Outcome after Surgery for Iatrogenic Acute Type A Aortic Dissection

Fausto Biancari^{1

2}, Matteo Pettinari³, Giovanni Mariscalco⁴, Caius Mustonen¹, Francesco Nappi⁵, Joscha Buech^{6

7}, Christian Hagl⁶, Antonio Fiore⁸, Joseph Touma⁹, Angelo M Dell'Aquila¹⁰, Konrad Wisniewski¹⁰, Andreas Rukosujew¹⁰, Andrea Perrotti¹¹, Amélie Hervé¹¹, Till Demal¹², Lenard Conradi¹², Marek Pol¹³, Petr Kacer¹³, Francesco Onorati¹⁴, Cecilia Rossetti¹⁴, Igor Vendramin¹⁵, Daniela Piani¹⁵, Mauro Rinaldi¹⁶, Luisa Ferrante¹⁶, Eduard Quintana¹⁷, Robert Pruna-Guillen¹⁷, Javier Rodriguez Lega¹⁸, Angel G Pinto¹⁸, Timo Mäkikallio², Metesh Acharya⁴, Zein El-Dean⁴, Mark Field¹⁹, Amer Harky¹⁹, Sebastien Gerelli²⁰, Dario Di Perna²⁰, Mikko Jormalainen¹, Giuseppe Gatti²¹, Enzo Mazzaro²¹, Tatu Juvonen^{1

22}, Sven Peterss⁶

Affiliations

¹ Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland.
² Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland.
³ Department of Cardiac Surgery, Ziekenhuis Oost Limburg, 3600 Genk, Belgium.
⁴ Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK.
⁵ Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, 93200 Paris, France.
⁶ Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany.
⁷ German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, 80539 Munich, Germany.
⁸ Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France.
⁹ Department of Vascular Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France.
¹⁰ Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany.
¹¹ Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, France.
¹² Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany.
¹³ Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic.
¹⁴ Division of Cardiac Surgery, Medical School, University of Verona, 37124 Verona, Italy.
¹⁵ Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy.
¹⁶ Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy.
¹⁷ Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain.
¹⁸ Cardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, Spain.
¹⁹ Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK.
²⁰ Centre Hospitalier Annecy Genevois, 74370 Annecy, France.
²¹ Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy.
²² Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, 90570 Oulu, Finland.

PMID: 36431205
PMCID: PMC9696328
DOI: 10.3390/jcm11226729

Outcome after Surgery for Iatrogenic Acute Type A Aortic Dissection

Fausto Biancari et al. J Clin Med. 2022.

. 2022 Nov 14;11(22):6729.

doi: 10.3390/jcm11226729.

Authors

Affiliations

¹ Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland.
² Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland.
³ Department of Cardiac Surgery, Ziekenhuis Oost Limburg, 3600 Genk, Belgium.
⁴ Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK.
⁵ Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, 93200 Paris, France.
⁶ Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80539 Munich, Germany.
⁷ German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, 80539 Munich, Germany.
⁸ Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France.
⁹ Department of Vascular Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France.
¹⁰ Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany.
¹¹ Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25030 Besancon, France.
¹² Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany.
¹³ Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, 10000 Prague, Czech Republic.
¹⁴ Division of Cardiac Surgery, Medical School, University of Verona, 37124 Verona, Italy.
¹⁵ Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy.
¹⁶ Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy.
¹⁷ Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain.
¹⁸ Cardiovascular Surgery Department, University Hospital Gregorio Marañón, 28007 Madrid, Spain.
¹⁹ Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK.
²⁰ Centre Hospitalier Annecy Genevois, 74370 Annecy, France.
²¹ Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy.
²² Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, 90570 Oulu, Finland.

PMID: 36431205
PMCID: PMC9696328
DOI: 10.3390/jcm11226729

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.

Keywords: aortic dissection; emergency; iatrogenic; type A aortic dissection.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Survival estimates after surgery for acute type A spontaneous aortic dissection and iatrogenic aortic dissection secondary to cardiac surgery, percutaneous coronary intervention (PCI), coronary angiography, peripheral vascular intervention and transcatheter aortic valve replacement (TAVR).

See this image and copyright information in PMC

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Outcome after Surgery for Iatrogenic Acute Type A Aortic Dissection

Affiliations

Outcome after Surgery for Iatrogenic Acute Type A Aortic Dissection

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources