{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:29:35Z","timestamp":1784939375536,"version":"3.55.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,1,4]],"date-time":"2024-01-04T00:00:00Z","timestamp":1704326400000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p\/><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Cardiopulmonary resuscitation (CPR) aggravates the pre-existing dismal prognosis of patients suffering from acute type A aortic dissection (ATAAD). We aimed to identify factors affecting survival and outcome in ATAAD patients requiring CPR at presentation at 2 European aortic centres.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Data on 112 surgical candidates and undergoing preoperative CPR were retrospectively evaluated. Patients were divided into 2 groups according to 30-day mortality. A multivariable model identified predictors for 30-day mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Preoperative death occurred in 23 patients (20.5%). In the remaining 89 surgical patients (79.5%) circulatory arrest time (41\u2009\u00b1\u200920\u2009min in 30-day non-survivors vs 30\u2009\u00b1\u200913\u2009min in 30-day survivor, P\u2009=\u20090.003) as well as cardiopulmonary bypass time (320\u2009\u00b1\u2009132\u2009min in 30-day non-survivors vs 252\u2009\u00b1\u2009140\u2009min in 30-day survivor, P\u2009=\u20090.020) time was significantly longer in patients with worse outcome. Thirty-day mortality of the total cohort was 61.6% (n\u2009=\u200969) with cardiac failure in 48% and aortic rupture or haemorrhagic shock (28%) as predominant reasons of death. Age [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01\u20131.09, P\u2009=\u20090.034], preoperative coronary (OR 3.42, 95% CI 1.34\u20139.26, p\u2009=\u20090.012) and spinal malperfusion (OR 12.49, 95% CI 1.83\u2013225.02, P\u2009=\u20090.028) emerged as independent predictors for 30-day mortality while CPR due to tamponade was associated with improved early survival (OR 0.29, 95% CI 0.091\u20130.81, P\u2009=\u20090.023).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Assessment of underlying cause for CPR is mandatory. Pericardial tamponade, rapidly resolved with pericardial drainage, is a predictor for improved survival, while age and presence of coronary and spinal malperfusion are associated with dismal outcome in this high-risk patient group.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezad436","type":"journal-article","created":{"date-parts":[[2024,1,4]],"date-time":"2024-01-04T18:12:37Z","timestamp":1704391957000},"source":"Crossref","is-referenced-by-count":7,"title":["Analysis of factors affecting outcome in acute type A aortic dissection complicated by preoperative cardiopulmonary resuscitation"],"prefix":"10.1093","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7535-9013","authenticated-orcid":false,"given":"Matteo","family":"Montagner","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 (DHZC) , Berlin, Germany"},{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Kofler","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 (DHZC) , Berlin, Germany"},{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Berlin, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Berlin , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0339-5791","authenticated-orcid":false,"given":"Leonard","family":"Pitts","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 (DHZC) , Berlin, Germany"},{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0180-8338","authenticated-orcid":false,"given":"Simone","family":"Gasser","sequence":"additional","affiliation":[{"name":"University Clinic of Cardiac Surgery, Innsbruck Medical University , Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9173-7336","authenticated-orcid":false,"given":"Lukas","family":"Stastny","sequence":"additional","affiliation":[{"name":"University Clinic of Cardiac Surgery, Innsbruck Medical University , Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan D","family":"Kurz","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 (DHZC) , Berlin, Germany"},{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Grimm","sequence":"additional","affiliation":[{"name":"University Clinic of Cardiac Surgery, Innsbruck Medical University , Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7911-8620","authenticated-orcid":false,"given":"Volkmar","family":"Falk","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 (DHZC) , Berlin, Germany"},{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Berlin, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Berlin , Berlin, Germany"},{"name":"Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2009-6375","authenticated-orcid":false,"given":"J\u00f6rg","family":"Kempfert","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charit\u00e9 (DHZC) , Berlin, Germany"},{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Berlin, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Berlin , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1263-6909","authenticated-orcid":false,"given":"Julia","family":"Dumfarth","sequence":"additional","affiliation":[{"name":"University Clinic of Cardiac Surgery, Innsbruck Medical University , Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,1,4]]},"reference":[{"key":"2024011515211244200_ezad436-B1","doi-asserted-by":"crossref","first-page":"e0237989","DOI":"10.1371\/journal.pone.0237989","article-title":"Surgical results in acute type A aortic dissection with preoperative cardiopulmonary resuscitation: survival and neurological outcome","volume":"15","author":"Lin","year":"2020","journal-title":"PLoS One"},{"key":"2024011515211244200_ezad436-B2","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1111\/jocs.14586","article-title":"Outcomes of patients operated for acute type A aortic dissection requiring preoperative cardiopulmonary resuscitation","volume":"35","author":"Reser","year":"2020","journal-title":"J Card Surg"},{"key":"2024011515211244200_ezad436-B3","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1016\/j.jtcvs.2019.11.135","article-title":"Surgical outcomes of acute type A aortic dissection in patients undergoing cardiopulmonary resuscitation","volume":"161","author":"Uehara","year":"2021","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024011515211244200_ezad436-B4","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1093\/ejcts\/ezv356","article-title":"Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA)","volume":"49","author":"Conzelmann","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024011515211244200_ezad436-B5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resuscitation.2019.08.039","article-title":"Outcome after type A aortic dissection repair in patients with preoperative cardiac arrest","volume":"144","author":"Pan","year":"2019","journal-title":"Resuscitation"},{"key":"2024011515211244200_ezad436-B6","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1093\/ejcts\/ezab401","article-title":"Validation of a novel risk score to predict mortality after surgery for acute type A dissection","volume":"61","author":"Kofler","year":"2022","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024011515211244200_ezad436-B7","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.jacc.2015.05.029","article-title":"Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection","volume":"66","author":"Pape","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2024011515211244200_ezad436-B8","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1177\/2048872620914931","article-title":"Acute type A aortic dissection: aortic dissection detection risk score in emergency care\u2014surgical delay because of initial misdiagnosis","volume":"9","author":"Zaschke","year":"2020","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2024011515211244200_ezad436-B9","first-page":"279","article-title":"State of the art review: surgical treatment of acute type A aortic dissection","volume":"38","author":"Pitts","year":"2021","journal-title":"Surg Technol Int"},{"key":"2024011515211244200_ezad436-B10","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/jocs.13511","article-title":"Contemporary management and outcomes of acute type A aortic dissection: an analysis of the STS adult cardiac surgery database","volume":"33","author":"Lee","year":"2018","journal-title":"J Card Surg"},{"key":"2024011515211244200_ezad436-B11","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1093\/ejcts\/ezaa156","article-title":"Prediction of mortality rate in acute type A dissection: the German Registry for Acute Type A Aortic Dissection score","volume":"58","author":"Czerny","year":"2020","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024011515211244200_ezad436-B12","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1016\/j.athoracsur.2020.11.007","article-title":"Acute type A aortic dissection with cardiopulmonary arrest at presentation","volume":"112","author":"Nakai","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"2024011515211244200_ezad436-B13","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.resuscitation.2020.08.001","article-title":"Extracorporeal cardiopulmonary resuscitation for acute aortic dissection during cardiac arrest: a nationwide retrospective observational study","volume":"156","author":"Ohbe","year":"2020","journal-title":"Resuscitation"},{"key":"2024011515211244200_ezad436-B14","doi-asserted-by":"crossref","first-page":"e266","DOI":"10.1161\/CIR.0b013e3181d47d48","article-title":"2010 ACCF\/AHA\/AATS\/ACR\/ASA\/SCA\/SCAI\/SIR\/STS\/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine","volume":"121","author":"Hiratzka","year":"2010","journal-title":"Circulation"},{"key":"2024011515211244200_ezad436-B15","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.jtcvs.2021.04.053","article-title":"2021 The American Association for Thoracic Surgery expert consensus document: surgical treatment of acute type A aortic dissection","volume":"162","author":"Malaisrie","year":"2021","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024011515211244200_ezad436-B16","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1093\/ejcts\/ezw387","article-title":"Acute type A dissection in octogenarians: does emergency surgery impact in-hospital outcome or long-term survival?","volume":"51","author":"Dumfarth","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024011515211244200_ezad436-B17","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.ejcts.2007.04.012","article-title":"Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations","volume":"32","author":"Geirsson","year":"2007","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024011515211244200_ezad436-B18","article-title":"Treatment strategies and in-hospital mortality in patients with type A acute aortic dissection and coronary artery involvement","author":"Hashimoto","year":"2022","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezad436\/55024539\/ezad436.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/65\/1\/ezad436\/56056686\/ezad436.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/65\/1\/ezad436\/56056686\/ezad436.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T02:53:51Z","timestamp":1730948031000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezad436\/7510851"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,1]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezad436","relation":{},"ISSN":["1873-734X"],"issn-type":[{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,1,1]]},"published":{"date-parts":[[2024,1,1]]},"article-number":"ezad436"}}