Patients presenting with acute type A aortic dissection
(ATAAD) and cardiac arrest before surgery are considered to have very
poor prognosis, but limited data is available. We used a large database
to evaluate the outcome of ATAAD patients with a cardiac arrest before
surgery.

We
evaluated 1154 surgically treated ATAAD patients from the Nordic
Consortium for Acute Type A Aortic Dissection (NORCAAD) database between
2005 and 2014. Patients with (n = 44, 3.8%) and without preoperative
cardiac arrest were compared and variables univariably associated with
mortality in the cardiac arrest group were identified. Median follow-up
time was 2.7 years (interquartile range 0.5–5.5).

Thirty-day
mortality in the arrest and non-arrest group was 43.2% and 16.6%,
respectively (odds ratio [OR] 3.83, CI 2.06–7.09; P < 0.001). In the
nine patients with ongoing cardiopulmonary resuscitation when cardiopulmonary bypass was initiated, five died intraoperatively and one died after 65 days. In patients surviving the operation, stroke
was significantly more common in the arrest group (48.4% vs 18.2%; OR
4.21, CI 2.05–8.67; P < 0.001). In total, 50.0% (22/44) of the arrest
patients survived to the end of follow-up. Non-survivors in the arrest
group more often had DeBakey type I dissection, cardiac tamponade, cardiac malperfusion and higher preoperative serum lactate (all P < 0.05).

Early
mortality and complications after ATAAD surgery in patients with a
preoperative cardiac arrest are high, but mid-term outcome after
surviving the initial period is acceptable. Preoperative cardiac arrest
should not be considered an absolute contraindication for a surgical ATAAD repair.