Outcome after Surgery for Iatrogenic Acute Type A Aortic Dissection.

Autor: Biancari F; Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland.; Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland., Pettinari M; Department of Cardiac Surgery, Ziekenhuis Oost Limburg, 3600 Genk, Belgium., Mariscalco G; Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK., Mustonen C; Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland., Nappi F; Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, 93200 Paris, France., Buech J; Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany.; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, 80539 Munich, Germany., Hagl C; Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany., Fiore A; Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France., Touma J; Department of Vascular Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France., Dell'Aquila AM; Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany., Wisniewski K; Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany., Rukosujew A; Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany., Perrotti A; Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, France., Hervé A; Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, France., Demal T; Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany., Conradi L; Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany., Pol M; Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic., Kacer P; Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic., Onorati F; Division of Cardiac Surgery, Medical School, University of Verona, 37124 Verona, Italy., Rossetti C; Division of Cardiac Surgery, Medical School, University of Verona, 37124 Verona, Italy., Vendramin I; Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy., Piani D; Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy., Rinaldi M; Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy., Ferrante L; Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy., Quintana E; Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain., Pruna-Guillen R; Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain., Rodriguez Lega J; Cardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, Spain., Pinto AG; Cardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, Spain., Mäkikallio T; Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland., Acharya M; Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK., El-Dean Z; Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK., Field M; Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK., Harky A; Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK., Gerelli S; Centre Hospitalier Annecy Genevois, 74370 Annecy, France., Di Perna D; Centre Hospitalier Annecy Genevois, 74370 Annecy, France., Jormalainen M; Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland., Gatti G; Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy., Mazzaro E; Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy., Juvonen T; Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland.; Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, 90570 Oulu, Finland., Peterss S; Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2022 Nov 14; Vol. 11 (22). Date of Electronic Publication: 2022 Nov 14.
DOI: 10.3390/jcm11226729
Abstrakt: (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.
Databáze: MEDLINE
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