Journal of Clinical Medicine (Nov 2022)
Outcome after Surgery for Iatrogenic Acute Type A Aortic Dissection
- Fausto Biancari,
- Matteo Pettinari,
- Giovanni Mariscalco,
- Caius Mustonen,
- Francesco Nappi,
- Joscha Buech,
- Christian Hagl,
- Antonio Fiore,
- Joseph Touma,
- Angelo M. Dell’Aquila,
- Konrad Wisniewski,
- Andreas Rukosujew,
- Andrea Perrotti,
- Amélie Hervé,
- Till Demal,
- Lenard Conradi,
- Marek Pol,
- Petr Kacer,
- Francesco Onorati,
- Cecilia Rossetti,
- Igor Vendramin,
- Daniela Piani,
- Mauro Rinaldi,
- Luisa Ferrante,
- Eduard Quintana,
- Robert Pruna-Guillen,
- Javier Rodriguez Lega,
- Angel G. Pinto,
- Timo Mäkikallio,
- Metesh Acharya,
- Zein El-Dean,
- Mark Field,
- Amer Harky,
- Sebastien Gerelli,
- Dario Di Perna,
- Mikko Jormalainen,
- Giuseppe Gatti,
- Enzo Mazzaro,
- Tatu Juvonen,
- Sven Peterss
Affiliations
- Fausto Biancari
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
- Matteo Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, 3600 Genk, Belgium
- Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK
- Caius Mustonen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, 93200 Paris, France
- Joscha Buech
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany
- Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany
- Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France
- Joseph Touma
- Department of Vascular Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France
- Angelo M. Dell’Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Andreas Rukosujew
- Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany
- Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, France
- Amélie Hervé
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, France
- Till Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
- Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
- Marek Pol
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic
- Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic
- Francesco Onorati
- Division of Cardiac Surgery, Medical School, University of Verona, 37124 Verona, Italy
- Cecilia Rossetti
- Division of Cardiac Surgery, Medical School, University of Verona, 37124 Verona, Italy
- Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy
- Daniela Piani
- Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy
- Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy
- Luisa Ferrante
- Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy
- Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
- Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
- Javier Rodriguez Lega
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, Spain
- Angel G. Pinto
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, Spain
- Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland
- Metesh Acharya
- Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK
- Zein El-Dean
- Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK
- Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Amer Harky
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Sebastien Gerelli
- Centre Hospitalier Annecy Genevois, 74370 Annecy, France
- Dario Di Perna
- Centre Hospitalier Annecy Genevois, 74370 Annecy, France
- Mikko Jormalainen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
- Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy
- Enzo Mazzaro
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy
- Tatu Juvonen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
- Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany
- DOI
- https://doi.org/10.3390/jcm11226729
- Journal volume & issue
-
Vol. 11,
no. 22
p. 6729
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 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.
Keywords
