Surgical Outcomes of Iatrogenic Acute Type A Aortic Dissection During Catheter-Based Procedures: An STS Cardiac...

Iatrogenic acute type A aortic dissection (iATAAD) after catheter-based procedures is rare, with limited data on postrepair outcomes.

Data provided by The Society of Thoracic Surgeons Adult Cardiac Surgery Database National Database Participant User File Research Program on all patients undergoing acute type A aortic dissection (ATAAD) repair from July 2017 to December 2023 were analyzed at the investigators' institution. Patients with intraoperative dissection, previous ascending or root aortic intervention, trauma, or infection were excluded. The iATAAD group (n = 971) included patients who had undergone percutaneous coronary intervention (PCI; n = 337), transcatheter aortic valve replacement (TAVR; n = 149), thoracic endovascular aortic repair (TEVAR; n = 190), or other catheterization (n = 295), compared with the spontaneous ATAAD (sATAAD) group (n = 25,026).

Patients with iATAAD were older, more likely to be female, and had greater rates of hypertension, heart failure, and preoperative anticoagulation than patients with sATAAD. The iATAAD operative mortality was greater than the sATAAD mortality (31.9% vs 18.2%; P < .001) and varied by subtype (TAVR, 43.0%; PCI, 35.0%; TEVAR, 20.0%; other, 30.5%; P < .001). Patients who underwent iATAAD repairs were more likely to have reoperation for bleeding (10.6% vs 8.1%, P = .007). There were no significant differences in stroke, renal failure, or 30-day readmission (P ≥ .05 for all). Risk factors for iATAAD mortality included age (odds ratio [OR], 1.05; 95% CI, 1.03-1.07), abdominal malperfusion (OR, 2.29; 95% CI, 1.04-5.03), any extracorporeal membrane oxygenation use (OR, 8.62; 95% CI, 4.78-15.52), any intraaortic balloon pump use (OR, 2.28; 95% CI, 1.30-3.98), and cardiogenic shock (OR, 3.78; 95% CI, 2.56-5.59).

Patients with iATAAD have high operative mortality, particularly patients undergoing TAVR and PCI. The presence of cardiogenic shock and the need for mechanical circulatory support portend poor outcomes in these patients.