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Aortic Surgery Symposium 2010 New York, NY April, 2010

Outcomes of Acute Type A Aortic Dissection After Previous Cardiac Surgery. AL Estrera, MD, CC Miller III, PhD, TK Lee, MD, T Kaneko, MD, JC Walkes, MD, H Safi, MD. Department of Cardiothoracic and Vascular Surgery The University of Texas Medical School at Houston

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Aortic Surgery Symposium 2010 New York, NY April, 2010

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  1. Outcomes of Acute Type A Aortic Dissection After Previous Cardiac Surgery AL Estrera, MD, CC Miller III, PhD, TK Lee, MD, T Kaneko, MD, JC Walkes, MD, H Safi, MD Department of Cardiothoracic and Vascular Surgery The University of Texas Medical School at Houston Memorial Hermann Heart & Vascular Institute Aortic Surgery Symposium 2010 New York, NY April, 2010

  2. Purpose • Since few data exist, we report outcomes of acute type A aortic dissection (ATAAD) after previous cardiac surgery (PCS).

  3. Methods 330 Acute Type A Aortic Dissection Jan. 1991 – March 2009 Median age: 62 (21-91) 69% 31% 281 Primary (85%) 49 PCS (15%)

  4. Preoperative Variables in Acute Type A Aortic Dissection with/without PCS

  5. Interval Mean Interval 56 ± 77 months Interval range 3d - 370 months 2 pts: 2 previous sternotomies

  6. Previous Cardiac Surgery

  7. Procedures (Re-Op) Total Arch10% ET1 4% Prox Arch 94% Ascending 100% CABG16% Aortic Root 8%

  8. Results

  9. Causes of Early Death

  10. Location of Aortic Dissection Tear * 12/15 (80%) of previous valves had a Bicuspid Aortic Valve

  11. Survival: Kaplan-Meier P<0.03

  12. Conclusions • Patients with ATAAD following PCS exhibited risks for malperfusion, hypotension, and cardiac tamponade that were similar to primary ATAAD cases. • This suggests that adhesions formed after PCS do not eliminate the risk of cardiac tamponade from aortic rupture. • Although results from surgical repair are acceptable, and thus justifying timely repair, mortality still remains higher than without a prior history of cardiac surgery. • Patients need to be individualized.

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