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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
647
Acute Type A Aortic Dissection With Cardiopulmonary Arrest at Presentation
Chikashi Nakai1, So Izumi1, Tomonori Haraguchi1
1Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital & Hyogo Emergency Medical Center, Kobe, Japan.
The Annals of Thoracic Surgery
|December 3, 2020
Summary
Acute type A aortic dissection with cardiopulmonary arrest has high mortality. Aortic repair offers a chance for recovery if spontaneous circulation returns, but extracorporeal CPR is not recommended.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Emergency Medicine
Background:
- Acute type A aortic dissection (AADA) with cardiopulmonary arrest (CPA) presents a critical management challenge.
- Aggressive resuscitation, including extracorporeal CPR, may precede aortic repair in these severe cases.
Purpose of the Study:
- To evaluate the early and long-term outcomes of patients experiencing preoperative CPA due to AADA.
Main Methods:
- Retrospective analysis of 474 AADA patients from September 2003 to August 2019.
- 157 patients (33.1%) presented with CPA, predominantly out-of-hospital (90%).
- Causes of CPA included cardiac tamponade (75%), hemothorax (10%), and coronary malperfusion (10%).
Main Results:
- Hospital mortality was 90%; survival was contingent on aortic repair.
- Return of spontaneous circulation (17%) followed by aortic repair resulted in 13 survivors (38% of ROSC group).
- All patients requiring extracorporeal CPR (20%) died, either pre- or post-operatively.
Conclusions:
- AADA with CPA carries a high mortality risk, but aortic repair offers a potential for functional recovery (30% likelihood) if spontaneous circulation is achieved.
- Preoperative extracorporeal membrane oxygenation is not advised for this patient group.
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