CONGRESS ABSTRACT

Background: Untreated acute type A aortic dissection has a bad prognosis. However, mortality rates remain high even for those patients which underwent a surgical procedure, depending on presentation symptoms, age and comorbidities. Adverse events such as neurological attacks and peripheral or visceral malperfusion may complicate these cases. Our aim is to investigate about the intra-operative mortality etiologies after surgical repair of acute type A aortic dissection.  Methods: Between 2000 and 2024, n=355 patients underwent surgical repair of acute type A dissection at our center. The main surgical procedures were ascending aorta replacement with open distal technique (n=320), followed by total- (n=97) and partial-arch replacement (n=77). Both simple and frozen elephant trunk procedures were performed in n=57 and n=53 cases, respectively. Seventy-six patients required an additional bioprosthetic aortic valve replacement, while root replacement was required in n=111 cases. Hypothermic circulatory arrest with antegrade cerebral perfusion was performed in all cases at a mean temperature of 21 ±4 °C, with additional retrograde perfusion in n=240 of them. Median cross-clamp and circulatory arrest times were 94 [60,135] and 45 [30,62] minutes, respectively.  Results: Intra-operative and 30-day mortality rates were 5,9% and 19,7% (n=21 and n=70), respectively. Overall mortality rate was (n=199), with n=108 patients which died during follow-up at a median time of 4,5 [0,6] years. Among the patients which died in the operative room, n=9 developed uncontrolled bleeding (42%), n=9 ventricular dysfunction, while one showed acute visceral ischemia. One-hundred patients had strokes (28%) and n=69 (19,4%) developed postoperative acute kidney disease. Sixty-four subjects developed peri-operative acute myocardial infarction (18%), while visceral malperfusion and leg ischemia were detected in n=57 and n=61 (16% and 17,1%), respectively. Seventy-three patients showed major bleeding.  Conclusions: Surgical repair of acute type A aortic dissection still has a high overall mortality rate, with ~20% of patients dying before 30 days and ~6% in the context of the operative theatre. The main etiologies of intra-operative mortality were basically due to the emergency status such as uncontrolled bleeding and ventricular dysfunction. Unfortunately, such adverse event could be of difficult management and sometimes impossible to overcome in the context of aortic dissection.