LAUSR

BACKGROUND As part of a multidisciplinary aortic dissection (AD) program, a more comprehensive repair strategy for acute type A aortic dissection (ATAAD) and frequent endografting for suitable type B aortic dissection (ATBAD) patients was adopted in 2015. The aim of this study was to evaluate the impact of these changes. METHODS This study is a retrospective review of a prospective database containing all patients treated for acute AD between 2003 and 2020. Patients were grouped based on differing repair strategies (pre 2015 vs post 2015). Clinical characteristics, procedural details, and survival data were analyzed. RESULTS During this time, 323 patients (210 pre, 113 post) were treated for acute AD at our institution. There were 221 ATAAD patients (149 pre, 72 post) and 102 ATBAD patients (61 pre, 41 post). The majority (60%) were males with a mean age of 65.9 ±15.2 years. There were no differences in cardiovascular risk factors or demographics between the groups. After 2015, fewer patients with ATAAD underwent medical management alone (15% pre vs 4% post, p=.014), and most that underwent surgical intervention had a total arch or aggressive hemiarch repair (27% pre vs 78% post, p<.001). Seventy-four patients (73%) with ATBAD were treated medically while 28 underwent medical management and endografting (23% pre, 34% post, p=.214). For all AD patients, thirty-day mortality was significantly improved (26% pre vs 10% post, p<.001) especially amongst ATAAD surgical patients (23% pre vs 9% post, p=.018). Three-year Kaplan-Meier survival estimates showed survival improvement among ATAAD patients (Logrank p-value=.019,) however, this improvement does not extend to type B dissections or the overall cohort. A survival analysis landmarked to 30-days after initial presentation showed no statistical difference in survival from 30 days to three years post-presentation. CONCLUSION A more comprehensive repair strategy in the management of acute AD patients resulted in improved overall patient outcomes and significantly decreased thirty-day mortality, even though more complex repairs were performed. The long-term impact of the changes made to our program remains to be evaluated.