Ramzi Abi Akar, Milos Matkovic, Julien Massot, Alain Bel, Jerôme Jouan, Léonora du Puy-Montbrun, Jean-Marc Alsac, Bernard Cholley, Florence Bellenfant, Romain Pirracchio, Christian Latremouille, Jean-Noël Fabiani, Paul Achouh
Institution : Département de chirurgie cardiovasculaire, département d’anesthésie-réanimation, hôpital européen Georges-Pompidou, AP-HP, Paris
Objectives : SOS Aorta is a program put in place in a university hospital for an immediate, round-the-clock, multidisciplinary protocolled management of all aortic emergencies. Acute aortic syndrome is the most frequent aortic emergency. It is an absolute complex surgical emergency, with a high initial mortality rate. The aim of this paper is to evaluate the characteristics, in-hospital mortality, short and mid term results of patients referred to this aortic emergency program for suspected or confirmed type A acute aortic syndrome (AAS)
Methods : From february 2010 to May 2015: 688 patients were admitted through the SOS aorta program for suspected or confirmed aortic emergencies. All patients were entered into a prospective database. Initially, 129 patients were referred to our center with the diagnosis of type A acute aortic syndrom (AAS) based on a pre-admission CT-scan. And 74 patients were directly referred from the Mobile Emergency Units with high suspiscion of AAS.
Of the 74 patients referred with high suspiscion of AAS: the diagnosis was confirmed with CT-scan on admission in 61; 13 patients were immediatly transferred to the operating room for a TEE confirmation, because in shock or cardiac arrest. We reviewed the characteristics of these patients on admission and their in-hospital mortality. We also reviewed the results at five years regarding their survival and the need for reintervention.
Results : Procedural mortality was 15% for hemodynamically stable patients and 100% for patients under mechanical cardiac resuscitation. In hospital mortality was 23, 38 and 51% for patients under 70 years old, septuagenarians and octogenarians respectively. At discharge, global mortality was 30%. 44% of operated patients were transferred to cardiovascular rehabilitation centers and 16% were send home directly.
Conclusion : Management of AAS in a round-the-clock, multidisciplinary aortic emergencies program reduces the time to treatment. This theoretically should allow improvement in survival. The benefit in survival is probably counterbalanced by a higher percentage of unstable and critical patients admitted through the program. Mortality is certain in patients who present with cardiac arrest before surgery. Octogenarian have a significantly higher in-hospital mortality rate.