P31. The Surgical Impact of Adrenergic Drug Use Associated Aortopathy

Objective: Methamphetamine and cocaine use disorders are a growing epidemic in the United States causing increasing deaths in the general population. Stanford Type A aortic syndromes (TAAS) including aortic dissection and intramural hematoma (IMH) are surgical emergencies that can result from profound hypertensive states following illicit adrenergic drug use. This study aims to characterize the prevalence and clinical impact of adrenergic drug use associated aortic syndrome in emergent aortic surgery.

Methods: Between 2009 and 2019, 575 adult patients underwent open surgical repair for TAAS at our institution. Operative outcomes were compared between patients with and without active adrenergic drug use. Survival analysis was conducted with the Kaplan-Meier method and multivariable Cox regression to adjust for relevant clinical risk factors. Cumulative incidence of dissection related aortic reintervention was analyzed using Fine-Gray competing risks regression with death as a competing factor.

Results: Adrenergic drug use was present in 10% (57/575) of patients undergoing surgery for TAAS. Methamphetamine was the most common drug of use (n=36), followed by cocaine (n=14), and combined meth/cocaine use (n=7). As compared to abstinent patients, those using adrenergic drugs were younger (50 vs. 63 years, p<0.01) with otherwise similar incidence of hypertension and connective tissue disorders. Patients with adrenergic drug use experienced more post-operative complications including mesenteric ischemia (9% vs 2%, p=0.02) and fasciotomy for limb ischemia (9% vs. 2%, p<0.01), with no differences in operative mortality (9% vs. 9%, p>0.99). At a median follow up of 5.4 years, long-term survival was similar between groups (log-rank P = 0.72) (Figure 1A). The cumulative incidence of dissection related reintervention at 10 years was 31.2% with adrenergic drug use vs. 20.3% without (HR 1.79, 95% CI [1.01-3.18], p=0.047) (Figure 1B). Multivariable analysis demonstrated adrenergic drug use to be a strong independent predictor of decreased survival (HR 1.95 [1.04 - 3.67], p=0.04).

Conclusions: Methamphetamine and cocaine use disorders are clinically important causes of type A aortic syndrome in young patients. Surgical repair in this setting is associated with similar operative mortality, increased morbidity, and higher incidence of dissection related reintervention. Careful follow-up and aortic surveillance are essential in this high-risk patient population.

Elbert E. Heng (1), Jennifer Kim (1), Matthew Duda (1), Aravind Krishnan (1), Alyssa Garrison (1), Daniel Alnasir (1), Y. Joseph Woo (1), Michael Fischbein (1), John MacArthur (1), (1) Stanford University Medical Center, Palo Alto, CA

Elbert E. Heng

Poster Presenter

Elbert Heng is a 6th year integrated cardiothoracic surgery resident at Stanford University. He attended medical school at Brown University, during which he conducted research on the comparative histology of bicuspid aortic valve associated aortopathy under the mentorship of Dr. Thoralf Sundt III at the Massachusetts General Hospital. He is currently a postdoctoral research fellow in the laboratory of Dr. John W. Macarthur, where he is investigating novel bioprinting technologies to promote microvascular organization in therapeutic angiogenesis. Dr. Heng's clinical interests include aortic reconstruction, coronary revascularization, and valve technologies.