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, Andréa Perrotti, Amélie Hervé, Till Demal, Lenard Conradi, Marek Pol, Petr Kačer, Francesco Onorati, Cecilia Rossetti, Igor Vendramin, Daniela Piani, Mauro Rinaldi, Luisa Ferrante, Eduard Quintana, Robert Pruna‐Guillen, Javier Rodríguez Lega, Ángel González Pinto, Timo Mäkikallio, Metesh Acharya, Zein El‐Dean, Mark Field, Amer Harky, Sébastien Gerelli, Dario Di Perna, Mikko Jormalainen, Giuseppe Gatti, Enzo Mazzaro, Tatu Juvonen, Sven Peterß
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.