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Figueroa AV, Tanenbaum MT, Timaran CH, Oderich GS, Eagleton MJ, Schanzer A, Farber MA, Beck AW, Schneider DB, Gasper W, Sweet MP, Lee A, Cantor RS, Li X. Postdissection aortic aneurysm sac enlargement after fenestrated and branched endovascular aortic aneurysm repair. J Vasc Surg 2024:S0741-5214(24)01092-9. [PMID: 38909915 DOI: 10.1016/j.jvs.2024.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES Aneurysm sac changes after fenestrated-branched endovascular aneurysm repair (FBEVAR) for postdissection thoracoabdominal aortic aneurysms (PD-TAAs) are poorly understood. Partial thrombosis of the false lumen and endoleaks may impair sac regression. To characterize sac changes after FBEVAR for PD-TAAs, this study examined midterm results and predictors for sac enlargement. METHODS FBEVARs performed for PD-TAAs in 10 physician-sponsored investigational device exemption studies from 2008 to 2023 were analyzed. The maximum aortic aneurysm diameter was compared between the 30-day computed tomography angiogram and follow-up imaging studies. Aneurysm sac enlargement was defined as an increase in diameter of ≥5 mm. Kaplan-Meier curves and Cox regression were used to evaluate sac enlargement and midterm FBEVAR outcomes. RESULTS Among 3296 FBEVARs, 290 patients (72.4% male; median age, 68.4 years) were treated for PD-TAAs. Most aneurysms treated were extent II (72%) and III (12%). Mean aneurysm diameter was 66.5 ± 11.2 mm. Mortality at 30 days was 1.4%. At a mean follow-up of 2.9 ± 1.9 years, at least one follow-up imaging study revealed sac enlargement in 43 patients (15%), sac regression in 115 patients (40%), and neither enlargement nor regression in 137 (47%); 5 (2%) demonstrated both expansion and regression during follow-up. Freedom from aneurysm sac enlargement was 93%, 82%, and 80% at 1, 3, and 5 years, respectively. Overall, endoleaks were detected in 27 patients (63%) with sac enlargement and 143 patients (58%) without enlargement (P = .54). Sac enlargement was significantly more frequent among older patients (mean age at the index procedure, 70.2 ± 8.9 years vs 66.5 ± 11 years; P = .04) and those with type II endoleaks at 1 year (74% vs 52%; P = .031). Cox regression revealed age >70 years at baseline (hazard ratio [HR], 2.146; 95% confidence interval [CI], 1.167-3.944; P = .010) and presence of type II endoleak at 1 year (HR, 2.25; 95% CI, 1.07-4.79; P = .032) were independent predictors of sac enlargement. Patient survival was 92%, 81%, and 68% at 1, 3, and 5 years, respectively. Cumulative target vessel instability was 7%, and aneurysm-related mortality was 2% at 5 years. At least 42% of patients required secondary interventions. Sac enlargement did not affect patient survival. CONCLUSIONS Aneurysm sac enlargement occurs in 15% of patients after FBEVAR for PD-TAAs. Elderly patients (>70 years at baseline) and those with type II endoleaks at 1 year may need closer monitoring and secondary interventions to prevent sac enlargement. Despite sac enlargement in some patients, aneurysm-related mortality at 5 years remains low and overall survival was not associated with sac enlargement.
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Affiliation(s)
- Andres V Figueroa
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mira T Tanenbaum
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Gustavo S Oderich
- Division of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Andres Schanzer
- Division of Vascular and Endovascular Surgery, University of Massachusetts Memorial Hospital, Worcester, MA
| | - Mark A Farber
- Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC
| | - Adam W Beck
- Division of Vascular and Endovascular Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Darren B Schneider
- Division of Vascular and Endovascular Surgery, University of Pennsylvania, Philadelphia, PA
| | - Warren Gasper
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA
| | - Matthew P Sweet
- Division of Vascular and Endovascular Surgery, University of Washington, Seattle, WA
| | - Anthony Lee
- Division of Vascular Surgery, Boca Raton Regional Hospital, Boca Raton, FL
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Kim JK, Goh JH, Kim JB, Song JK, Yang DH, Kang JW, Kim SO, Koo HJ. Predictors of Late Adverse Events in Patients with Surgically Treated Type I Aortic Dissection. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00382-4. [PMID: 38719137 DOI: 10.1016/j.ejvs.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/11/2024] [Accepted: 05/01/2024] [Indexed: 06/17/2024]
Abstract
OBJECTIVE Residual aortic dissection (AD) following DeBakey type I AD repair is associated with a high rate of adverse events that need additional intervention or surgery. This study aimed to identify clinical and early post-operative computed tomography (CT) imaging factors associated with adverse events in patients with type I AD after ascending aorta replacement. METHODS This single centre, retrospective cohort study included consecutive patients with type I AD who underwent ascending aorta replacement from January 2011 to December 2017 and post-operative CT within three months. The primary outcome was AD related adverse events, defined as AD related death and re-operation due to aortic aneurysm or impending rupture. The location and size of the primary intimal tears, aortic diameter, and false lumen status were evaluated. Regression analyses were performed to identify factors associated with AD related adverse events. A decision tree model was used to classify patients as high or low risk. RESULTS Of 103 participants (55.43 ± 13.94 years; 49.5% male), 24 (23.3%) experienced AD related adverse events. In multivariable Cox regression analysis, connective tissue disease (hazard ratio [HR] 15.33; p < .001), maximum aortic diameter ≥ 40 mm (HR 4.90; p < .001), and multiple (three or more) intimal tears (HR 7.12; p < .001) were associated with AD related adverse events. The three year cumulative survival free from AD related events was lower in the high risk group with aortic diameter ≥ 40 mm and multiple intimal tears (41.7% vs. 90.9%; p < .001). CONCLUSION Early post-operative CT findings indicating a maximum aortic diameter ≥ 40 mm and multiple intimal tears may predict a higher risk of adverse events. These findings suggest the need for careful monitoring and more vigilant management approaches in these cases.
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Affiliation(s)
- Jin Kyoung Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Jung Hwan Goh
- University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Jae-Kwan Song
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Hyun Jung Koo
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea.
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Chang Y, Qian X, Guo H, Wei Y, Yu C, Sun X, Wei B, Ma Q, Shi Y. Perioperative and Short-Term Outcomes of Sinus Replacement and Conservative Repair for Aortic Root in Acute Type A Aortic Dissection: A Prospective Cohort Study. Front Cardiovasc Med 2022; 9:880411. [PMID: 35665244 PMCID: PMC9160325 DOI: 10.3389/fcvm.2022.880411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022] Open
Abstract
Background To compare outcomes between sinus replacement (SR) and conservative repair (CR) for dissected roots with normal size. Methods From October 2018 to April 2021, a prospective cohort study was carried out. Patients were assigned to two groups (SR group and CR group) according to whether they underwent sinus replacement. Propensity score matching was applied to adjust preoperative variables and Kaplan–Meier method was used for survival analysis. Results Three hundred and eighty-seven patients were enrolled. In the whole cohort, 18 patients (4.7%) died postoperatively. The operative mortality of SR group was comparable to CR group (3.2% vs. 6.0%, p = 0.192 before matching; 3.5% vs. 7.0%, p = 0.267 after matching) and the incidence of hemostasis management under restarted cardiopulmonary bypass for root bleeding was lower in SR group (1.6% vs. 7.0%, p = 0.002 before matching; 2.1% vs. 8.5%, p = 0.03 after matching). The median follow-up duration was 12 months. There were 3 reoperations in the CR group. The estimated cumulative event rate of reoperation was 1.1 % at 12 months and 1.6% at 24 months in CR group, with a trend of a lower rate in the SR group (log-rank p = 0.089 before matching, p = 0.075 after matching). There was one late death in each group. The estimated cumulative event rate of death was 3.8% at 12 months and 24 months in the SR group, and was 6.6% in the CR group with no significant difference (log-rank p = 0.218 before matching, p = 0.120 after matching). Aortic regurgitation significantly improved postoperatively and remained stable during follow-up. Conclusions Sinus replacement is a simple, safe, and effective technique for repairing severely dissected sinus with a comparable time spent in operation and excellent immediate and short-term results. It had the advantages of eliminating false lumen and avoiding aortic root bleeding.
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López Gómez A, Rodríguez R, Zebdi N, Ríos Barrera R, Forteza A, Legarra Calderón JJ, Garrido Martín P, Hernando B, Sanjuan A, González Bardanca S, Varela Martínez MÁ, Fernández FE, Llorens R, Valera Martínez FJ, Gómez Felices A, Aranda Granados PJ, Sádaba Sagredo R, Echevarría JR, Vicente Guillén R, Silva Guisasola J. Anaesthetic-surgical guide in the treatment of ascending aorta and surgery of the ascending aorta and aortic arch. Consensus document of the Spanish Society of Cardiovascular and Endovascular Surgery and the Sociedad of Anaesthesiology, Resuscitation and Pain Therapy. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:143-178. [PMID: 35288050 DOI: 10.1016/j.redare.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/09/2021] [Indexed: 06/14/2023]
Abstract
Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.
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Affiliation(s)
- A López Gómez
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - R Rodríguez
- Servicio de Cirugía Cardiaca, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - N Zebdi
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - R Ríos Barrera
- Servicio de Cirugía Cardiaca, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - A Forteza
- Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - P Garrido Martín
- Servicio de Cirugía Cardiaca, Hospital Universitario de Canarias, San Cristobal de La Laguna, Spain
| | - B Hernando
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Sanjuan
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - S González Bardanca
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M Á Varela Martínez
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - F E Fernández
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - R Llorens
- Servicio de Cirugía Cardiaca, Hospital Hospiten Rambla, Tenerife, Spain
| | - F J Valera Martínez
- Servicio de Cirugía Cardiaca, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - A Gómez Felices
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - P J Aranda Granados
- Servicio de Cirugía Cardiaca, Hospital Universitario Carlos Haya, Málaga, Spain
| | - R Sádaba Sagredo
- Servicio de Cirugía Cardiaca, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - J R Echevarría
- Servicio de Cirugía Cardíaca, Hospital Universitario de Valladolid, Valladolid, Spain
| | - R Vicente Guillén
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J Silva Guisasola
- Servicio de Cirugía Cardíaca, Hospital Universitario Central de Asturias, Oviedo, Spain
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Fleischmann D, Afifi RO, Casanegra AI, Elefteriades JA, Gleason TG, Hanneman K, Roselli EE, Willemink MJ, Fischbein MP. Imaging and Surveillance of Chronic Aortic Dissection: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2022; 15:e000075. [PMID: 35172599 DOI: 10.1161/hci.0000000000000075] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
All patients surviving an acute aortic dissection require continued lifelong surveillance of their diseased aorta. Late complications, driven predominantly by chronic false lumen degeneration and aneurysm formation, often require surgical, endovascular, or hybrid interventions to treat or prevent aortic rupture. Imaging plays a central role in the medical decision-making of patients with chronic aortic dissection. Accurate aortic diameter measurements and rigorous, systematic documentation of diameter changes over time with different imaging equipment and modalities pose a range of practical challenges in these complex patients. Currently, no guidelines or recommendations for imaging surveillance in patients with chronic aortic dissection exist. In this document, we present state-of-the-art imaging and measurement techniques for patients with chronic aortic dissection and clarify the need for standardized measurements and reporting for lifelong surveillance. We also examine the emerging role of imaging and computer simulations to predict aortic false lumen degeneration, remodeling, and biomechanical failure from morphological and hemodynamic features. These insights may improve risk stratification, individualize contemporary treatment options, and potentially aid in the conception of novel treatment strategies in the future.
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6
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White A, Bozso SJ, Ouzounian M, Chu MW, Moon MC. Acute type A aortic dissection and the consequences of a patent false lumen. JTCVS Tech 2021; 9:1-8. [PMID: 34647041 PMCID: PMC8500985 DOI: 10.1016/j.xjtc.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Abigail White
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sabin J. Bozso
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael W.A. Chu
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Michael C. Moon
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
- Address for reprints: Michael C. Moon, MD, Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, Department of Surgery, University of Alberta, 8602 112 St NW, Edmonton, Alberta T6G 2E1, Canada.
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7
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Manunga J, Smith J, Schmidt CW, Titus J, Mudy K, Pavlovec MP, Sun B, Teng X, Mirza A, Skeik N, Sharma A, Harris KM. Impact of a multidisciplinary acute aortic dissection program: Improved outcomes with a comprehensive initial surgical repair strategy. J Vasc Surg 2021; 75:484-494.e1. [PMID: 34506889 DOI: 10.1016/j.jvs.2021.08.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE As part of a multidisciplinary aortic dissection (AD) program, a more comprehensive repair strategy for patients with acute type A aortic dissection (ATAAD) and frequent endografting for suitable patients with type B aortic dissection (ATBAD) was adopted in 2015. The aim of this study was to evaluate the impact of these changes. METHODS This study is a retrospective review of a prospective database containing all patients treated for acute AD between 2003 and 2020. Patients were grouped based on differing repair strategies (pre 2015 vs post 2015). Clinical characteristics, procedural details, and survival data were analyzed. RESULTS During this time, 323 patients (210 pre, 113 post) were treated for acute AD at our institution. There were 221 patients with ATAAD (149 pre, 72 post) and 102 patients with ATBAD (61 pre, 41 post). The majority (60%) were males, with a mean age of 65.9 ± 15.2 years. There were no differences in cardiovascular risk factors or demographics between the groups. After 2015, fewer patients with ATAAD underwent medical management alone (15% pre vs 4% post; P = .014), and most that underwent surgical intervention had a total arch or aggressive hemiarch repair (27% pre vs 78% post; P < .001). Seventy-four patients (73%) with ATBAD were treated medically, whereas 28 underwent medical management and endografting (23% pre, 34% post; P = .214). For all patients with AD, 30-day mortality was significantly improved (26% pre vs 10% post; P < .001) especially among patients who underwent ATAAD surgery (23% pre vs 9% post; P = .018). Three-year Kaplan-Meier survival estimates showed survival improvement among patients with ATAAD (Log rank P-value = .019); however, this improvement does not extend to type B dissections or the overall cohort. A survival analysis landmarked to 30 days after initial presentation showed no statistical difference in survival from 30 days to 3 years post-presentation. CONCLUSIONS A more comprehensive repair strategy in the management of patients with acute AD resulted in improved overall patient outcomes and significantly decreased 30-day mortality, even though more complex repairs were performed. The long-term impact of the changes made to our program remains to be evaluated.
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Affiliation(s)
- Jesse Manunga
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn; Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn.
| | - Jenna Smith
- Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Christian W Schmidt
- Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Jessica Titus
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Karol Mudy
- Section of Cardiovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Matthew P Pavlovec
- Section of Cardiology, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Benjamin Sun
- Section of Cardiovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Xiaoyi Teng
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Aleem Mirza
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Nedaa Skeik
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Amit Sharma
- Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Kevin M Harris
- Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn; Section of Cardiology, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
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8
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López Gómez A, Rodríguez R, Zebdi N, Ríos Barrera R, Forteza A, Legarra Calderón JJ, Garrido Martín P, Hernando B, Sanjuan A, González Bardanca S, Varela Martínez MÁ, Fernández FE, Llorens R, Valera Martínez FJ, Gómez Felices A, Aranda Granados PJ, Sádaba Sagredo R, Echevarría JR, Vicente Guillén R, Silva Guisasola J. Anaesthetic-surgical guide in the treatment of ascending aorta and surgery of the ascending aorta and aortic arch. Consensus document of the Spanish Society of Cardiovascular and Endovascular Surgery and the Sociedad of Anaesthesiology, Resuscitation and Pain Therapy. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00104-3. [PMID: 34304902 DOI: 10.1016/j.redar.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/03/2020] [Accepted: 02/09/2021] [Indexed: 10/20/2022]
Abstract
Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.
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Affiliation(s)
- A López Gómez
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - R Rodríguez
- Servicio de Cirugía Cardiaca, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - N Zebdi
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - R Ríos Barrera
- Servicio de Cirugía Cardiaca, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - A Forteza
- Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - P Garrido Martín
- Servicio de Cirugía Cardiaca, Hospital Universitario de Canarias, San Cristobal de La Laguna, España
| | - B Hernando
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Sanjuan
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Miguel Servet, Zaragoza, España
| | - S González Bardanca
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - M Á Varela Martínez
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Álvaro Cunqueiro, Vigo, España
| | - F E Fernández
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Central de Asturias, Oviedo, España
| | - R Llorens
- Servicio de Cirugía Cardiaca, Hospital Hospiten Rambla, Tenerife, España
| | - F J Valera Martínez
- Servicio de Cirugía Cardiaca, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - A Gómez Felices
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - P J Aranda Granados
- Servicio de Cirugía Cardiaca, Hospital Universitario Carlos Haya, Málaga, España
| | - R Sádaba Sagredo
- Servicio de Cirugía Cardiaca. Complejo Hospitalario de Navarra, Pamplona, España
| | - J R Echevarría
- Servicio de Cirugía Cardíaca. Hospital Universitario de Valladolid, Valladolid, España
| | - R Vicente Guillén
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J Silva Guisasola
- Servicio de Cirugía Cardíaca. Hospital Universitario Central de Asturias, Oviedo, España
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9
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Endovascular Treatment of Post Type A Chronic Aortic Arch Dissection With a Branched Endograft: Early Results From a Retrospective International Multicenter Study. Ann Surg 2021; 273:997-1003. [PMID: 30973389 DOI: 10.1097/sla.0000000000003310] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the outcome of endovascular aortic arch repair for chronic dissection with a custom-made branched endograft. BACKGROUND Acute type A aortic dissections are often treated with prosthetic replacement of the ascending aorta. During follow-up, repair of an aneurysmal evolution of the false lumen distal to the ascending prosthesis can be a challenge both for the surgeon and the patient. METHODS We conducted a multicenter, retrospective study of consecutive patients from 14 vascular units treated with a custom-made, inner-branched device (Cook Medical, Bloomington, IN) for chronic aortic arch dissection. Rates of in-hospital mortality and stroke, technical success, early and late complications, reinterventions, and mortality during follow-up were evaluated. RESULTS Seventy consecutive patients were treated between 2011 and 2018. All patients were considered unfit for conventional surgery. In-hospital combined mortality and stroke rate was 4% (n = 3), including 1 minor stroke, 1 major stroke causing death, and 1 death following multiorgan failure. Technical success rate was 94.3%. Twelve (17.1%) patients required early reinterventions: 8 for vascular access complication, 2 for endoleak correction, and 2 for pericardial effusion drainage. Median follow-up was 301 (138-642) days. During follow-up, 20 (29%) patients underwent secondary interventions: 9 endoleak corrections, 1 open repair for prosthetic kink, and 10 distal extensions of the graft to the thoracic or thoracoabdominal aorta. Eight patients (11%) died during follow-up because of nonaortic-related cause in 7 cases. CONCLUSIONS Endovascular treatment of aortic arch chronic dissections with a branched endograft is associated with low mortality and stroke rates but has a high reintervention rate. Further follow-up is required to confirm the benefits of this novel approach.
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Salem M, Friedrich C, Rusch R, Frank D, Hoffmann G, Lutter G, Berndt R, Cremer J, Haneya A, Puehler T. Is total arch replacement associated with an increased risk after acute type A dissection? J Thorac Dis 2020; 12:5517-5531. [PMID: 33209385 PMCID: PMC7656345 DOI: 10.21037/jtd-20-871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background The surgical strategy for acute type A aortic dissection (AADA) usually consists of reconstruction of the tear-lesion in the affected part of the ascending aorta. The optimal strategy either to replace the ascending aorta (AAR) or to replace the ascending aorta and the total aortic arch (TAAR) is still under debate. Our study compares the 30-day mortality between AAR and TAAR in AADA surgery. Methods In this retrospective observational study, we analysed a total patient cohort of 339 patients who underwent surgery for AADA from January 2001 until December 2016. A propensity score-matched analysis between the AAR- and the TAAR-group with 43 patients for each subgroup was subsequently carried out. A multivariable analysis was performed to identify risk-factors for the 30-d-mortality. The 30-day mortality was defined as the primary end-point and long-term survival was the secondary endpoint. Results In 292 (86.1%) patients AAR and in 47 (13.9%) patients TAAR was performed for emergent AADA. Patients were older (P=0.049) in the AAR group. The median log Euro-SCORE was 25.5% (12.7; 41.7) for AAR and 19.7% (11.7; 32.2) for the TAAR patient cohort (P=0.12). Operative time, cardiopulmonary bypass- (CPB), cross-clamp- and ischemic time were significantly longer in the TAAR group (P<0.001). The overall 30-day mortality-rate was 17.7% (n=60) but was not significantly different between the two groups (P=0.27). Forty-nine (16.8%) patients died in the AAR and 11 patients (23.4%) in the TAAR group. After propensity-score matching, no difference in mortality was seen between the subgroups as well (P=0.44). Multivariable analysis identified the Euro-SCORE, long operation-time, postoperative dialysis and arrhythmia and administration of red blood cell concentrates as risk factors for 30-day mortality, but not for TAAR versus AAR. Conclusions The therapeutic goal in AADA surgery should be the complete restoration of the aorta to avoid further long-term complications and re-operations. Though 30-day mortality and postoperative co-morbidity for AAR are comparable to those in TAAR after treatment of AADA in our analysis, decision-making for the surgical strategy should weigh the operative risk of TAAR against the long-term outcome.
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Affiliation(s)
- Mohamed Salem
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christine Friedrich
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Rene Rusch
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Derk Frank
- Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Grischa Hoffmann
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Rouven Berndt
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Repair of residual aortic dissections with frozen elephant trunk technique. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:419-425. [PMID: 32953203 DOI: 10.5606/tgkdc.dergisi.2020.19273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/26/2020] [Indexed: 11/21/2022]
Abstract
Background In this study, we present our mid-term results of reoperation with the frozen elephant trunk procedure due to patent false lumen-related complications in patients previously undergoing supracoronary aortic repair for acute type A aortic dissection. Methods Between January 2013 and September 2018, a total of 23 patients (17 males, 6 females; mean age 51.5±9.7 years; range, 30 to 67 years) who underwent ascending aortic replacement due to type A aortic dissection and, later, frozen elephant trunk procedure for residual distal dissection were included. For diagnostic purposes and follow-up, computed tomography angiography was performed in all patients, and both re-entry and aortic diameters were evaluated. Echocardiography was used to evaluate cardiac function and valve pathologies. Results The Ishimaru zone 0 (n=11, 47.8%), Ishimaru zone 1 (n=1, 4.3%), Ishimaru zone 2 (n=4, 17.4%), and Ishimaru zone 3 (n=7, 30.4%) were used for frozen elephant trunk stent graft fixation. The mean duration of cardiopulmonary bypass and antegrade selective cerebral perfusion was 223.9±71.2 min and 88.9±60.3 min, respectively. In-hospital mortality was 13%, while there was one (4.3%) aortic-related death and four (17.4%) re-interventions during follow-up. Conclusion Early repair should be considered in the presence of persistent dissections due to alarmingly high mortality rates of reoperations. Reoperation with the frozen elephant trunk procedure has acceptable results and the decision of the procedure to be performed should be based on preoperative risk factors of the patient.
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Fate of the Preserved Sinuses of Valsalva After Emergency Repair for Acute Type A Aortic Dissection. Ann Thorac Surg 2020; 110:1476-1483. [PMID: 32156587 DOI: 10.1016/j.athoracsur.2020.01.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/29/2019] [Accepted: 01/31/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patients with acute type A aortic dissection (ATAAD) present with heterogeneous involvement of the aortic root complex. Despite this variation, the aortic root can usually be preserved the majority of the time by Teflon (WL Gore, Newark, DE) inlay patch reconstruction of the dissected sinuses of Valsalva (SOV). In this study, we report the long term anatomic, functional, and clinical outcomes associated with the preserved SOV after surgery for ATAAD. METHODS From 2002-2017, of 776 emergency ATAAD operations at a single institution, 558 (71.9%) underwent valve resuspension with SOV preservation. Echocardiography reports were reviewed to obtain postoperative SOV dimensions. Cumulative incidence of SOV dilation ≥ 4 5mm was calculated using the Fine-Gray method with death as a competing risk. Repeated-measures linear mixed effects model was used to determine risk factors for SOV growth over time. RESULTS During the follow-up period, 62 of 558 (11.1%) patients developed SOV diameter ≥ 45 mm. Cumulative incidence of SOV dilation ≥ 45 mm at 1, 5, and 10 years was 5.5%, 12.4%, and 18.9% respectively. In a multivariable Cox regression model, preoperative SOV diameter ≥ 45 mm was associated with a hazard ratio of 14.11 (95% confidence interval 7.03-31.62) for postoperative SOV dilation ≥ 45 mm. In a repeated-measures linear mixed effects model, preoperative and discharge SOV diameter were significant predictors of SOV dilation. Postoperative time course was also identified as significant indicating growth over time. CONCLUSIONS The preserved sinuses of Valsalva after surgery for ATAAD may be prone to progressive dilatation over time. Closer echocardiographic surveillance may be warranted in these patients.
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López Gómez A, Rodríguez R, Zebdi N, Ríos Barrera R, Forteza A, Legarra Calderón JJ, Garrido Martín P, Hernando B, Sanjuan A, González S, Varela Martíne MÁ, Fernández FE, Llorens R, Valera Martínez FJ, Gómez Felices A, Aranda Granados PJ, Rafael Sádaba Sagredo, Echevarría JR, Silva Guisasola J. Guía anestésico-quirúrgica en el tratamiento de la cirugía de la aorta ascendente y del arco aórtico. Documento de consenso de las Sociedades Española de Cirugía Cardiovascular y Endovascular y la Sociedad Española de Anestesiología, Reanimación y Terapeútica del Dolor. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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14
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Concomitant true and false lumen "parallel thoracic endovascular aortic repair" as an endovascular alternative to open arch/descending aortic reconstruction for chronic DeBakey type I dissection with aneurysmal degeneration. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:557-560. [PMID: 31867472 PMCID: PMC6906654 DOI: 10.1016/j.jvscit.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/15/2019] [Indexed: 11/22/2022]
Abstract
A 77-year-old woman presented with symptomatic thoracic aortic aneurysm within a dissected thoracoabdominal aorta distal to a previous Dacron ascending aortic replacement. She was not a candidate for open repair and had no proximal landing zone for conventional thoracic endovascular aortic repair (TEVAR) resulting from dissection extension into the brachiocephalic vessels. A concomitant parallel graft true and false lumen TEVAR was performed from the distal aortic arch to diaphragm. Follow-up imaging demonstrated successful exclusion of the false lumen aneurysm and successful protection of the true lumen with the adjacent parallel TEVAR device.
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15
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Outcomes After Acute Type A Aortic Dissection in Patients With Prior Cardiac Surgery. Ann Thorac Surg 2019; 108:708-713. [DOI: 10.1016/j.athoracsur.2019.02.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/04/2019] [Accepted: 02/25/2019] [Indexed: 11/18/2022]
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16
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Akbulut M, Ak A, Arslan Ö, Çekmecelioğlu D, Taş S, Antal Dönmez A, Şişmanoğlu M, Tuncer MA. Early and mid-term results of frozen elephant trunk procedure for acute type A aortic dissection. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2019; 27:135-142. [PMID: 32082844 PMCID: PMC7021407 DOI: 10.5606/tgkdc.dergisi.2019.16879] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/02/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aims to investigate the early and mid-term results of total thoracic aorta repair with E-vita OPEN PLUS stent graft, which we used to remove the residual false lumen and prevent late-term complications in patients with acute type A aortic dissections. METHODS The study included 41 patients (29 males, 12 females; mean age 51.9±10.4 years; range, 30 to 77 years) who underwent total thoracic aorta repair with frozen elephant trunk stent graft for acute type A aortic dissection between November 2013 and November 2017. The reduction in false lumen size and thrombosis were evaluated by repeated computed tomographyangiography on 10th day and third, sixth, and 12th months. RESULTS Six patients (14.6%) were lost during hospital stay and one patient (2.4%) was lost during the follow-up period. Frozen elephant trunk stent graft"s distal end at descending aorta ended at T6, T7, and T8 levels in 15 (36.6%), 21 (51.2%), and five (12.2%) patients, respectively. The supra-aortic vessels were re-implanted separately in 21 (51.2%) or as island in 20 (48.8%) patients. Transient paraparesis (spinal cord ischemia) was observed in only one patient (2.4%), while permanent neurologic deficit (stroke or coma) was observed in two patients (4.9%). Mean duration of follow-up was 26.5±20.5 months. Computed tomography-angiography at first month showed that false lumen became thrombosed at rates of 93.9% and 54.5% at pulmonary trunk and diaphragmatic level, respectively. CONCLUSION We believe that total arcus repair in acute type A aortic dissection treatment with single-session frozen elephant trunk technique by ensuring early false lumen thrombosis is safe and successful.
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Affiliation(s)
- Mustafa Akbulut
- Department of Cardiovascular Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Adnan Ak
- Department of Cardiovascular Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Özgür Arslan
- Department of Cardiovascular Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Davut Çekmecelioğlu
- Department of Cardiovascular Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Serpil Taş
- Department of Cardiovascular Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Arzu Antal Dönmez
- Department of Cardiovascular Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Mesut Şişmanoğlu
- Department of Cardiovascular Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Altuğ Tuncer
- Department of Cardiovascular Surgery, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
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Kim JH, Choi JB, Kim TY, Kim KH, Kuh JH. Simplified surgical approach to improve surgical outcomes in the center with a small volume of acute type A aortic dissection surgery. Technol Health Care 2019; 26:675-685. [PMID: 29966210 PMCID: PMC6218144 DOI: 10.3233/thc-171169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND: Despite recent advances in surgical techniques and perioperative management, the surgical mortality of acute type A aortic dissection remains high. OBJECTIVE: In a hospital with few acute type A aortic dissection operations, we retrospectively investigated whether simplified surgical approach could obtain proper surgical outcomes. METHODS: Between October 2007 and December 2016, we performed emergency surgery in 99 patients who had acute type A aortic dissection, including replacement of the hemi-arch in 62 patients (63%) and total arch in 32 patients (32%) and aortic root surgery in 7 patients (7%). Surgical strategy has been simplified over time. RESULTS: We performed right axillary artery perfusion in 61 patients (62%) and antegrade cerebral perfusion in 78 patients (79%). During the last 3 years, in-hospital mortality was decreased to 4% (2/47). Preoperative unresolved shock was an independent predictor of hospital death. Although the patients with total arch replacement or aortic root surgery had a mean significantly long cardiopulmonary bypass or circulatory arrest time, in-hospital mortality or neurologic complications was not increased. CONCLUSIONS: Simplified surgical approach could provide a reasonable surgical outcome in acute type A aortic dissection surgery in a center with a small volume of acute aortic dissection surgery.
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Affiliation(s)
- Jong Hun Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Jeonju, Chonbuk, Korea.,Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Chonbuk, Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk, Korea.,Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Jeonju, Chonbuk, Korea
| | - Jong Bum Choi
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Jeonju, Chonbuk, Korea.,Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Chonbuk, Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk, Korea.,Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Jeonju, Chonbuk, Korea
| | - Tae Youn Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Jeonju, Chonbuk, Korea.,Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Jeonju, Chonbuk, Korea
| | - Kyung Hwa Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Jeonju, Chonbuk, Korea.,Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Jeonju, Chonbuk, Korea
| | - Ja Hong Kuh
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Jeonju, Chonbuk, Korea.,Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Jeonju, Chonbuk, Korea
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18
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Charchyan ER, Abugov SA, Khachatryan ZR, Puretsky MV, Khovrin VV, Skvortsov AA, Belov YV. Postoperative care in patients with DeBakey type I aortic dissection: criteria of aortic remodeling and risk factors of disease progression. Khirurgiia (Mosk) 2019:6-17. [PMID: 31169813 DOI: 10.17116/hirurgia20190516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM To present current treatment modes for DeBakey type I aortic dissection, to compare their early and mid-term postoperative results, to evaluate predictors of negative aortic remodeling after surgery. MATERIAL AND METHODS Retrospective cohort analysis included 78 patients with DeBakey type I aortic dissection who underwent surgical treatment in 2009-2017. Patients were divided into 3 groups depending on type of intervention: group I (n=22) - Elephant Trunk procedure, group II (n=29) - hybrid interventions, group III (n=27) - proximal aortic replacement alone. Early postoperative results and aortic remodeling in mid-term postoperative period were compared. RESULTS There were no significant differences in postoperative morbidity, in-hospital mortality and freedom from aortic death. However, 7 patients were lost for follow-up in group III. Analysis of false lumen patency showed results in favor of more aggressive approach (groups I and II) with significantly higher rate of false lumen thrombosis in segments 1 and 2 (p<0,001 and p=0,004 respectively). Freedom from negative aortic remodeling was also significantly higher in groups I and II. Risk factors of patent false lumen were residual fenestration, large volume of false lumen in segment 2, dissection of supra-aortic vessels and connective tissue disorders. Risk factors of negative aortic remodeling were connective tissue disorders, patent false lumen and dissection of supra-aortic vessels. CONCLUSION Advanced surgical approach (Elephant Trunk procedure or hybrid interventions) should be preferred for DeBakey type I aortic dissection.
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Affiliation(s)
- E R Charchyan
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - S A Abugov
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - Z R Khachatryan
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - M V Puretsky
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - V V Khovrin
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - A A Skvortsov
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - Yu V Belov
- Petrovsky Russian Research Center for Surgery, Moscow, Russia
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Spear R, Hertault A, Van Calster K, Settembre N, Delloye M, Azzaoui R, Sobocinski J, Fabre D, Tyrrell M, Haulon S. Complex endovascular repair of postdissection arch and thoracoabdominal aneurysms. J Vasc Surg 2018; 67:685-693. [DOI: 10.1016/j.jvs.2017.09.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022]
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20
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Pan E, Kytö V, Savunen T, Gunn J. Early and late outcomes after open ascending aortic surgery: 47-year experience in a single centre. Heart Vessels 2017; 33:427-433. [PMID: 29170887 PMCID: PMC5861156 DOI: 10.1007/s00380-017-1075-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 11/01/2017] [Indexed: 11/30/2022]
Abstract
The aims of the study are to describe the long-term survival of patients undergoing primary open ascending aortic surgery and to portray the evolution of aortic surgery during six decades in a single centre. Included were all 614 patients who underwent primary ascending aortic surgery in 1968–2014 at one Nordic university hospital. Patients were identified and data were collected from patient records and surgical logs. Mortality data were acquired from the national registry. Median follow-up was 11.2 years using reverse Kaplan–Meier method. Overall 30-day survival was 91.2% and for 30-day survivor rates were 86.9, 77.6, 52.1, 38.3 and 26.7% at 5, 10, 20, 30 and 40 years. There was no significant difference in long-term survival for 30-day survivors (p = 0.105) between patients treated emergently for dissection/rupture and electively (mainly ascending aortic aneurysms). On Cox regression era of surgery (p = 0.006), increasing age (p < 0.001) and indication (p < 0.001) were predictors of 30-day mortality. Arch involvement indicated twofold risk (HR 2.09, p = 0.05) compared to non-arch involved. Only increasing age (p < 0.001) predicted long-term mortality. There was a sixfold risk of 30-day mortality in the earliest era compared to the latest (p = 0.03). After the early postoperative phase following ascending aortic surgery, the surgical indication and urgency of the index operation have no significant impact on long-term survival. The very long term survival after ascending aortic surgery is excellent for 30-day survivors and improved through the era. Surgical treatment has improved and perioperative mortality has decreased significantly in 47 years.
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Affiliation(s)
- Emily Pan
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Timo Savunen
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
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Olsson C, Ahlsson A, Fuglsang S, Geirsson A, Gunn J, Hansson EC, Hjortdal V, Jarvela K, Jeppsson A, Mennander A, Nozohoor S, Wickbom A, Zindovic I, Gudbjartsson T. Medium-term survival after surgery for acute Type A aortic dissection is improving. Eur J Cardiothorac Surg 2017; 52:852-857. [DOI: 10.1093/ejcts/ezx302] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 07/07/2017] [Indexed: 11/12/2022] Open
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Berretta P, Di Eusanio M. Descending endograft for DeBakey type 1 aortic dissection: pro. Ann Cardiothorac Surg 2016; 5:222-6. [PMID: 27386410 DOI: 10.21037/acs.2016.03.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The surgical management of patients with DeBakey type 1 acute aortic dissection (DBT1-AAD) represents a major challenge for aortic surgeons. It has been demonstrated that the distal false lumen remains patent in about 70% to 80% of patients undergoing DBT1-AAD surgery and that a patent false lumen worsens the prognosis. In order to improve long term outcomes and reduce the frequency of late aneurysm formation and reoperation, a more aggressive primary operation involving total arch replacement (TAR) and concomitant antegrade stenting of the descending thoracic aorta (DTA) with a frozen elephant trunk (FET) has been introduced. Such extensive operations, however, remain controversial due to their increased technical complexity and perceived higher operative mortality and morbidity. This perspective article will overview the rationale behind, and the potential advantages and current evidence for, FET surgery in acute aortic dissection.
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Affiliation(s)
- Paolo Berretta
- Division of Cardiac Surgery, G. Mazzini Hospital, Teramo, Italy
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Castrovinci S, Pacini D, Di Marco L, Berretta P, Cefarelli M, Murana G, Alfonsi J, Pantaleo A, Leone A, Di Eusanio M, Di Bartolomeo R. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis. Eur J Cardiothorac Surg 2016; 50:223-9. [DOI: 10.1093/ejcts/ezw038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 01/11/2016] [Indexed: 11/12/2022] Open
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Yu PJ, Cassiere HA, Kohn N, Dellis SL, Manetta F, Esposito RA, Hartman AR. Utility of Established Risk Models to Predict Surgical Mortality in Acute Type-A Aortic Dissection. J Cardiothorac Vasc Anesth 2016; 30:39-43. [DOI: 10.1053/j.jvca.2015.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Indexed: 11/11/2022]
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Kalkan ME, Kalkan AK, Gündeş A, Yanartaş M, Oztürk S, Gurbuz AS, Ozturk D, Iyigun T, Akcakoyun M, Emiroglu MY, Tuncer MA, Koksal C. Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection. Perfusion 2015; 32:321-327. [PMID: 26467992 DOI: 10.1177/0267659115590625] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: The inflammatory process has been reported to be associated with aortic dissection (AD) from the development to the prognosis. The aim of the study was to investigate a relationship between the neutrophil to lymphocyte ratio (NLR) and in-hospital outcomes in patients with acute aortic dissection (AAD) who underwent surgical repair. Methods: One hundred and eighty-four patients who were admitted with the diagnosis of type A AAD who underwent surgical repair at two large tertiary hospitals. According to their NLR, 91 patients had high NLR (>6.0) and 93 patients had low NLR (⩽6.0). Results: The frequency of major bleeding, hospital-related infection, multi-organ dysfunction and mortality in hospital were higher in the high NLR group compared to the low NLR group. NLR, WBC count and operation duration were found to be independent predictors for in-hospital mortality. Conclusions: The novel inflammatory marker NLR may be used to predict worse outcomes and hospital mortality in patients with AAD treated by surgical repair.
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Affiliation(s)
- Mehmet Emin Kalkan
- Kartal Kosuyolu Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Ali Kemal Kalkan
- Mehmet Akif Ersoy Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Ahmet Gündeş
- Mersin University School of Medicine, Cardiology Department, Mersin, Turkey
| | - Mehmed Yanartaş
- Kartal Kosuyolu Education and Research Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Semi Oztürk
- Kartal Kosuyolu Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Ahmet Seyfeddin Gurbuz
- Kartal Kosuyolu Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Derya Ozturk
- Mehmet Akif Ersoy Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Taner Iyigun
- Mehmet Akif Ersoy Education and Research Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Mustafa Akcakoyun
- Kartal Kosuyolu Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Mehmet Yunus Emiroglu
- Kartal Kosuyolu Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Mehmet Altuğ Tuncer
- Kartal Kosuyolu Education and Research Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Cengiz Koksal
- Kartal Kosuyolu Education and Research Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
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26
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Settepani F, Cappai A, Basciu A, Barbone A, Citterio E, Ornaghi D, Tarelli G. Hybrid Versus Conventional Treatment of Acute Type A Aortic Dissection. J Card Surg 2015. [DOI: 10.1111/jocs.12598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Fabrizio Settepani
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Antioco Cappai
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Alessio Basciu
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Alessandro Barbone
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Enrico Citterio
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Diego Ornaghi
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Giuseppe Tarelli
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
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27
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Late reoperations after acute aortic dissection repair: Single-center experience. Asian Cardiovasc Thorac Ann 2015; 23:787-94. [DOI: 10.1177/0218492315584523] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background After repair of acute type A aortic dissection, aortic complications can develop, and reoperations might be necessary. In our retrospective study, we wanted to assess early and late outcomes in this cohort of patients. Methods From September 2005 to July 2012, 21 consecutive patients previously operated on for acute type A aortic dissection underwent 27 redo aortic surgical procedures. Indications for redo procedures were: enlargement of the false lumen in the residual aorta (18 events), severe aortic regurgitation with or without aortic root dilatation (8 events), suture dehiscence and pseudoaneurysm at the proximal or distal aortic graft anastomosis (5 events) or at the coronary button anastomosis in patients who previously underwent a Bentall procedure (1 patient). In all cases, total or partial cardiopulmonary bypass was used. Hypothermic cardiocirculatory arrest was needed in 22 (81%) procedures. Results Hospital mortality was 3.7% (1/27), reexploration for bleeding and paraplegia rates were 7.4% and 7.4%, respectively. Marfan patients received 3.2 procedures per patient vs. 1.5 in non-Marfan patients ( p < 0.01). At a mean follow-up of 6.5 years, 2 aortic events occurred: 1 aortic death, and 1 additional aortic redo surgery. Conclusions When procedures are carried out on elective basis, redo aortic surgery can be performed in all segments of the aorta with good early and late outcomes. Close lifelong clinical and radiological follow-up is mandatory. After repair of acute type A aortic dissection, Marfan patients are more prone to develop late complications, with a more rapid evolution.
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28
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Bajona P, Quintana E, Schaff HV, Daly RC, Dearani JA, Greason KL, Pochettino A. Aortic arch surgery after previous type A dissection repair: results up to 5 years. Interact Cardiovasc Thorac Surg 2015; 21:81-5; discussion 85-6. [DOI: 10.1093/icvts/ivv036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/23/2015] [Indexed: 11/14/2022] Open
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29
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El-Sayed Ahmad A, Papadopoulos N, Detho F, Srndic E, Risteski P, Moritz A, Zierer A. Surgical Repair for Acute Type A Aortic Dissection in Octogenarians. Ann Thorac Surg 2015; 99:547-51. [DOI: 10.1016/j.athoracsur.2014.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/28/2014] [Accepted: 08/06/2014] [Indexed: 11/28/2022]
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30
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Di Bartolomeo R, Pantaleo A, Berretta P, Murana G, Castrovinci S, Cefarelli M, Folesani G, Di Eusanio M. Frozen elephant trunk surgery in acute aortic dissection. J Thorac Cardiovasc Surg 2015; 149:S105-9. [DOI: 10.1016/j.jtcvs.2014.07.098] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/26/2014] [Accepted: 07/24/2014] [Indexed: 10/24/2022]
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31
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Wang Z, Greason KL, Pochettino A, Schaff HV, Suri RM, Stulak JM, Dearani JA. Long-term outcomes of survival and freedom from reoperation on the aortic root or valve after surgery for acute ascending aorta dissection. J Thorac Cardiovasc Surg 2014; 148:2117-22. [DOI: 10.1016/j.jtcvs.2013.12.059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/25/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
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32
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Bashir M, Fok M, Shaw M, Field M, Kuduvalli M, Desmond M, Harrington D, Rashid A, Oo A. Liverpool Aortic Surgery Symposium V: New Frontiers in Aortic Disease and Surgery. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:100-9. [PMID: 26798724 DOI: 10.12945/j.aorta.2014.13-051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 04/09/2014] [Indexed: 11/18/2022]
Abstract
Aortic aneurysm disease is a complex condition that requires a multidisciplinary approach in management. The innovation and collaboration among vascular surgery, cardiothoracic surgery, interventional radiology, and other related specialties is essential for progress in the management of aortic aneurysms. The Fifth Liverpool Aortic Surgery Symposium that was held in May 2013 aimed at bringing national and international experts from across the United Kingdom and the globe to deliver their thoughts, applications, and advances in aortic and vascular surgery. In this report, we present a selected short synopsis of the key topics presented at this symposium.
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Affiliation(s)
- Mohamad Bashir
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Fok
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Shaw
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Michael Desmond
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Abbas Rashid
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Aung Oo
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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33
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Ergüneş K, Yilik L, Yurekli I, Celik E, Gurbuz A. Surgery for false aneurysm developing after type A acute aortic dissection. Asian Cardiovasc Thorac Ann 2014; 23:1090-2. [PMID: 24803546 DOI: 10.1177/0218492314534248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic false aneurysm is life-threatening with high morbidity and mortality rates. Surgical treatment varies according to the pathologic process, infection status, and site of origin of the aneurysm. We presented a case of false aneurysm of the ascending aorta, developing after type A acute aortic dissection repair. The operation was performed with the use of deep hypothermia and circulatory arrest to avoid massive uncontrollable hemorrhage.
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Affiliation(s)
- Kazım Ergüneş
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Levent Yilik
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ismail Yurekli
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ersin Celik
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ali Gurbuz
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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34
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Lower heart rate in the early postoperative period does not correlate with long-term outcomes after repair of type A acute aortic dissection. Heart Vessels 2014; 30:355-61. [PMID: 24566590 PMCID: PMC4427614 DOI: 10.1007/s00380-014-0486-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 02/07/2014] [Indexed: 11/22/2022]
Abstract
Little evidence exists regarding the need for a reduction in postoperative heart rate after repair of type A acute aortic dissection. This single-center retrospective study was conducted to determine if lower heart rate during the early postoperative phase is associated with improved long-term outcomes after surgery for patients with type A acute aortic dissection. We reviewed 434 patients who underwent aortic repair between 1990 and 2011. Based on the average heart rate on postoperative days 1, 3, 5, and 7, 434 patients were divided into four groups, less than 70, 70–79, 80–89, and greater than 90 beats per minute. The mean age was 63.3 ± 12.1 years. During a median follow-up of 52 months (range 16–102), 10-year survival in all groups was 67 %, and the 10-year aortic event-free rate was 79 %. The probability of survival and being aortic event-free using Kaplan–Meier estimates reveal that there is no significant difference when stratified by heart rate. Cox proportional regression analysis for 10-year mortality shows that significant predictors of mortality are age [Hazard Ratio (HR) 1.04; 95 % confidence interval (CI) 1.07–1.06; p = 0.001] and perioperative stroke (HR 2.30; 95 % CI 1.18–4.50; p = 0.024). Neither stratified heart rate around the time of surgery nor beta-blocker use at the time of discharge was significant. There is no association between stratified heart rate in the perioperative period with long-term outcomes after repair of type A acute aortic dissection. These findings need clarification with further clinical trials.
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35
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McFarland-Kennedy M, Murtaza G, Hossein Almassi G, Rashid ZA, Pagel PS. A widened mediastinum in an asymptomatic man with a remote history of repaired type-A aortic dissection. J Cardiothorac Vasc Anesth 2014; 28:1167-70. [PMID: 24529410 DOI: 10.1053/j.jvca.2013.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | - Ghulam Murtaza
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Zahir A Rashid
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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36
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Dell'Aquila AM, Concistrè G, Gallo A, Pansini S, Piccardo A, Passerone G, Regesta T. Fate of the preserved aortic root after treatment of acute type A aortic dissection: 23-year follow-up. J Thorac Cardiovasc Surg 2013; 146:1456-60. [DOI: 10.1016/j.jtcvs.2012.09.049] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/18/2012] [Accepted: 09/20/2012] [Indexed: 10/27/2022]
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37
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Di Eusanio M, Castrovinci S, Tian DH, Folesani G, Cefarelli M, Pantaleo A, Murana G, Berretta P, Yan TD, Bartolomeo RD. Antegrade stenting of the descending thoracic aorta during DeBakey type 1 acute aortic dissection repair. Eur J Cardiothorac Surg 2013; 45:967-75. [DOI: 10.1093/ejcts/ezt493] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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38
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Gebhard C, Biaggi P, Stähli BE, Schwarz U, Felix C, Falk V. Complete graft dehiscence 8 months after repair of acute type A aortic dissection. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 2:72-6. [PMID: 24062936 DOI: 10.1177/2048872612471214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 11/24/2012] [Indexed: 11/16/2022]
Abstract
Acute type A aortic dissection is a dreaded differential diagnosis of acute chest pain. Long-term outcome mainly depends on pre-existing comorbidities and post-operative complications. We present a patient with aortic graft dehiscence and subsequent severe aortic regurgitation due to fungal graft infection 8 months after repair of acute type A aortic dissection. Redo aortic surgery had to be delayed for 28 days due to intracerebral haemorrhage caused by septic embolism and clipping of a mycotic left middle cerebral artery aneurysm. Surgery revealed a circumferentially detached graft at the site of the proximal anastomosis thereby forming a massive pseudoaneurysm. The patient underwent successful aortic root replacement using a Freestyle porcine root bioprosthesis (25 mm), followed by re-anastomosis of the coronary arteries and partial replacement of the ascending aorta with a 28 mm Dacron graft. The patient was discharged on day 67 in stable cardiac condition with persistent neurological deficits. This case highlights the challenging management of patients with aortic graft infection and neurological dysfunction after redissection of the ascending aorta who require redo cardiac surgery.
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Affiliation(s)
- Cathérine Gebhard
- University Hospital Zurich, Zurich, Switzerland ; Montreal Heart Institute, Montreal, Canada
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39
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Appoo JJ, Pozeg Z. Strategies in the surgical treatment of type A aortic arch dissection. Ann Cardiothorac Surg 2013; 2:205-11. [PMID: 23977584 DOI: 10.3978/j.issn.2225-319x.2013.01.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/23/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Jehangir J Appoo
- Libin Cardiovascular Institute of Alberta, Division of Cardiac Surgery, Department of Cardiac Sciences and Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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40
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Olsson C, Hillebrant CG, Liska J, Lockowandt U, Eriksson P, Franco-Cereceda A. Mortality and reoperations in survivors operated on for acute type A aortic dissection and implications for catheter-based or hybrid interventions. J Vasc Surg 2013; 58:333-339.e1. [DOI: 10.1016/j.jvs.2012.12.078] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/21/2012] [Accepted: 12/26/2012] [Indexed: 11/29/2022]
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41
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Numata S, Tsutsumi Y, Monta O, Yamazaki S, Seo H, Yoshida S, Samura T, Ohashi H. Mid-Long-Term Results After Aortic Arch Repair Using a Four-Branched Graft With Antegrade Selective Cerebral Perfusion. J Card Surg 2013; 28:537-42. [DOI: 10.1111/jocs.12166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Satoshi Numata
- Department of Cardiovascular Surgery; Fukui Cardiovascular Center; Fukui Japan
| | - Yasushi Tsutsumi
- Department of Cardiovascular Surgery; Fukui Cardiovascular Center; Fukui Japan
| | - Osamu Monta
- Department of Cardiovascular Surgery; Fukui Cardiovascular Center; Fukui Japan
| | - Sachiko Yamazaki
- Department of Cardiovascular Surgery; Fukui Cardiovascular Center; Fukui Japan
| | - Hiroyuki Seo
- Department of Cardiovascular Surgery; Fukui Cardiovascular Center; Fukui Japan
| | - Shohei Yoshida
- Department of Cardiovascular Surgery; Fukui Cardiovascular Center; Fukui Japan
| | - Takaaki Samura
- Department of Cardiovascular Surgery; Fukui Cardiovascular Center; Fukui Japan
| | - Hirokazu Ohashi
- Department of Cardiovascular Surgery; Fukui Cardiovascular Center; Fukui Japan
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42
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Abstract
Patients with aortic disease are some of the highest acuity patients that emergency clinicians encounter. Dissection is the most common aortic catastrophe and involves separation of the aortic layers in a longitudinal fashion leading to diminished perfusion and systemic ischemia. Characteristics of pain, branch vessel involvement, and incidence lead to an understanding of patient presentation, morbidity, and mortality. Diagnosis, selection of diagnostic studies, the degree of preoperative ischemia, and risk of operative mortality can be accomplished using validated clinical decision tools. Emergency interventions are guided by the type of dissection according to the Stanford classification system. Medical management includes pain control and anti-impulse, antihypertensive therapy through vasodilatation and blockage of the sympathetic β-response. The patient may then be evaluated for open surgical intervention, aortic fenestration, endovascularly placed stent grafts, or a combination possibly in a staged approach. Morbidity includes rupture, stroke, paraplegia, acute renal failure, bowel ischemia, and peripheral ischemia.
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43
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Song SW, Yoo KJ, Shin YR, Lim SH, Cho BK. Effects of intermittent lower body perfusion on end-organ function during repair of acute DeBakey type I aortic dissection under moderate hypothermic circulatory arrest. Eur J Cardiothorac Surg 2013; 44:1070-4; discussion 1074-5. [DOI: 10.1093/ejcts/ezt145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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44
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Malvindi PG, van Putte BP, Sonker U, Heijmen RH, Schepens MA, Morshuis WJ. Reoperation After Acute Type A Aortic Dissection Repair: A Series of 104 Patients. Ann Thorac Surg 2013; 95:922-7. [DOI: 10.1016/j.athoracsur.2012.11.029] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/09/2012] [Accepted: 11/13/2012] [Indexed: 11/30/2022]
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45
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Evangelista A, Salas A, Ribera A, Ferreira-González I, Cuellar H, Pineda V, González-Alujas T, Bijnens B, Permanyer-Miralda G, Garcia-Dorado D. Long-Term Outcome of Aortic Dissection With Patent False Lumen. Circulation 2012; 125:3133-41. [DOI: 10.1161/circulationaha.111.090266] [Citation(s) in RCA: 266] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Patent false lumen in aortic dissection has been associated with poor prognosis. We aimed to assess the natural evolution of this condition and predictive factors.
Methods and Results—
One hundred eighty-four consecutive patients, 108 surgically treated type A and 76 medically treated type B, were discharged after an acute aortic dissection with patent false lumen. Transesophageal echocardiography was performed before discharge, and computed tomography was performed at 3 months and yearly thereafter. Median follow-up was 6.42 years (quartile 1 to quartile 3: 3.31–10.49). Forty-nine patients died during follow-up (22 type A, 27 type B), 31 suddenly. Surgical or endovascular treatment was indicated in 10 type A and 25 type B cases. Survival free from sudden death and surgical-endovascular treatment was 0.90, 0.81, and 0.46 (95% CI, 0.36–0.55) at 3, 5, and 10 years, respectively. Multivariate analysis identified baseline maximum descending aorta diameter (hazard ratio [HR]: 1.32 [1.10–1.59];
P
=0.003), proximal location (HR: 1.84 [1.06–3.19];
P
=0.03), and entry tear size (HR: 1.13 [1.08–1.2];
P
<0.001) as predictors of dissection-related adverse events, whereas mortality was predicted by baseline maximum descending aorta diameter (HR: 1.36 [1.08–1.70];
P
=0.008), entry tear size (HR: 1.1 [1.04–1.16];
P
=0.001), and Marfan syndrome (HR: 3.66 [1.65–8.13];
P
=0.001).
Conclusions—
Aortic dissection with persistent patent false lumen carries a high risk of complications. In addition to Marfan syndrome and aorta diameter, a large entry tear located in the proximal part of the dissection identifies a high-risk subgroup of patients who may benefit from earlier and more aggressive therapy.
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Affiliation(s)
- Artur Evangelista
- From the Servei de Cardiologia (A.E., A.S., A.R., I.F.-G., T.G.-A., B.B., G.P.-M., D.G.-D.), Institut de Diagnòstic per la Imatge (H.C., V.P.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona; Unitat de Epidemiologia, CIBER de Epidemiología y Salud Pública (CIBERESP) (A.R., I.F.-G., G.P.-M.); and Institució Catalana de Recerca i Estudis Avançats (B.B.), Barcelona, Spain
| | - Armando Salas
- From the Servei de Cardiologia (A.E., A.S., A.R., I.F.-G., T.G.-A., B.B., G.P.-M., D.G.-D.), Institut de Diagnòstic per la Imatge (H.C., V.P.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona; Unitat de Epidemiologia, CIBER de Epidemiología y Salud Pública (CIBERESP) (A.R., I.F.-G., G.P.-M.); and Institució Catalana de Recerca i Estudis Avançats (B.B.), Barcelona, Spain
| | - Aida Ribera
- From the Servei de Cardiologia (A.E., A.S., A.R., I.F.-G., T.G.-A., B.B., G.P.-M., D.G.-D.), Institut de Diagnòstic per la Imatge (H.C., V.P.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona; Unitat de Epidemiologia, CIBER de Epidemiología y Salud Pública (CIBERESP) (A.R., I.F.-G., G.P.-M.); and Institució Catalana de Recerca i Estudis Avançats (B.B.), Barcelona, Spain
| | - Ignacio Ferreira-González
- From the Servei de Cardiologia (A.E., A.S., A.R., I.F.-G., T.G.-A., B.B., G.P.-M., D.G.-D.), Institut de Diagnòstic per la Imatge (H.C., V.P.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona; Unitat de Epidemiologia, CIBER de Epidemiología y Salud Pública (CIBERESP) (A.R., I.F.-G., G.P.-M.); and Institució Catalana de Recerca i Estudis Avançats (B.B.), Barcelona, Spain
| | - Hug Cuellar
- From the Servei de Cardiologia (A.E., A.S., A.R., I.F.-G., T.G.-A., B.B., G.P.-M., D.G.-D.), Institut de Diagnòstic per la Imatge (H.C., V.P.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona; Unitat de Epidemiologia, CIBER de Epidemiología y Salud Pública (CIBERESP) (A.R., I.F.-G., G.P.-M.); and Institució Catalana de Recerca i Estudis Avançats (B.B.), Barcelona, Spain
| | - Victor Pineda
- From the Servei de Cardiologia (A.E., A.S., A.R., I.F.-G., T.G.-A., B.B., G.P.-M., D.G.-D.), Institut de Diagnòstic per la Imatge (H.C., V.P.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona; Unitat de Epidemiologia, CIBER de Epidemiología y Salud Pública (CIBERESP) (A.R., I.F.-G., G.P.-M.); and Institució Catalana de Recerca i Estudis Avançats (B.B.), Barcelona, Spain
| | - Teresa González-Alujas
- From the Servei de Cardiologia (A.E., A.S., A.R., I.F.-G., T.G.-A., B.B., G.P.-M., D.G.-D.), Institut de Diagnòstic per la Imatge (H.C., V.P.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona; Unitat de Epidemiologia, CIBER de Epidemiología y Salud Pública (CIBERESP) (A.R., I.F.-G., G.P.-M.); and Institució Catalana de Recerca i Estudis Avançats (B.B.), Barcelona, Spain
| | - Bart Bijnens
- From the Servei de Cardiologia (A.E., A.S., A.R., I.F.-G., T.G.-A., B.B., G.P.-M., D.G.-D.), Institut de Diagnòstic per la Imatge (H.C., V.P.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona; Unitat de Epidemiologia, CIBER de Epidemiología y Salud Pública (CIBERESP) (A.R., I.F.-G., G.P.-M.); and Institució Catalana de Recerca i Estudis Avançats (B.B.), Barcelona, Spain
| | - Gaietà Permanyer-Miralda
- From the Servei de Cardiologia (A.E., A.S., A.R., I.F.-G., T.G.-A., B.B., G.P.-M., D.G.-D.), Institut de Diagnòstic per la Imatge (H.C., V.P.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona; Unitat de Epidemiologia, CIBER de Epidemiología y Salud Pública (CIBERESP) (A.R., I.F.-G., G.P.-M.); and Institució Catalana de Recerca i Estudis Avançats (B.B.), Barcelona, Spain
| | - David Garcia-Dorado
- From the Servei de Cardiologia (A.E., A.S., A.R., I.F.-G., T.G.-A., B.B., G.P.-M., D.G.-D.), Institut de Diagnòstic per la Imatge (H.C., V.P.), Hospital Vall d'Hebron, Universitat Autonoma de Barcelona; Unitat de Epidemiologia, CIBER de Epidemiología y Salud Pública (CIBERESP) (A.R., I.F.-G., G.P.-M.); and Institució Catalana de Recerca i Estudis Avançats (B.B.), Barcelona, Spain
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Bekkers JA, Bol Raap G, Takkenberg JJ, Bogers AJ. Acute type A aortic dissection: long-term results and reoperations. Eur J Cardiothorac Surg 2012; 43:389-96. [DOI: 10.1093/ejcts/ezs342] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Salah K, van Straten AHM, Soliman Hamad MA, ter Woorst JF, Tan MESH. Evolution of cerebral perfusion techniques in type a aortic dissection surgery: a single center experience. Perfusion 2012; 27:363-70. [PMID: 22611026 DOI: 10.1177/0267659112448411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the effect of using antegrade selective cerebral perfusion (ASCP) with moderate hypothermia on hospital mortality after surgery for acute type A aortic dissection (AAAD). METHODS Between January 1998 and December 2008, 142 consecutive patients were operated on for AAAD. Patients were divided into two subgroups: the cohort of patients operated on from January 1998 until December 2003 (without ASCP) (P1998-2003, n=64) and the cohort operated on from January 2004 until December 2008 (with ASCP)(P2004-2008, n=78). RESULTS The difference in hospital mortality was statistically significant (P1998-2003: 42.2%; P2004-2008: 14.1%, p<0.0005). Survival rates were 51.6±6.2% vs. 75.1±5.5% and 45.9±6.2% vs. 69.7±7.3% for one and four years, respectively (p=0.001). Multivariate logistic regression analysis revealed that ASCP was the only independent protective factor of hospital mortality (p=0.047). CONCLUSION In patients operated on for AAAD, antegrade selective cerebral perfusion with moderate hypothermia is a significant factor in decreasing hospital mortality.
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Affiliation(s)
- K Salah
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
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Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. J Am Coll Cardiol 2012; 58:2455-74. [PMID: 22133845 DOI: 10.1016/j.jacc.2011.06.067] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 06/07/2011] [Indexed: 01/11/2023]
Abstract
Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.
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Ong B, Harvey M, Cave G. Images in emergency medicine: giant ascending aortic aneurysm dissection with hemopericardium. World J Emerg Med 2012; 3:235-6. [PMID: 25215070 DOI: 10.5847/wjem.j.issn.1920-8642.2012.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 02/11/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute chest pain represents a common presentation at emergency department. Aortic dissection in young patients, however, is fortunately rare. METHODS We report a case of giant ascending aortic aneurysm with Stanford type A aortic dissection in an otherwise well 22-year-old male patient. Operative aortic valve and root replacement was undertaken with favourable outcome. RESULTS Histopathologic examination of the resected aorta revealed acute on chronic inflammatory change with Langerhans type giant cells consistent with a diagnosis of giant cell aortitis. CONCLUSION While uncommon, emergencies of the aorta may present in young patients. Predisposing conditions are discussed.
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Affiliation(s)
- Boon Ong
- Emergency Medicine Department, Waikato Hospital, Hamilton, New Zealand
| | - Martyn Harvey
- Emergency Medicine Department, Waikato Hospital, Hamilton, New Zealand
| | - Grant Cave
- Emergency Medicine Department, Hutt Hospital, Lower Hutt, New Zealand
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van Putte BP, Ozturk S, Siddiqi S, Schepens MAAM, Heijmen RH, Morshuis WJ. Early and late outcome after aortic root replacement with a mechanical valve prosthesis in a series of 528 patients. Ann Thorac Surg 2011; 93:503-9. [PMID: 22200369 DOI: 10.1016/j.athoracsur.2011.07.089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/26/2011] [Accepted: 07/29/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Aortic root replacement with a mechanical valve prosthesis is a widely accepted surgical technique. This study aims to evaluate short-term and long-term outcomes of this approach and to identify predictors of 30-day mortality. METHODS We retrospectively analyzed a consecutive series of 528 patients (mean age, 54±13 years) who underwent aortic root replacement for aneurysm (83%), acute type A dissection (15%), or endocarditis (2%) in the period between 1974 and 2008. The mean time of follow-up was 9.0±7.0 years (range, 0 to 36 years). Concomitant aortic surgery was performed in 71%, coronary revascularization in 18%, and mitral valve surgery in 3%. Selective antegrade cerebral perfusion was applied in 25% and deep hypothermic circulatory arrest in 28% of patients. RESULTS Overall 30-day mortality was 3.2% to 2.5% for elective surgery and 6.5% for urgent surgery. Morbidity included resternotomy for bleeding or tamponade (19%), pacemaker implantation (3.6%), myocardial infarction (4.0%), and neurologic damage (4.2%). Multivariate analysis revealed myocardial infarction (p<0.001) and the lack of glue use (p=0.018) as independent predictors of 30-day mortality. Subanalysis of the selective antegrade cerebral perfusion patients and the deep hypothermic circulatory arrest patients revealed infarction (p=0.005) and coronary artery disease (p=0.45) for selective antegrade cerebral perfusion and wrapping (p=0.035) for deep hypothermic circulatory arrest as independent risk factors. The survival rate was 87%, 73%, and 29% after 5, 10, and 25 years, respectively. CONCLUSIONS Aortic root replacement with a mechanical valve prosthesis can be performed safely with low mortality and acceptable morbidity. Perioperative myocardial infarction is the strongest independent risk factor of 30-day mortality.
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Affiliation(s)
- Bart P van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
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