis of the International Registry of Acute Aortic Dissection (IRAD). Of 2,196 patients with TAAD enrolled in IRAD, 352 had PCS. Those with no prior history of PCS were compared with those who had PCS. In-hospital mortality was the primary outcome.
Results:
Compared to patients without PCS, those with PCS were more likely to be older and male, have select comorbidities (hypertension, atherosclerosis, and diabetes mellitus), and have greater time from symptom onset to diagnosis and initial hospital presentation (all p < 0.05). In-hospital mortality was significantly higher for PCS patients (34% vs. 23%; p < 0.001). Patients without a history of PCS were more likely to be managed surgically than those with PCS (87% vs. 76%; p < 0.001). Propensity-matched analysis to correct for the difference in underlying comorbidities between medical and operative therapy groups demonstrated a significant increase in mortality with medical management, but not with PCS.
Conclusions:
The authors concluded that patients with PCS and TAAD, when compared to those without PCS in IRAD, have delayed time from symptom onset to initial hospital presentation and greater in-hospital mortality.
Perspective:
The limitations of this analysis aside, the current study demonstrates the adverse impact of PCS on outcomes in patients with TAAD. The findings from the authors’ propensity-matched analysis are particularly revealing, and would suggest that the significant increase in mortality in this patient population with PCS may be driven by decreased operative intervention for TAAD (i.e., medical therapy alone). This has implications, as the authors suggest, for the recommendation to proceed with operative therapy in appropriately selected patients, regardless of whether the patient has had prior cardiac surgery.
Keywords: Hospital Mortality, Aortic Aneurysm, Thoracic, Atherosclerosis, Cardiology, Sarcoma 180, Thoracic Surgery, Cardiac Surgical Procedures, Hypertension, Diabetes Mellitus
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