Abstract 19473: Impact of Immediate Aortic Repair After Cardiopulmonary Resuscitation on Acute Type A Aortic Dissection Complicated by Cardiopulmonary Arrest
Introduction: Management of acute type A aortic dissection (AADA) presented with cardiopulmonary arrest (CPA) remains controversial varying from aggressive cardiopulmonary resuscitation (CPR) followed by immediate aortic repair to medical management. Neurological outcome after aortic repair remains a primary concern. We analyzed our experience managing AADA complicated by CPA.
Methods: Between 9/03 and 5/16, 365 patients with AADA were arrived, including 111 patients presented with CPA. In CPA patients, mean age was 74.8±11.4 y/o, and prevalence of out-of-hospital CPA was 89% (99/111). Causes of CPA included aortic rupture into pericardium in 72% (80), into left pleural cavity in 9% (10), coronary malperfusion in 7.2% (8), and unclear in 11.7% (13). CPR was performed for all CPA patients, and extracorporeal CPR (ECPR) was applied for 20 patients. Ninety-one CPA patients (81%) died before surgical treatment and 20 patients (19%) returned spontaneous circulation and eventual aortic repair was undertaken. For brain protection, deep hypothermic circulatory arrest with selective cerebral perfusion during procedure was selected and postoperative induced hypothermia for 48 hours was performed. Surgical mortality and neurological outcome were analyzed.
Results: Ten patients survived after aortic repair and full recovery of consciousness was achieved in 60 % (6/10). Surgical mortality for AADA presented with CPA was 50% (10/20): 64% (7/11) with out-of-hospital CPA, and 33% (3/9) who received CPR for in-hospital CPA. Overall mortality of AADA presented with CPA was 91% (101/111), and all patients who received ECPR died eventually. We found significantly less incidence of out-of-hospital CPA and application of ECPR in the survivor group. Age, sex, time from onset, and causes of CPA did not predict outcomes.
Conclusions: Immediate aortic repair, if spontaneous circulation were returned after initial CPR, showed meaningful result for acute type A aortic dissection presented with CPA. Extracorporeal CPR is not strongly recommended in this patient population.
Author Disclosures: C. Nakai: None. T. Haraguchi: None. Y. Okada: None. S. Nakayama: None. T. Tsukube: None.
- © 2016 by American Heart Association, Inc.