Cardiac Tamponade Complicating Type A Acute Aortic Dissection: Insights From 25 Years of Registry Research

Abstract

Malaltia aòrtica; Tamponament cardíac; Dissecció aòrtica aguda tipus a

Enfermedad aórtica; Taponamiento cardíaco; Disección aórtica aguda tipo a

Aortic disease; Cardiac tamponade; Type a acute aortic dissection

Background Cardiac tamponade (TMP) is a catastrophic complication of type A acute aortic dissection (TAAAD), increasing the risk of morbidity and mortality. Objectives The present study aimed to assess the characteristics, management, and outcomes of TAAAD patients with preoperative TMP enrolled in the International Registry of Acute Aortic Dissection database from 1996 to 2022. Methods Data from 63 aortic centers were analyzed and TAAAD patients with and without preoperative TMP were compared. Multivariable modeling to assess factors associated with the presence of preoperative cardiac TMP and survival curves were performed. Overall median follow-up was 35.8 months (Q1-Q3: 11.6-59.4 months). Results Of the 6,014 patients with TAAAD in the International Registry of Acute Aortic Dissection during the 25-year study period, 865 individuals (14.4%) developed TMP. Patients with TMP were older (age 64.9 vs 60.8 years; P < 0.0001) and less often male (61.8% vs 66.8%; P = 0.005). No differences were seen in time to presentation or diagnosis. Prior cardiac surgery was less common in patients with TMP (7.6% vs 12.8%; P < 0.0001). Syncope (37.4% vs 13.4%; P < 0.0001) and coma or altered consciousness (28% vs 8%; P < 0.0001) on presentation were more frequent in the TMP group. The majority of the cohort were managed surgically, rates of which were similar between groups (87.5% vs 87.7%; P = 0.911). In-hospital mortality was higher in patients with TMP (38.4% vs 15.4%; P < 0.001) but 4-year survival was similar (log-rank P = 0.767). Conclusions TMP is an important prognosticator of in-hospital mortality. It is associated with increased mortality of TAAAD and prompt surgery is required. Those who survive the hospital course, go on to share the same postdischarge course as those who did not have TMP.