The Impact of Prior Cardiac Surgery on Outcomes Following Acute Type A Aortic Dissection Repair: Insights from a High-Volume Aortic Center.

Abstract

To investigate the impact of prior cardiac surgery (PCS) on outcomes following Acute Type A Aortic Dissection (ATAAD) repair at a high-volume, aortic center. This was a retrospective analysis including all ATAAD repairs from July 1997 to October 2024. Multivariable regression analysis (MVA) assessed independent association with primary and secondary outcomes. The primary outcome was the composite of in-hospital major adverse events (MAEs), including operative mortality (OM), myocardial infarction (MI), cerebrovascular accident (CVA), tracheostomy, renal failure and re-exploration for bleeding. The secondary outcome was all-cause mortality over follow-up. In total, 413 patients were included; 17.4%(72/413) had PCS. The PCS cohort had a greater comorbid burden than the first cardiac surgery (FCS) cohort, including increased incidence of prior MI (36.1%[26/72] vs. 11.4%[39/341], p<0.001), prior CVA (34.7%[25/72] vs. 15.8%[54/341], p<0.001) and renal disease (48.6%[35/72] vs. 26.4%[90/341], p<0.001). The incidence of MAE was higher in the PCS cohort (26.4%[19/72] vs 15.5%[53/341]; p=0.042) as was OM (11.1%[8/72] vs 3.5%[12/341], p=0.015). At median follow-up 6.6 years (95% Confidence Interval [CI] 5.2-8.5 years), the PCS cohort had lower survival (45.2% [95%CI:33-61.9%] vs. 71% [95%CI:65.2-77.3%]). On MVA, PCS was not associated with increased risk of MAEs (Odds Ratio 1.16[95%CI:0.58-2.24], p=0.68) but was associated with increased risk of all-cause mortality over follow-up (Hazard Ratio 1.69[95%CI:1.15-2.49], p=0.008). Prior cardiac surgery was not independently associated with increased risk of MAE following ATAAD repair. However, the PCS cohort exhibited greater comorbidity burden than the FCS, contributing to their increased morbidity and mortality postoperatively.