Outcome after Surgery for Iatrogenic Acute Type A Aortic Dissection
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Published:2022-11-14
Issue:22
Volume:11
Page:6729
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ISSN:2077-0383
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Container-title:Journal of Clinical Medicine
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language:en
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Short-container-title:JCM
Author:
Biancari FaustoORCID, Pettinari MatteoORCID, Mariscalco Giovanni, Mustonen Caius, Nappi FrancescoORCID, Buech JoschaORCID, Hagl Christian, Fiore AntonioORCID, Touma Joseph, Dell’Aquila Angelo M., Wisniewski KonradORCID, Rukosujew AndreasORCID, Perrotti AndreaORCID, Hervé Amélie, Demal TillORCID, Conradi LenardORCID, Pol Marek, Kacer Petr, Onorati FrancescoORCID, Rossetti CeciliaORCID, Vendramin Igor, Piani DanielaORCID, Rinaldi Mauro, Ferrante LuisaORCID, Quintana Eduard, Pruna-Guillen RobertORCID, Rodriguez Lega JavierORCID, Pinto Angel G., Mäkikallio Timo, Acharya Metesh, El-Dean ZeinORCID, Field Mark, Harky AmerORCID, Gerelli Sebastien, Di Perna DarioORCID, Jormalainen Mikko, Gatti GiuseppeORCID, Mazzaro Enzo, Juvonen Tatu, Peterss SvenORCID
Abstract
(1) Background: Acute Stanford type A aortic dissection (TAAD) may complicate the outcome of cardiovascular procedures. Data on the outcome after surgery for iatrogenic acute TAAD is scarce. (2) Methods: The European Registry of Type A Aortic Dissection (ERTAAD) is a multicenter, retrospective study including patients who underwent surgery for acute TAAD at 18 hospitals from eight European countries. The primary outcomes were in-hospital mortality and 5-year mortality. Twenty-seven secondary outcomes were evaluated. (3) Results: Out of 3902 consecutive patients who underwent surgery for acute TAAD, 103 (2.6%) had iatrogenic TAAD. Cardiac surgery (37.8%) and percutaneous coronary intervention (36.9%) were the most frequent causes leading to iatrogenic TAAD, followed by diagnostic coronary angiography (13.6%), transcatheter aortic valve replacement (10.7%) and peripheral endovascular procedure (1.0%). In hospital mortality was 20.5% after cardiac surgery, 31.6% after percutaneous coronary intervention, 42.9% after diagnostic coronary angiography, 45.5% after transcatheter aortic valve replacement and nihil after peripheral endovascular procedure (p = 0.092), with similar 5-year mortality between different subgroups of iatrogenic TAAD (p = 0.710). Among 102 propensity score matched pairs, in-hospital mortality was significantly higher among patients with iatrogenic TAAD (30.4% vs. 15.7%, p = 0.013) compared to those with spontaneous TAAD. This finding was likely related to higher risk of postoperative heart failure (35.3% vs. 10.8%, p < 0.0001) among iatrogenic TAAD patients. Five-year mortality was comparable between patients with iatrogenic and spontaneous TAAD (46.2% vs. 39.4%, p = 0.163). (4) Conclusions: Iatrogenic origin of acute TAAD is quite uncommon but carries a significantly increased risk of in-hospital mortality compared to spontaneous TAAD.
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