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Masraf H, Navaratnarajah M, Viola L, Sef D, Malvindi PG, Miskolczi S, Velissaris T, Luthra S. Perioperative and Long-Term Outcomes of Acute Stanford Type A Aortic Dissection Repair in Octogenarians. Med Sci (Basel) 2024; 12:45. [PMID: 39311158 PMCID: PMC11417756 DOI: 10.3390/medsci12030045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/20/2024] [Accepted: 08/28/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND The aims of this study were to assess the perioperative morbidity, mortality and long-term survival of octogenarians undergoing acute type A aortic dissection repair (ATAAD), and to compare open and closed distal anastomosis techniques. METHODS This was a single-centre retrospective study (2007-2021). Open versus closed distal anastomosis were compared. Uni- and multivariable logistic regression analyses were performed to identify independent predictors of in-hospital mortality. Kaplan-Meier and Cox proportional hazards methods were used to compare long-term survival. RESULTS Fifty octogenarian patients were included (median age-82 years; closed distal-22; open distal-28). Median cardiopulmonary bypass time was 187 min (open distal vs. closed distal group; 219 min vs. 115.5 min, p < 0.01, respectively). Median cross-clamp time was 93 min (IQR; 76-130 min). Median circulatory arrest time was 26 min (IQR; 20-39 min) in the open-distal group. In-hospital mortality was 18% (open distal; 14.2% vs. closed distal; 22.7%, p = 0.44). Stroke was 26% (open distal; 28.6% vs. closed distal; 22.7%, p = 0.64). Median survival was 7.2 years (IQR; 4.5-11.6 years). Survival was comparable between open and closed distal groups (median 10.6 vs. 7.2 years, p = 0.35, respectively). Critical preoperative status (HR; 3.2, p = 0.03) and composite endpoint (renal replacement therapy, new neurological event, length of stay > 30 days or return to theatre; HR; 4.1, p = 0.02) predicted adverse survival. Open distal anastomosis did no impact survival. CONCLUSIONS ATAAD repair in selected octogenarians has acceptable short- and long-term survival. There is no significant difference between open versus closed distal anastomosis strategies.
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Affiliation(s)
- Hannah Masraf
- Division of Surgery, Kingston Hospital NHS Foundation Trust, Kingston upon Thames KT2 7QB, UK
| | - Manoraj Navaratnarajah
- Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Laura Viola
- Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Davorin Sef
- Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Pietro G. Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Szabolcs Miskolczi
- Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Theodore Velissaris
- Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Suvitesh Luthra
- Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
- Department of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
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Matei DC, Antohi EL, Radu RI, Ciobanu CG, Geavlete OD, Filipescu D, Bubenek Ș, Moldovan H, Iliescu VA, Chioncel OD. Predictors of In-Hospital Mortality in Type A Acute Aortic Syndrome: Data From the RENADA-RO Registry. Heart Lung Circ 2024; 33:1348-1356. [PMID: 38955595 DOI: 10.1016/j.hlc.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND This study aimed to analyse the baseline characteristics of patients admitted with acute type A aortic syndrome (ATAAS) and to identify the potential predictors of in-hospital mortality in surgically managed patients. METHODS Data regarding demographics, clinical presentation, laboratory work-up, and management of 501 patients with ATAAS enrolled in the National Registry of Aortic Dissections-Romania registry from January 2011 to December 2022 were evaluated. The primary endpoint was in-hospital all-cause mortality. Multivariate logistic regression was conducted to identify independent predictors of mortality in patients with acute Type A aortic dissection (ATAAD) who underwent surgery. RESULTS The mean age was 60±11 years and 65% were male. Computed tomography was the first-line diagnostic tool (79%), followed by transoesophageal echocardiography (21%). Cardiac surgery was performed in 88% of the patients. The overall mortality in the entire cohort was 37.9%, while surgically managed ATAAD patients had an in-hospital mortality rate of 29%. In multivariate logistic regression, creatinine value (OR 6.76), ST depression on ECG (OR 6.3), preoperative malperfusion (OR 5.77), cardiogenic shock (OR 5.77), abdominal pain (OR 4.27), age ≥70 years (OR 3.76), and syncope (OR 3.43) were independently associated with in-hospital mortality in surgically managed ATAAD patients. CONCLUSIONS Risk stratification based on the variables collected at admission may help to identify ATAAS patients with high risk of death following cardiac surgery.
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Affiliation(s)
- Diana-Cristina Matei
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C.C. Iliescu" Bucharest, Romania; University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania.
| | - Elena-Laura Antohi
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C.C. Iliescu" Bucharest, Romania; University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
| | - Răzvan Ilie Radu
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C.C. Iliescu" Bucharest, Romania; University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
| | - Celia Georgiana Ciobanu
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C.C. Iliescu" Bucharest, Romania; University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
| | - Oliviana Dana Geavlete
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C.C. Iliescu" Bucharest, Romania; University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
| | - Daniela Filipescu
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C.C. Iliescu" Bucharest, Romania; University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
| | - Șerban Bubenek
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C.C. Iliescu" Bucharest, Romania; University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
| | - Horațiu Moldovan
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania; Emergency Clinical Hospital, Bucharest, Romania; The Academy of Romanian Scientists (AOSR), Bucharest, Romania
| | - Vlad Anton Iliescu
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C.C. Iliescu" Bucharest, Romania; University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
| | - Ovidiu Dragomir Chioncel
- Emergency Institute for Cardiovascular Diseases "Prof. Dr. C.C. Iliescu" Bucharest, Romania; University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
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Moriyama S, Hara M, Hirota T, Nakata K, Doi H, Matsumura T, Araki Y, Inomata Y, Fukui T. Population-Based Study of the Incidence and Mortality Rate of Acute Aortic Dissection. Circ J 2024; 88:297-306. [PMID: 37673647 DOI: 10.1253/circj.cj-23-0076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND Acute aortic dissection (AAD) has high morbidity and a high fatality rate for a cardiovascular disease. Recent studies suggested that the incidence of AAD is increasing. However, the actual incidence and mortality rates of AAD are not well known. This study investigated the current epidemiology of AAD within the Yatsushiro medical jurisdictional area. METHODS AND RESULTS A population-based review of patients with AAD was performed in a geographically well-defined area. Data were collected retrospectively from January 2011 to December 2020 for a total of 196 patients with AAD (Stanford Type A, n=126 [64.3%]; Stanford Type B, n=70 [35.7%]). The mean patient age was 74.3 years, and 55.6% (109/196) were women. The crude and age-standardized incidence rates of AAD in our medical jurisdictional area were 13.6 and 11.4 per 100,000 inhabitants per year, respectively. The crude and age-standardized 30-day mortality rates of AAD were 4.9 and 4.0 per 100,000 inhabitants per year, respectively. There were upward tendencies for both the incidence and 30-day mortality rate of AAD with age, with both being significantly higher in patients aged ≥85 years (P<0.001). CONCLUSIONS This population-based study detected a higher incidence of AAD than previous studies, but reported a lower incidence of AAD in men than in women. Increasing age was associated with an increased incidence and mortality rate of AAD.
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Affiliation(s)
- Shuji Moriyama
- Department of Cardiovascular Surgery, Kumamoto Rosai Hospital
| | - Masahiko Hara
- Department of Cardiovascular Surgery, Kumamoto Rosai Hospital
| | - Takafumi Hirota
- Department of Cardiovascular Surgery, Kumamoto Rosai Hospital
| | - Kosuke Nakata
- Department of Cardiovascular Surgery, Kumamoto Rosai Hospital
| | - Hideki Doi
- Department of Cardiovascular Medicine, Kumamoto Rosai Hospital
| | | | - Yushi Araki
- Department of Radiology, Kumamoto Rosai Hospital
| | - Yukihiro Inomata
- Department of Pediatric Surgery and Transplantation, Kumamoto Rosai Hospital
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University Hospital
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Yamasaki M, Yoshino H, Kunihara T, Akutsu K. Reply to Gaisendrees et al. Eur J Cardiothorac Surg 2024; 65:ezae002. [PMID: 38216527 DOI: 10.1093/ejcts/ezae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/09/2024] [Indexed: 01/14/2024] Open
Affiliation(s)
- Manabu Yamasaki
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
- Department of Cardiovascular Surgery, Itabashi Chuo Medical Center, Tokyo, Japan
| | | | | | - Koichi Akutsu
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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Ogino H, Yoshino H, Shimokawa T, Akutsu K, Takahashi T, Usui M, Kunihara T, Watanabe K, Nakai M, Yamamoto T, Takayama M. A new insight into superacute care for type A acute aortic dissection in the Tokyo Acute Aortic Super Network. J Thorac Cardiovasc Surg 2024; 167:41-51.e4. [PMID: 37659462 DOI: 10.1016/j.jtcvs.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE To determine the status of type A acute aortic dissection using the Tokyo Acute Aortic Super Network. METHODS Data of 6283 patients with acute aortic dissection between 2015 and 2019 were collected. Data of 3303 patients with type A acute aortic dissection were extracted for analysis. RESULTS Overall, 51.0% of patients were nondirect admissions. On arrival, 23.1% of patients were in shock, 10.0% in cardiopulmonary arrest, and 11.8% in deep coma or coma. Overall, 9.8% of patients were assessed as untreatable. Of 2979 treatable patients, 18.3% underwent medical treatment, whereas 80.7% underwent surgery (open [78.8%], endovascular [1.9%], and peripheral [1.1%] repair). The early mortality rate was 20.5%, including untreatable cases. Among treatable patients, in-hospital mortality rates were 8.6% for open repair, 10.7% for endovascular repair, and 25.3% for medical treatment. Advanced age, preoperative comorbidities, classical dissection, and medical treatment were risk factors for in-hospital mortality. Nondirect admission did not cause increased deaths. The mortality rates were high during the superacute phase following symptom onset. CONCLUSIONS This study demonstrated current practices in the emergency care of type A acute aortic dissection via the Tokyo Acute Aortic Super Network system, specifically a high rate of untreatable or inoperable cases and favorable outcomes in patients undergoing surgical treatment. High mortality rates were observed during the super acute phase after symptom onset or hospital arrival.
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Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Hideaki Yoshino
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Tomoki Shimokawa
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Koichi Akutsu
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | | | - Michio Usui
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takashi Kunihara
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Kazuhiro Watanabe
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Yamamoto
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Morimasa Takayama
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
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Kageyama S, Ohashi T, Yoshida T, Kobayashi Y, Kojima A, Kobayashi D, Kojima T. Early mortality of emergency surgery for acute type A aortic dissection in octogenarians and nonagenarians: A multi-center retrospective study. J Thorac Cardiovasc Surg 2024; 167:65-75.e8. [PMID: 35277246 DOI: 10.1016/j.jtcvs.2022.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The clinical data on postoperative mortality and central nervous system (CNS) complications in older adults who underwent acute type A aortic dissection are limited. Thus, in this study we aimed to evaluate the association between age and early postoperative mortality and occurrence of CNS complications. METHODS This multicentric retrospective cohort study included 5 tertiary hospitals in Japan. All patients who underwent emergency surgery for acute type A aortic dissection between October 1998 and December 2019 were enrolled. The multilevel Cox proportional hazards model, which considered years as level 1, institutions as level 2, and surgeons as level 3, was used to evaluate the association between age and early postoperative hospital mortality and occurrence of CNS complications. RESULTS Of the 1037 patients, 227 (21.9%) were ≥80 years old and 810 (78.1%) were <80 years old. Overall, 134 patients (12.9%) died within 30 days postoperatively; among them, 42/227 (18.5%) and 92/810 (11.4%) were aged ≥80 and <80 years, respectively (hazard ratio [HR], 1.63; P = .0046). CNS complications within 30 days postoperatively occurred in 140/1037 (13.5%) patients; among them, 42/227 (18.5%) and 98/810 (12.1%) were aged ≥80 and <80 years, respectively (HR, 1.63; P = .011). In multivariate analysis, age ≥80 years was associated with mortality within 30 days postoperatively (adjusted HR, 2.37; 95% CI, 1.23-4.57; P = .01) but not with CNS complications (adjusted HR, 1.58; 95% CI, 0.93-2.69; P = .091). CONCLUSIONS The early postoperative mortality in older patients was approximately 50% higher than in the younger population. A thorough discussion regarding the surgical indications should be done.
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Affiliation(s)
- Soichiro Kageyama
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Takeki Ohashi
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Takeshi Yoshida
- Department of Cardiovascular Surgery, Matsubara Tokushukai Hospital, Matsubara-city, Osaka, Japan
| | - Yutaka Kobayashi
- Department of Cardiovascular Surgery, Uji Tokushukai Hospital, Makishima-cho, Uji-city, Kyoto, Japan
| | - Akinori Kojima
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Daiki Kobayashi
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu-shi, Aichi, Japan.
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Ogino H, Kumamaru H, Motomura N, Fujiyoshi T, Shimahara Y, Azuma N, Kinukawa N, Ueda Y, Okita Y. Current status of surgical treatment for acute aortic dissection in Japan: Nationwide database analysis. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01120-0. [PMID: 38056765 DOI: 10.1016/j.jtcvs.2023.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To clarify the current status of surgical treatment of acute aortic dissection (AAD) in Japan through the Japan Cardiovascular Database analysis. METHODS In total, 7194 patients who underwent surgical treatment for AAD in 2021, including type A (TAAAD) (n = 6416) and type B (TBAAD) (n = 778), were investigated. RESULTS The median age was 70 years, with patients older than age 80 years constituting 21.7% and 23.4% of TAAAD and TBAAD cases. Emergency admission was 88.5% and 78.5%. Shock was found in 11.8% and 6.0%. Rupture/impending rupture occurred in 10.7%/6.0% and 24.0%/11.1%, respectively. Branch malperfusion was complicated in 10.4% and 25.2%. Open repairs were performed in 97.7% and 20.3%, whereas endovascular repairs were performed in 2.3% and 79.7%, respectively. In the increased prevalence of endografting procedures, neurological complications and renal failure occurred frequently after open repair with frozen elephant trunk for 29.9% and 50.3%. The operative mortality rate was 9.8% and 11.5% for open repair and 8.1% and 10.0% for endovascular repair. In patients with TAAAD, age older than 80 years, preoperative critical comorbidities, classical dissection, and coexisting chronic vital organ diseases were independent risk factors for mortality. In frozen elephant trunk procedures, neurologic complications and renal failure were frequent. The operative mortality was higher during the superacute phase within 1 or 2 hours from onset to arrival and between arrival and surgery. CONCLUSIONS The current status of surgical treatments for AAD including the increased prevalence of endografting of thoracic endovascular aortic repair and frozen elephant trunk were demonstrated with favorable outcomes in the Japan Cardiovascular Database analyses.
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Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Toshiki Fujiyoshi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yusuke Shimahara
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Naoko Kinukawa
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuichi Ueda
- Nara Prefectural Hospital Organization, Nara, Japan
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Takatsuki, Japan
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Osada H, Minatoya K. Overview of acute type A dissection in Japan. Indian J Thorac Cardiovasc Surg 2023; 39:280-286. [PMID: 38093936 PMCID: PMC10713900 DOI: 10.1007/s12055-023-01548-x] [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: 03/21/2023] [Revised: 05/04/2023] [Accepted: 05/24/2023] [Indexed: 12/17/2023] Open
Abstract
Acute type A aortic dissection is a relatively uncommon but devastating disease and usually requires emergency surgery. Based on the several database projects, a large amount of perioperative patient data has now been accumulated and is expected to be useful in clinical practice. Especially in Japan, the number of surgeries for acute type A aortic dissection has been gradually increasing recently, and the overall mortality rate has stabilized at less than 10%. One of the keys to further improvement in outcomes will be to improve the results of aortic root replacement. In addition, strategies need to be established for very elderly patients, comatose patients, and patients with malperfusion as preoperative conditions. The use of a relatively new device, the frozen elephant trunk, is also increasing and might be changing the surgical outcome. In this report, we describe the current status of acute type A aortic dissection in Japan, with reference to recent guidelines and literature.
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Affiliation(s)
- Hiroaki Osada
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507 Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507 Japan
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Shimamoto T, Komiya T, Matsuo T. Clinical impact of turn-up anastomosis in the treatment of type A acute aortic dissection. Asian Cardiovasc Thorac Ann 2023; 31:759-767. [PMID: 37731318 DOI: 10.1177/02184923231203753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND The management of anastomosis and hemostasis of the dissected aorta remains challenging. This study aims to establish an optimal surgical strategy for type A acute aortic dissection by reviewing single-center data using the turn-up anastomosis technique. METHODS Between 2003 and 2015, 264 consecutive patients with type A acute aortic dissection who underwent emergency surgery within 14 days of symptom onset were enrolled. RESULTS The mean age of the patients was 67.7 ± 13.4 years, and 129 were males. The operative time and surgical bleeding were 390.9 ± 144.5 min and 2983.8 ± 3026.5 mL, respectively. In-hospital mortality was observed in 25 patients (9.4%), and 3 (1.1%) experienced uncontrolled bleeding (from the aortic root in two patients and coagulopathy due to dabigatran in one patient). Immediate reopening for bleeding was performed in 20 patients, and bleeding from the aortic anastomosis was observed at three proximal and two distal sites. Proximal re-dissection was observed in 18 patients; in all of which, glue was used, although two re-ruptures of the aortic root were observed among those without glue use. The rates of freedom from all-cause death, aortic death, and aortic events at postoperative 5 years were 78.5 ± 2.7%, 86.8 ± 2.1%, and 74.4 ± 2.9%, respectively. When these values were stratified according to the operative extent, no significant differences were observed. CONCLUSIONS Turn-up anastomosis facilitates short circulatory arrest, short operative time, and stable hemostasis, with few anastomotic complications during surgery for type A acute aortic dissection.
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Affiliation(s)
- Takeshi Shimamoto
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Shizuoka, Japan
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Takehiko Matsuo
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
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Inoue Y, Matsuda H. Will the Advanced Aging Society Produce Brand New Insight on Aortic Dissection? Circ J 2023; 87:1162-1163. [PMID: 37423746 DOI: 10.1253/circj.cj-23-0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
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11
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Zhu X, Wang J, Chong H, Jiang Y, Fan F, Pan J, Cao H, Xue Y, Wang D, Zhou Q. Analysis of risk factors for postoperative mortality in acute type A aortic dissection patients under different critical levels. Sci Rep 2023; 13:8107. [PMID: 37208480 DOI: 10.1038/s41598-023-35351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
We built up a risk stratification model to divide acute type A aortic dissection (aTAAD) patients into low- and high-risk groups, further, to evaluate the risk factors for postoperative mortality. A total of 1364 patients from 2010 to 2020 in our center were retrospectively analyzed. More than twenty clinical variables were related with postoperative mortality. The postoperative mortality of the high-risk patients was doubled than the low-risk ones (21.8% vs 10.1%). The increased operation time, combined coronary artery bypass graft, cerebral complications, re-intubation, continuous renal replacement therapy and surgical infection were risk factors of postoperative mortality in low-risk patients. In addition, postoperative lower limbs or visceral malperfusion were risk factors, axillary artery cannulation and moderate hypothermia were protective factors in high-risk patients. A scoring system for quick decision-making is needed to select appropriate surgical strategy in aTAAD patients. For low-risk patients, different surgical treatments can be performed with similar clinical prognosis. Limited arch treatment and appropriate cannulation approach are crucial in high-risk aTAAD patients.
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Affiliation(s)
- Xiyu Zhu
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Junxia Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Hoshun Chong
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Yi Jiang
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Fudong Fan
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Jun Pan
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Hailong Cao
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Yunxing Xue
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Dongjin Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Qing Zhou
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, China.
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China.
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Yamasaki M, Yoshino H, Kunihara T, Akutsu K, Shimokawa T, Ogino H, Kawata M, Takahashi T, Usui M, Watanabe K, Fujii T, Yamamoto T, Nagao K, Takayama M. Outcomes of type A acute aortic dissection with cardiopulmonary arrest: Tokyo Acute Aortic Super-network Registry. Eur J Cardiothorac Surg 2023; 63:ezad056. [PMID: 36806920 DOI: 10.1093/ejcts/ezad056] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/06/2023] [Accepted: 02/19/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES Preventing loss of life in patients with type A acute aortic dissection (AAD) who present with cardiopulmonary arrest (CPA) can be extremely difficult. Thus, we investigated the early outcomes in these patients. METHODS Patients with type A AAD who were transported to hospitals belonging to the Tokyo Acute Aortic Super-network between January 2015 and December 2019 were considered for this study. We assessed the early mortality of these patients presenting with CPA and also investigated the differences in outcomes between patients with out-of-hospital and in-hospital CPA. RESULTS A total of 3307 patients with type A AAD were transported, 434 (13.1%) of whom presented with CPA. The overall mortality of patients presenting with CPA was 88.2% (383/434), of which 94.5% (240/254) experienced out-of-hospital CPA and 79.4% (143/180) experienced in-hospital CPA (P < 0.001). Multivariable analysis revealed that aortic surgery [odds ratio (OR), 0.022; 95% confidence interval (CI), 0.008-0.060; P < 0.001] and patient age over 80 years (OR, 2.946; 95% CI, 1.012-8.572; P = 0.047) were related with mortality in patients with type A AAD and CPA. Between in-hospital and out-of-hospital CPA, the proportions of DeBakey type 1 (OR, 2.32; 95% CI, 1.065-5.054; P = 0.034), cerebral malperfusion (OR, 0.188; 95% CI, 0.056-0.629; P = 0.007), aortic surgery (OR, 0.111; 95% CI, 0.045-0.271; P = 0.001), age (OR, 0.969; 95% CI, 0.940-0.998; P = 0.039) and the time from symptom onset to hospital admission (OR, 1.122; 95% CI, 1.025-1.228; P = 0.012) were significantly different. CONCLUSIONS Patients with type A AAD presenting with CPA exhibited extremely high rates of death. Patient outcomes following in-hospital CPA tended to be better than those following out-of-hospital CPA; however, this difference was not significantly different. To prevent deaths, aortic surgery, when possible, should be considered in patients with type A AAD who sustained CPA.
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Affiliation(s)
- Manabu Yamasaki
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
- Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Hideaki Yoshino
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takashi Kunihara
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Koichi Akutsu
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Tomoki Shimokawa
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Hitoshi Ogino
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Mitsuhiro Kawata
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | | | - Michio Usui
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Kazuhiro Watanabe
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takeshiro Fujii
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takeshi Yamamoto
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Ken Nagao
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Morimasa Takayama
- Tokyo, Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
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Narita M, Tsutsui M, Ushioda R, Kikuchi Y, Shirasaka T, Ishikawa N, Kamiya H. Proximal and extended aortic arch replacement in acute DeBakey type I aortic dissection. Front Surg 2023; 10:1081167. [PMID: 36860951 PMCID: PMC9968786 DOI: 10.3389/fsurg.2023.1081167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Objective This study aimed to compare the short- and long-term outcomes of proximal repair vs. extensive arch surgery for acute DeBakey type I aortic dissection. Subjects From April 2014 to September 2020, 121 consecutive patients with acute type A dissection were surgically treated at our institute. Of these patients, 92 had dissections extending beyond the ascending aorta. Methods Of the 92 patients, 58 underwent proximal repair, including aortic root and/or hemiarch replacement, and 34 underwent extended repair, including partial and total arch replacement. Perioperative variables and early and late postoperative results were statistically analyzed. Results The duration of surgery, cardiopulmonary bypass, and circulatory arrest was significantly shorter in the proximal repair group (p < 0.01). The overall operative mortality rate was 10.3% in the proximal repair group and 14.7% in the extended repair group (p = 0.379). The mean follow-up period was 31.1 ± 26.7 months in the proximal repair group and 35.3 ± 26.8 months in the extended repair group. During follow-up, the cumulative survival and freedom from reintervention rates at 5 years were 66.4% and 92.9% in the proximal repair group, and 76.1% and 72.6% in the extended repair group, respectively (p = 0.515 and p = 0.134). Conclusions No significant differences were found in the rates of long-term cumulative survival and freedom from aortic reintervention between the two surgical strategies. These findings suggest limited aortic resection achieves acceptable patient outcomes.
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Affiliation(s)
- Masahiko Narita
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | | | - Ryouhei Ushioda
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yuta Kikuchi
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Tomonori Shirasaka
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Natsuya Ishikawa
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
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14
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Li J, Zhou Y, Qin W, Su C, Huang F, Chen X. Surgical outcomes of total arch replacement with modified elephant trunk technique in type A aortic dissection: insights from single-center experience. Asian Cardiovasc Thorac Ann 2023; 31:8-14. [PMID: 35014890 DOI: 10.1177/02184923211070115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Total arch replacement with modified elephant trunk technique plays an important role in treating acute type A aortic dissection in China. We aim to summarize the therapeutic effects of this procedure in our center over a 17-year period. METHODS Consecutive patients treated at our hospital due to type A aortic dissection from January 2004 to January 2021 were studied. Relevant data of these patients undergoing total arch replacement with modified elephant trunk technique were collected and analyzed. RESULTS A total of 589 patients were included with a mean age of 53.1 ± 12.2 years. The mean of cardiopulmonary bypass, cross-clamping, and selected cerebral perfusion time were 199.6 ± 41.9, 119.0 ± 27.2, and 25.1 ± 5.0 min, respectively. In-hospital death occurred in 46 patients. Multivariate analysis identified four significant risk factors for in-hospital mortality: preexisting renal hypoperfusion (OR 5.43; 95% CI 1.31 - 22.44; P = 0.020), cerebral malperfusion (OR 11.87; 95% CI 4.13 - 34.12; P < 0.001), visceral malperfusion (OR 4.27; 95% CI 1.01 - 18.14; P = 0.049), and cross-clamp time ≥ 130 min (OR 3.26; 95% CI 1.72 - 6.19; P < 0.001). The 5, 10, and 15 years survival rates were 86.4%, 82.6%, and 70.2%, respectively. CONCLUSIONS Total arch replacement with modified elephant trunk technique is an effective treatment for acute type A aortic dissection with satisfactory perioperative results. Patients with preexisting renal hypoperfusion, cerebral malperfusion, visceral malperfusion, and long cross-clamp time are at a higher risk of in-hospital death.
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Affiliation(s)
- Jian Li
- Department of Thoracic and Cardiovascular Surgery, 385685Nanjing First Hospital, 385685Nanjing Medical University, P.R. China
| | - Yueyun Zhou
- Department of Thoracic and Cardiovascular Surgery, 385685Nanjing First Hospital, 385685Nanjing Medical University, P.R. China
| | - Wei Qin
- Department of Thoracic and Cardiovascular Surgery, 385685Nanjing First Hospital, 385685Nanjing Medical University, P.R. China
| | - Cunhua Su
- Department of Thoracic and Cardiovascular Surgery, 385685Nanjing First Hospital, 385685Nanjing Medical University, P.R. China
| | - Fuhua Huang
- Department of Thoracic and Cardiovascular Surgery, 385685Nanjing First Hospital, 385685Nanjing Medical University, P.R. China
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, 385685Nanjing First Hospital, 385685Nanjing Medical University, P.R. China
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15
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Wu SJ, Fan YF, Tsai YC, Sun S, Chien CY, Li JY. Non-prompt surgery for patients with acute type A aortic dissection without pre-operative shock and malperfusion. Front Cardiovasc Med 2022; 9:988179. [PMID: 36545025 PMCID: PMC9760729 DOI: 10.3389/fcvm.2022.988179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Background Acute type A aortic dissection (ATAAD) requires urgent surgical treatment. However, during daily practice, there were some patients with ATAAD sought for medical attention several days after symptoms occurred and some other patients hesitated to receive aortic surgery after the diagnosis of ATAAD was made. This study aims to investigate the surgical outcomes of non-prompt aortic surgery (delayed diagnosis caused by the patient or delayed surgery despite immediate diagnosis) for ATAAD patients. Methods From November 2004 to June 2020, of more than 200 patients with ATAAD patients who underwent aortic surgery at our hospital, there were 30 patients without pre-operative shock and malperfusion who sought for medical attention with symptoms for several days or delayed aortic surgery several days later despite ATAAD was diagnosed. Of the 30 patients (median age 60.9, range 33.4~82.5 years) in the study group, there were 18 patients undergoing surgery when they arrived at our hospital (delayed diagnosis by the patient) and 12 patients receiving surgery days later (delayed surgery despite immediate diagnosis). Patients with prompt surgery after symptom onset (control group) were matched from our database by propensity score matching. The surgical mortality rate and post-operative morbidities were compared between the study group and control group. Results The in-hospital mortality was 3.3% for the study group and 6.7% for the control group (p = non-significant). The incidence of post-operative cerebral permanent neurological defect was 0% for the study group and 13.3% for the control group (p = 0.112). There were three patients receiving aortic re-intervention or re-do aortic surgery during follow-up for the study group and two patients for the control group. Conclusion Prompt surgery for ATAAD is usually a good choice if everything is well prepared. Besides, urgent but non-prompt aortic surgery could also provide acceptable surgical results for ATAAD patients without pre-operative shock and malperfusion who did not seek medical attention or who could not make their minds to undergo surgery immediately after symptom onset. Hospitalization with intensive care is very important for pre-operative preparation and monitoring for the patients who decline prompt aortic surgery.
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Affiliation(s)
- Shye-Jao Wu
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan,MacKay Medical College, New Taipei, Taiwan,*Correspondence: Shye-Jao Wu
| | - Ya-Fen Fan
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Chu Tsai
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shen Sun
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan,MacKay Medical College, New Taipei, Taiwan
| | - Chen-Yen Chien
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan,MacKay Medical College, New Taipei, Taiwan
| | - Jiun-Yi Li
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan,MacKay Medical College, New Taipei, Taiwan
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16
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Zhao R, Qiu J, Dai L, Song J, Fan S, Cao F, Qiu J, Xu Z, Fan R, Guo Y, Gu T, Jiang X, Li D, Qiao C, Chen Z, Song B, Yu C. Current Surgical Management of Acute Type A Aortic Dissection in China: A Multicenter Registry Study. JACC. ASIA 2022; 2:869-878. [PMID: 36713764 PMCID: PMC9876964 DOI: 10.1016/j.jacasi.2022.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 12/03/2022]
Abstract
Background Many countries and regions have established multicenter registration studies to improve the outcomes of acute type A aortic dissection (ATAAD). Objectives The aims of this study were to report actual preoperative management, surgery type, and early outcomes of surgical treatment for ATAAD in China. Methods This cohort study uses data from the China Registry of Type A Aortic Dissection, a national clinical registry to investigate management of patients with Stanford type A aortic dissection. The data, including surgical management and outcomes of patients with ATAAD, were analyzed from January 2018 to December 2021. Results A total of 1,058 patients with ATAAD were enrolled in this study between January 2018 and December 2021. The mean age of all patients was 51.6 ±11.7 years. The median interval from onset to hospital was 10.65 hours (IQR: 6-24 hours), and the median interval from entering the emergency room to starting operation was 13 hours (IQR: 4.08-28.7 hours). Total arch repair was performed in 938 patients (88.7%), and frozen elephant trunk repair was performed in 800 patients (75.6%). The incidence of early mortality was 7.6%. Conclusions The population of patients with ATAAD in China experienced a longer interval from onset to arrival at the hospital, received more extensive aortic arch repair, and showed a relatively lower early mortality. These findings suggest that there may be a huge survivor bias in patients with ATAAD in China, more efforts should be made to promote prehospital emergency care and preoperative management of Chinese ATAAD patients. (A multicenter registration study of aortic dissection in China; ChiCTR1800015338).
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Affiliation(s)
- Rui Zhao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juntao Qiu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Dai
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Song
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuya Fan
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fangfang Cao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiawei Qiu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiyun Xu
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ruixing Fan
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Tianxiang Gu
- Cardiac Surgery, First Hospital of China Medical University, Shenyang, China
| | - Xionggang Jiang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Decai Li
- Shandong Provincial Hospital, School of Medicine, Shandong University, Jinan, China
| | - Chenhui Qiao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ziying Chen
- Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bing Song
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Cuntao Yu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Aortic dissection: global epidemiology. CARDIOLOGY PLUS 2022. [DOI: 10.1097/cp9.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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18
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Li Z, Zhang H, Baraghtha S, Mu J, Matniyaz Y, Jiang X, Wang K, Wang D, Xue YX. Short- and Mid-Term Survival Prediction in Patients with Acute Type A Aortic Dissection Undergoing Surgical Repair: Based on the Systemic Immune-Inflammation Index. J Inflamm Res 2022; 15:5785-5799. [PMID: 36238764 PMCID: PMC9553311 DOI: 10.2147/jir.s382573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The postoperative survival of patients with acute type A aortic dissection (aTAAD) remains unsatisfactory. The current study developed an easy-to-use survival prediction model and calculator. Methods A total of 496 patients with aTAAD undergoing surgical repair were included in this study. The systemic immune-inflammation index (SII) and other clinical features were collected and subjected to logistic and Cox regression analyses. The survival prediction model was based on Cox regression analyses and exhibited as a nomogram. For convenience of use, the nomogram was further developed into calculator software. Results We demonstrated that a higher preoperative SII was associated with in-hospital death (OR: 4.116, p < 0.001) and a higher postoperative overall survival rate (HR: 2.467, p < 0.001) in aTAAD patients undergoing surgical repair. A survival prediction model and calculator based on SII and four other clinical features were developed. The overall C-index of the model was 0.743. The areas under the curves (AUCs) of the 1- and 3-month and 1- and 3-year survival probabilities were 0.73, 0.71, 0.71 and 0.72, respectively. The model also showed good calibration and clinical utility. Conclusion Preoperative SII is significantly associated with postoperative survival. Based on SII and other clinical features, we created the first easy-to-use prediction model and calculator for predicting the postoperative survival rate in aTAAD patients, which showed good prediction performance.
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Affiliation(s)
- Zeshi Li
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Nanjing, People’s Republic of China,Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China,Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - He Zhang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Nanjing, People’s Republic of China,Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China,Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Sulaiman Baraghtha
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China,International School, University of Mannheim, Mannheim, Baden-Württemberg, Federal Republic of Germany
| | - Jiabao Mu
- School of Data Science, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
| | - Yusanjan Matniyaz
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China
| | - Xinyi Jiang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Nanjing, People’s Republic of China,Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China,Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Kuo Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China,Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of XuZhou Medical University, Nanjing, People’s Republic of China
| | - Dongjin Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Nanjing, People’s Republic of China,Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China,Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China,Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of XuZhou Medical University, Nanjing, People’s Republic of China
| | - Yun Xing Xue
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China,Correspondence: Yun Xing Xue; Dongjin Wang, Email ;
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Evangelista Masip A, López-Sainz Á, Barros Membrilla AJ, Calvo Iglesias F, López Ayerbe J, Azqueta Molluna M, Mosquera Rodríguez VX, Arregui Montoya F, Tarrío Fernández R, Revilla Orodea A, Sánchez Sánchez V, Cantero Pérez EM, Ferrera C, Toral Sepúlveda D, Nistal F, Fernández Golfín C, Sao A, Rodríguez-Palomares J. Spanish Registry of Acute Aortic Syndrome (RESA). Changes in therapeutic management and lower mortality in acute aortic syndrome. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:816-824. [PMID: 35527170 DOI: 10.1016/j.rec.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Spanish Registry of Acute Aortic Syndrome (RESA) was launched in 2005 to identify the characteristics of acute aortic syndrome (AAS) in Spain. The aim of this study was to analyze the differences in management and mortality in the 3 RESA iterations. METHODS We analyzed data from patients with AAS prospectively included by 24 to 30 tertiary centers during the 3 iterations of the registry: RESA I (2005-2006), RESA-II (2012-2013), and RESA III (2018-2019). RESULTS AAS was diagnosed in 1902 patients (74% men; age, 60.7±12.5 years): 1329 (69.9%) type A and 573 (30.1%) type B. Comparison of the 3 periods revealed that the use of computed tomography increased as the first diagnostic technique (77.1%, 77.9%, and 84.2%, respectively; P=.001). In type A, surgical management increased (79.6%, 78.7%, and 84.5%; P=.045) and overall mortality decreased (41.2%, 34.5%, and 31.2%; P=.002), due to a reduction in surgical mortality (33.4%, 25.1%, and 23.9%; P=.003). In type B, endovascular treatment increased (22.8%, 32.8%, and 38.7%; P=.006), while medical and surgical treatment decreased. Overall type B mortality also decreased (21.6%, 16.1%, and 12.0%; P=.005) in line with a reduction in mortality with medical (16.8%, 13.8%, and 8.8%, P=.030) and endovascular (27.0%, 18.0%, and 9.2%; P=.009) treatments. CONCLUSIONS The iterations of RESA show a decrease in mortality from type A AAS, coinciding with an increase in surgical treatment and a reduction in surgical mortality. In type B, the use of endovascular treatment was associated with improved survival, allowing better management in patients with complications.
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Affiliation(s)
| | - Ángela López-Sainz
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Jordi López Ayerbe
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | - Francisco Arregui Montoya
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Ana Revilla Orodea
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Carlos Ferrera
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - David Toral Sepúlveda
- Servei de Cirurgia Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Nistal
- Servicio de Cirugía Cardiaca, Hospital Universitario Valdecilla, Santander, Spain
| | | | - Augusto Sao
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Okita Y. Recent trends of open surgery for acute type A aortic dissection in Japan. Asian Cardiovasc Thorac Ann 2022:2184923221080799. [PMID: 36177503 DOI: 10.1177/02184923221080799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Reporting clinical outcomes of acute type A aortic dissection. METHODS Data derived from the survey of the Japanese Association for Thoracic Surgery, the Japan Cardiovascular Database, and the Japanese Registry of All Cardiac and Vascular Diseases were analyzed. RESULTS Between 2012 and 2015, the Japanese Registry of All Cardiac and Vascular Diseases study collected 13,131 patients and the hospital mortality was 24.3%. The surgical mortality was significantly lower than medical one (11.8% vs 49.7%; p < 0.001). The Japanese Association for Thoracic Surgery survey disclosed the number of surgeries has been increased to 6157 in 2018 and the hospital death has decreased to 10.5%. The Japan Cardiovascular Database, collected 29,486 patients from 2013 to 2018. Age at surgery was 59.8 ± 14.2 years and patients younger than 65 years in 61% and 21% were older than 75 years. Ninety-four percent had surgery within 24 h after diagnosis. Antegrade cerebral perfusion was used in 74% and deep hypothermic circulatory arrest with/without retrograde cerebral perfusion in 26%. Replacement of the ascending aorta was performed in 62% and total arch replacement in 28%. The aortic valve was replaced in 7.9% and repaired in 4.4%. The hospital mortality was 11%. New stroke occurred in 12%, hemodialysis in 7.3%, paraplegia in 3.9%, and prolonged ventilation in 15%. CONCLUSION The number of operations for type A aortic dissection has increased, and hospital mortality has improved. Although the early results after surgery for type A aortic dissection are acceptable, new strategies to improve early outcomes in patients with preoperative comorbidities are required.
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Qin W, Fan R, Wang J, Li J, Huang F, Chen X. Outcomes of surgical treatment on type A acute aortic dissection accompanied with coronary artery involvement. Front Surg 2022; 9:950264. [PMID: 36225217 PMCID: PMC9549406 DOI: 10.3389/fsurg.2022.950264] [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: 05/22/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Coronary artery (CA) involvement due to acute aortic dissection (AAD) is a catastrophic cardiovascular disease with high mortality. Two main surgery strategies, local coronary repair and coronary artery bypass grafting (CABG) can be applied to reestablish the blood flow in the aortic repair. This study was to evaluate the operative and long-term outcomes of type A AAD patients, who received aortic dissection repair plus CABG or local coronary repair. Method We reviewed our database and screened 148 type A AAD patients with CA involvement from January 2001 to December 2021. Local coronary repair or CABG was performed concomitantly on these enrolled patients. Results At the time of aortic repair, there were 58 patients with concomitant CABG (Group I) and 90 patients with local coronary repair (Group II). The basal characteristics of these two groups had no difference, except for acute myocardial ischemia (AMI) and CA involvement type. 45 patients with AMI in Group I, but none in Group II (P < 0.001). There was a higher frequency of type B and C lesions of CA involvement in Group I than that in Group II (P < 0.001). There was no difference in surgical procedures and complications, except for postoperative acute kidney injury (AKI) (34.5% vs. 8.9%, P < 0.001). Hospital mortality in Group I was higher than that in Group II, but without statistical difference (20.7% vs. 11.1%, P = 0.155). No significant difference was obtained in long-term survival rate between the two groups (82.5 ± 4.8% vs. 81.2 ± 6.9%, P = 0.19). Conclusion CABG and local coronary repair suits different types of CA involvement, and their effects on perioperative results and long-term survival for type A AAD patients with CA involvement are equal.
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Affiliation(s)
- Wei Qin
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rui Fan
- School of Medicine, Southeast University, Nanjing, China
| | - Jiankai Wang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jian Li
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fuhua Huang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Correspondence: Fuhua Huang Xin Chen
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
- Correspondence: Fuhua Huang Xin Chen
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22
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Eranki A, Merakis M, Williams ML, Flynn CD, Villanueva C, Wilson-Smith A, Lee Y, Mejia R. Outcomes of surgery for acute type A dissection in octogenarians versus non-octogenarians: a systematic review and meta analysis. J Cardiothorac Surg 2022; 17:222. [PMID: 36050776 PMCID: PMC9434858 DOI: 10.1186/s13019-022-01980-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Acute Type A Aortic Dissection (ATAAD) is a cardiothoracic emergency that requires urgent intervention. Elderly status, particularly age over 80, is an independent risk factor for mortality and morbidity. The mid-term outcomes of this age group are also unknown. This systematic review and meta-analysis of observational studies was therefore performed to analyse short- and mid-term mortality and morbidity in octogenarians following surgery for ATAAD. METHODS A systematic review was conducted for studies published since January 2000. The primary endpoint was short-term mortality, either reported as 30-day mortality or in-hospital mortality and medium-term (five year) survival. Secondary endpoints were rates of postoperative complications, namely stroke, acute renal failure (ARF), re-exploration and intensive care unit (ICU) length of stay (LOS). RESULTS A total of 16 retrospective studies, with a total of 16, 641 patients were included in the systematic review and meta-analysis. Pooled analysis demonstrated that octogenarian cohorts are at significantly higher risk of short-term mortality than non-octogenarians (OR 1.93; 95% CI 1.33-2.81; P < 0.001). Actuarial survival was significantly lower in the octogenarian cohort, with a five-year survival in the octogenarian cohort of 54% compared to 76% in the non-octogenarian cohort (P < 0.001). There were no significant differences between the cohorts in terms of secondary outcomes: stroke, ARF, re-exploration or ICU LOS. CONCLUSION Octogenarians are twice as likely to die in the short-term following surgery for ATAAD and demonstrate a significantly lower five-year actuarial survival. Patients and family members should be well informed of the risks of surgery and suitable octogenarians selected for surgery.
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Affiliation(s)
- Aditya Eranki
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia.
| | - Michael Merakis
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Michael L Williams
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Campbell D Flynn
- Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Claudia Villanueva
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia
| | - Ashley Wilson-Smith
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Yangsin Lee
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia
| | - Ross Mejia
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia
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23
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Inoue T, Omura A, Chomei S, Nakai H, Yamanaka K, Inoue T, Okada K. Early and late outcomes of type A acute aortic dissection with common carotid artery involvement. JTCVS OPEN 2022; 10:1-11. [PMID: 36004235 PMCID: PMC9390160 DOI: 10.1016/j.xjon.2022.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022]
Abstract
Objective The relationship between common carotid artery (CCA) involvement in acute type A aortic dissection (ATAAD) and postoperative outcomes remains unclear. We investigated outcomes and described our current advanced strategy. Methods Of 492 patients who underwent surgical repair for ATAAD between September 1999 and February 2021, CCA involvement was identified in 114. Eighty of these 114 patients (70.2%) were classified as having a thrombosed CCA and 34 (29.8%) were classified as nonthrombosed. To prevent postoperative cerebral malperfusion, we initiated a strategy of early reperfusion and direct reconstruction of dissected and thrombosed CCAs regardless of neurologic symptoms. Results Fifty-five patients (48.2%) showed preoperative neurologic symptoms. No significant differences between the thrombosed and nonthrombosed groups were seen in postoperative mortality (20.0% vs 11.8%; P = .421) or frequency of postoperative modified Rankin scale (mRS) score ≥5 (30.0% vs 17.6%; P = .245). The rate of postoperative neurologic deficit was significantly higher (48.8% vs 23.5%; P = .013) and long-term survival rate was significantly lower (5 years; 59.1 ± 6.3% vs 77.9 ± 7.4%; 10 years: 50.0 ± 7.9% vs 72.3 ± 8.7%; P = .041) in the thrombosed group. Risk factors for mRS ≥5 from multivariable analysis included occluded thrombosed CCA, preoperative coma, preoperative shock, and prolonged operation time. Fifteen patients were treated with the early reperfusion and direct reconstruction strategy; postoperative mortality 13.3% (2 patients). No patients showed cerebral reperfusion syndrome. Conclusions In patients with CCA involvement, a thrombosed false lumen, especially an occluded CCA, resulted in worse outcomes regardless of preoperative neurologic symptoms. Further study is needed to evaluate the efficacy of the current strategy.
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24
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Jia H, Huang B, Kang L, Lai H, Li J, Wang C, Sun Y. Preoperative and intraoperative risk factors of postoperative stroke in total aortic arch replacement and stent elephant trunk implantation. EClinicalMedicine 2022; 47:101416. [PMID: 35518120 PMCID: PMC9062417 DOI: 10.1016/j.eclinm.2022.101416] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Acute type A aortic dissection (AAAD) is a disease with high mortality, for which total aortic arch replacement (TAAR) combined with stent elephant implantation (SETI) is a reliable surgical treatment; however, it is associated with a high incidence of postoperative stroke. This retrospective study aimed to find preoperative and postoperative risk factors for postoperative stroke in patients with TAAR combined with SETI, and to provide predictive models and single-factor threshold suggestions. METHODS From October 2019 to March 2021, 229 AAAD patients who underwent TAAR and SETI were selected. Patients were divided into stroke group (n = 23) and non-stroke group (n = 206), and preoperative/intraoperative factors were evaluated by independent-samples T-test/ Mann-Whitney U test/Chi-Square test and odds ratio (OR) analysis. The Logistic regression equation and decision tree were used to construct the prediction model of the probability of postoperative stroke. Bayesian-learning model and 2-order derivation were used to calculate the inflection points of the continuous variables. FINDINGS Platelet count (PLT), International normalised ratio (INR) value, presence of diabetic history, and cardiopulmonary bypass (CPB) time were independent predictors of postoperative stroke (P-value < 0.05), and the above four factors were used to construct the Logistic regression equation. As for the decision-tree model, a radical model with higher accuracy in stroke predicting was chosen. Three inflection points for the effect of continuous variables (PLT count = 60 × 10^9/L; INR value = 1.82; CPB time = 300 min) on postoperative stroke were found by 2-order derivation. INTERPRETATION PLT count, INR value, presence of diabetic history, and CPB time were significant preoperative and intraoperative risk factors for postoperative stroke, and the identification and modeling of these factors can help us to take more active brain protection measures in high-risk patients. FUNDING YS was funded by the National Natural Science Foundation of China (Grant ID 81671942).
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Key Words
- AAAD, acute type A aortic dissection
- Acute type A aortic dissection
- CABG, coronary artery bypass grafting
- CPB, cardiopulmonary bypass
- CT, computed tomography
- CTA, Computed tomographic angiography
- CTP, computed tomographic perfusion imaging
- DHCA, deep hypothermic circulatory arrest
- OR, odds ratio
- PLT, platelet count
- Postoperative stroke
- Predictive model
- SETI, stent elephant trunk implantation
- TAAR, Total aortic arch replacement
- δrso2min, the lowest relative regional cerebral oxygen saturation to base‐line
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25
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Li X, Zhu L, Zhang L, Song C, Zhang H, Xia S, Guo W, Jing Z, Lu Q. Anatomical Feasibility Study on Novel Ascending Aortic Endograft With More Proximal Landing Zone for Treatment of Type A Aortic Dissection. Front Cardiovasc Med 2022; 9:843551. [PMID: 35463748 PMCID: PMC9019117 DOI: 10.3389/fcvm.2022.843551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Type A aortic dissection (TAAD) is associated with high morbidity and mortality, and open surgery is the best treatment option. Development of endovascular repair devices for TAAD will benefit patients deemed unfit for open surgery. In this study, we performed a thorough investigation of anatomical features in Asian patients with TAAD to learn about the patient eligibility of a novel ascending aortic endograft technique. Methods Computed tomography angiography (CTA) images of TAAD cases in our institution from January 2015 to November 2021 were reviewed, and three-dimensional reconstructions were performed with the Endosize software (Therenva, Rennes, France). Anatomic structures including length measured along centerline and greater/lesser curvature, ascending aorta/aortic root dimensions, as well as location of entry tear and extent of dissection were analyzed. Results A total of 158 patients were included [median age 58 years, interquartile range (IQR), 30–76 years; 115 males, 72.8%]. In 99 (62.7%) of the cases, entry tear was distal to the sinotubular junction (STJ). In 106 (67.1%) of the cases, the pathology proximally extended into the aortic root, which was intramural hematoma in 37 (23.4%) of the cases, and the aortic root was free from the pathology in 52 (32.9%) of the cases. The median distance from the STJ to the proximal edge of the ostium of the innominate artery (IA) measured along the centerline was 65 mm (IQR 58–74 mm). The median distance from the distal edge of the higher coronary ostium to the STJ was 7.95 mm (IQR 5.625–10.9 mm). The bare metal stent part was set between the edge of the higher coronary ostium and the STJ. In our series, 63 (39.9%) of the cases had this distance >10 mm. The relative difference was <20% between the STJ and the proximal edge of the ostium of the IA in 92 (58.2%) of the cases. Ascending aorta radius of curvature was 52.2 mm (IQR 43.7–63.7 mm). Conclusions Our study demonstrates that 56.3% of the TAAD cases would be amenable to endovascular repair by the novel ascending aortic endograft, with sufficient landing zone free of the dissected aorta.
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26
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Nakai Y, Yamada T, Ogawa S, Kamiya S, Saitoh Y, Suda H. Surgical outcomes of acute type A aortic dissection in septuagenarians and octogenarians. Asian Cardiovasc Thorac Ann 2022; 30:772-778. [PMID: 35234053 DOI: 10.1177/02184923221083369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We studied surgical outcomes of acute type A aortic dissection and compared early and late outcomes between septuagenarians and octogenarians. METHODS From 2010 to 2019, we evaluated 254 consecutive patients with acute type A aortic dissection. We performed emergent operations within 48 h of symptom onset for 188 patients, including 59 septuagenarians and 32 octogenarians. RESULTS The overall 30-day mortality rate was 8.5% in septuagenarians and 9.4% in octogenarians (p = 1.0). The hospital mortality rate was 10.2% in septuagenarians and 12.5% in octogenarians (p = 0.74). Multivariate analysis identified prolonged ventilation (≥ 72 h) as a significant risk factor for hospital mortality. Being an octogenarian was not significantly associated with hospital mortality. The actuarial survival rate at 5 years was 80.1% in septuagenarians and 58.5% in octogenarians (log-rank p = 0.09). The freedom from aortic event rate at 5 years was 91.0% in septuagenarians and 100% in octogenarians (log-rank p = 0.23). CONCLUSION The two groups showed no significant differences in hospital mortality or morbidity. Our tear-oriented strategies might be appropriate for both septuagenarians and octogenarians. Prolonged ventilation (≥ 72 h) was a significant risk predictor for hospital mortality.
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Affiliation(s)
- Yosuke Nakai
- Department of Cardiovascular Surgery, 38386Nagoya City University Graduate School of Medical Sciences, Japan
| | - Toshiyuki Yamada
- Department of Cardiovascular Surgery, 38386Nagoya City University Graduate School of Medical Sciences, Japan
| | - Shinji Ogawa
- Department of Cardiovascular Surgery, 38386Nagoya City University Graduate School of Medical Sciences, Japan
| | - Shinji Kamiya
- Department of Cardiovascular Surgery, 38386Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yuhei Saitoh
- Department of Cardiovascular Surgery, 38386Nagoya City University Graduate School of Medical Sciences, Japan
| | - Hisao Suda
- Department of Cardiovascular Surgery, 38386Nagoya City University Graduate School of Medical Sciences, Japan
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27
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Cambios en el tratamiento y disminución de la mortalidad del síndrome aórtico agudo. Lecciones del Registro Español del Síndrome Aórtico Agudo (RESA). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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28
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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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29
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Inoue Y, Inoue M, Koga M, Koizumi S, Yokawa K, Masada K, Seike Y, Sasaki H, Yoshitani K, Minatoya K, Matsuda H. Novel brain computed tomography perfusion for cerebral malperfusion secondary to acute type A aortic dissection. Interact Cardiovasc Thorac Surg 2022; 35:6537619. [PMID: 35218663 PMCID: PMC9336564 DOI: 10.1093/icvts/ivac046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/05/2022] [Accepted: 02/06/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The management of acute type A aortic dissection with malperfusion syndrome remains challenging. To evaluate preoperative condition, symptoms might be subjective and objective evaluation of cerebral artery has not yet been established. For quantitative evaluation, this study focused on brain computed tomography perfusion (CTP), which has been recommended by several guidelines of acute ischaemic stroke. METHODS In the last 2 years, 147 patients hospitalized due to acute type A aortic dissection were retrospectively reviewed. Among the 23 (16%) patients with cerebral malperfusion, 14 who underwent brain CTP (6 preoperative and 8 postoperative) were enrolled. CTP parameters, including regional blood flow and time to maximum, were automatically computed using RApid processing of Perfusion and Diffusion software. The median duration from the onset to hospital arrival was 129 (31-659) min. RESULTS Among the 6 patients who underwent preoperative CTP, 4 with salvageable ischaemic lesion (penumbra: 8-735 ml) without massive irreversible ischaemic lesion (ischaemic core: 0-31 ml) achieved acceptable neurological outcomes after emergency aortic replacement regardless of preoperative neurological severity. In contrast, 2 patients with an ischaemic core of >50 ml (73, 51 ml) fell into a vegetative state or neurological death due to intracranial haemorrhage. CTP parameters guided postoperative blood pressure augmentation without additional supra-aortic vessel intervention in the 8 patients who underwent postoperative CTP, among whom 6 achieved normal neurological function regardless of common carotid true lumen stenosis severity. CONCLUSIONS CTP was able to detect irreversible ischaemic core, guide critical decisions in preoperative patients and aid in determining the blood pressure augmentation for postoperative management focusing on residual brain ischaemia.
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Affiliation(s)
- Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shigeki Koizumi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenta Masada
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshimasa Seike
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenji Yoshitani
- Department of Transfusion, Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan,Corresponding author. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shimmachi, Suita, Osaka 564-8565, Japan. Tel: +81-6-6170-1070; fax: +81-6-6170-1782; e-mail: (H. Matsuda)
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30
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Benedetto U, Dimagli A, Kaura A, Sinha S, Mariscalco G, Krasopoulos G, Moorjani N, Field M, Uday T, Kendal S, Cooper G, Uppal R, Bilal H, Mascaro J, Goodwin A, Angelini G, Tsang G, Akowuah E. Determinants of outcomes following surgery for type A acute aortic dissection: the UK National Adult Cardiac Surgical Audit. Eur Heart J 2021; 43:44-52. [PMID: 34468733 PMCID: PMC8720141 DOI: 10.1093/eurheartj/ehab586] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/21/2021] [Accepted: 08/17/2021] [Indexed: 01/16/2023] Open
Abstract
Aims Operability of type A acute aortic dissections (TAAAD) is currently based on non-standardized decision-making process, and it lacks a disease-specific risk evaluation model that can predict mortality. We investigated patient, intraoperative data, surgeon, and centre-related variables for patients who underwent TAAAD in the UK. Methods and results We identified 4203 patients undergoing TAAAD surgery in the UK (2009–18), who were enrolled into the UK National Adult Cardiac Surgical Audit dataset. The primary outcome was operative mortality. A multivariable logistic regression analysis was performed with fast backward elimination of variables and the bootstrap-based optimism-correction was adopted to assess model performance. Variation related to hospital or surgeon effects were quantified by a generalized mixed linear model and risk-adjusted funnel plots by displaying the individual standardized mortality ratio against expected deaths. Final variables retained in the model were: age [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.02–1.03; P < 0.001]; malperfusion (OR 1.79, 95% CI 1.51–2.12; P < 0.001); left ventricular ejection fraction (moderate: OR 1.40, 95% CI 1.14–1.71; P = 0.001; poor: OR 2.83, 95% CI 1.90–4.21; P < 0.001); previous cardiac surgery (OR 2.29, 95% CI 1.71–3.07; P < 0.001); preoperative mechanical ventilation (OR 2.76, 95% CI 2.00–3.80; P < 0.001); preoperative resuscitation (OR 3.36, 95% CI 1.14–9.87; P = 0.028); and concomitant coronary artery bypass grafting (OR 2.29, 95% CI 1.86–2.83; P < 0.001). We found a significant inverse relationship between surgeons but not centre annual volume with outcomes. Conclusions Patient characteristics, intraoperative factors, cardiac centre, and high-volume surgeons are strong determinants of outcomes following TAAAD surgery. These findings may help refining clinical decision-making, supporting patient counselling and be used by policy makers for quality assurance and service provision improvement.
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Affiliation(s)
- Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
| | - Arnaldo Dimagli
- Bristol Heart Institute, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
| | - Amit Kaura
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W21NY, UK
| | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, Groby Rd, Leicester LE3 9QP, UK
| | - George Krasopoulos
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Papworth Rd, Trumpington, Cambridge CB2 0AY, UK
| | - Mark Field
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool L14 3PE, UK
| | - Trivedi Uday
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Barry Building, Eastern Rd, Brighton BN2 5BE, UK
| | - Simon Kendal
- South Tees Hospitals NHS Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - Graham Cooper
- Sheffield Teaching Hospitals Foundation Trust, Royal Hallamshire Hospital, Glossop Rd, Broomhall, Sheffield S10 2JF, UK
| | - Rakesh Uppal
- Barts Heart Centre, William Harvey Research Institute, W Smithfield, London EC1A 7BE, UK
| | - Haris Bilal
- Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, UK
| | - Jorge Mascaro
- University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - Andrew Goodwin
- South Tees Hospitals NHS Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - Gianni Angelini
- Bristol Heart Institute, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
| | - Geoffry Tsang
- Wessex Cardiothoracic Center, University Hospital Southampton NHS Trust, Tremona Road Southampton, Hampshire SO16 6YD, UK
| | - Enoch Akowuah
- South Tees Hospitals NHS Trust, Marton Road, Middlesbrough TS4 3BW, UK
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Dufendach KA, Chu D. Commentary: Location, location, location-proximal right subclavian cannulation for thoracic aortic surgery. JTCVS Tech 2021; 8:7-8. [PMID: 34401792 PMCID: PMC8350886 DOI: 10.1016/j.xjtc.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Keith A. Dufendach
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Danny Chu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pa
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Yamaguchi T, Nakai M, Yano T, Matsuyama M, Yoshino H, Miyamoto Y, Sumita Y, Matsuda H, Inoue Y, Okita Y, Minatoya K, Ueda Y, Ogino H. Population-based incidence and outcomes of acute aortic dissection in Japan. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:701-709. [PMID: 34189568 DOI: 10.1093/ehjacc/zuab031] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 12/11/2022]
Abstract
AIMS The population-based incidence and outcomes of acute aortic dissection (AAD) are still unknown because some patients are already dead on arrival, and the accurate diagnosis of AAD is difficult due to the low autopsy rate. We performed a population-based review of all patients with AAD in a well-defined geographical area in Japan between 2016 and 2018. METHODS AND RESULTS Data of all patients with AAD at Miyazaki Prefectural Nobeoka Hospital (MPNH), which performs medical care for 120 000 residents, were collected retrospectively. The emergency medical service is dedicated to the transfer of all patients in this area to the MPNH. For all patients who were dead on arrival, the diagnosis of AAD was made by autopsy imaging (AI) using computed tomography. The age-adjusted incidence and mortality per 100 000 population were calculated using the Japanese population distribution model in 2015. The total incidence of AAD was 79 (type A: 64.5%, n = 51). Of those, 60.8% (31/51) of patients with type A and 21.4% (6/28) with type B were dead on arrival and diagnosed by AI. The 30-day mortality rates were 74.5% (38/51) in type A and 25.0% (7/28) in type B. The age-adjusted incidence and mortality of AAD per 100 000 inhabitants were 17.6 (type A: 11.3, type B: 6.2) and 9.9 (type A: 8.4, type B: 1.5), respectively. CONCLUSIONS The population-based survey of AAD showed that the age-adjusted incidence of AAD was two-fold higher than in previous reports, and the actual mortality rates were markedly higher due to the high incidence of dead-on-arrival.
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Affiliation(s)
- Tetsuo Yamaguchi
- Department of Cardiovascular Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita city, Osaka 565-8565, Japan
| | - Takao Yano
- Department of Critical Care and Emergency Medicine, Miyazaki Prefectural Nobeoka Hospital, 2-1-10, Shin-koji, Nobeoka City, Miyazaki 882-0835, JAPAN
| | - Masakazu Matsuyama
- Department of Cardiovascular Surgery, Miyazaki Prefectural Nobeoka hospital, 2-1-10, Shin-koji, Nobeoka city, Miyazaki 882-0835, Japan
| | - Hideaki Yoshino
- Department of Cardiology, Kyorin University Graduate School of Medicine, 20-2, Shinkawa, Mitaka city, Tokyo 181-8611, Japan
| | - Yoshihiro Miyamoto
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita city, Osaka 565-8565, Japan
| | - Yoko Sumita
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita city, Osaka 565-8565, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita city, Osaka 565-8565, Japan
| | - Yousuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita city, Osaka 565-8565, Japan
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunokicho, chuo-ku, Kobe city, Hyogo 650-0017, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54, Shogoin-Kawaramachi, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yuichi Ueda
- Department of Cardiology, Nara Prefecture General Medical Center, 2-897-5, Shichijo-Nishimachi, Nara 630-8581, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
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Sun S, Chien CY, Fan YF, Wu SJ, Li JY, Tan YH, Hsu KH. Retrograde cerebral perfusion for surgery of type A aortic dissection. Asian J Surg 2021; 44:1529-1534. [PMID: 33888364 DOI: 10.1016/j.asjsur.2021.03.047] [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: 12/16/2020] [Revised: 02/17/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND For type A aortic dissection (TAAD), antegrade cerebral perfusion (ACP) was proposed as a more physiological method than retrograde cerebral perfusion (RCP) for intra-operative brain protection, but it is still debatable whether antegrade cerebral perfusion (ACP) or retrograde cerebral perfusion (RCP) is related to the better clinical outcome. The present study was undertaken to compare the results in our patients receiving surgery for TAAD with ACP or RCP. The primary aim of this study was focused on the incidence of and the factors associated with surgical mortality, post-operative neurological outcomes and long-term survival. METHODS From February 2001 to March 2019, there were 223 consecutive patients with TAAD treated surgically at our hospital. The median age at presentation was 56 years (range 29-88 years) and 70 patients (31.4%) over 65 years of age. There were 168 patients treated with RCP and 55 patients treated with ACP. The primary endpoints were surgical mortality and neurological outcome. Propensity score matching was used to compare the treatment results of surgeries with RCP or ACP. The long-term survival was also analyzed. RESULTS The overall in-hospital mortality rate and the overall 30-day mortality rate were 15.6% and 14.3% respectively. For the patients without pre-operative shock (n = 184), the in-hospital mortality rate was 10.3% and the 30-day mortality rate was 8.7% and higher long-term survival rates (88.3% for 5 years, 86.5% for 10 years, 86.5% for 15 years) were documented for this patient group. There was no significant difference on the surgical mortality between the ACP group and the RCP group. In the entire cohort, there were 23 patients (10.3%) who suffered from post-operative neurological deficits (PND) and there were less PND for the patients with RCP than the patients with ACP (7.7% vs 18.1%, p = 0.027). After propensity score matching, there was still higher incidence of PND in the ACP group than in the RCP group but without statistical significance (18.5% vs 11.1%, p = 0.279). CONCLUSIONS Aortic surgery carries high risk for the patients with TAAD and PND is not an unusual post-operative morbidity. In our series, pre-operative shock, pre-operative CPR, CRI, past history with CAD are related to higher surgical mortality. The younger patients (<65 years old) without pre-operative shock got better surgical outcome and long-term survival. RCP could provide acceptable cerebral protection during aortic surgery for the TAAD patients. Old age, pre-operative shock, CRI and past history of CAD are independent risk factors for long-term survival.
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Affiliation(s)
- Shen Sun
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chen-Yen Chien
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ya-Fen Fan
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shye-Jao Wu
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan.
| | - Jiun-Yi Li
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Hern Tan
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Kung-Hong Hsu
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
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Current status of open surgery for acute type A aortic dissection in Japan. J Thorac Cardiovasc Surg 2020; 164:785-794.e1. [PMID: 33334600 DOI: 10.1016/j.jtcvs.2020.09.147] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/06/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The study objective was to report the clinical outcomes of open surgery for acute aortic dissection by using the Japan Cardiovascular Database. METHODS Between 2013 and 2018, a total of 29,486 patients with acute aortic dissection who underwent open surgery were registered in the Japan Cardiovascular Database. Some 50% of patients were male. Age of patients at surgery was 59.8 ± 14.2 years; 61% of patients were aged less than 65 years, and 21% of patients were aged more than 75 years. Connective tissue disease was found in 1.2% of patients. Some 13% of patients had disturbed consciousness, and 12% of patients had cardiogenic shock. Some 11% of patients had moderate or severe aortic valve regurgitation, and 2.3% of patients had acute myocardial infarction. Some 94% of patients underwent surgery within 24 hours after diagnosis. Antegrade cerebral perfusion was used in 74% of patients, hypothermic circulatory arrest with retrograde cerebral perfusion was used in 17.1% of patients, and deep hypothermic circulatory arrest was used in 9.4% of patients. Cardiopulmonary bypass time was 216 ± 90 minutes, and cardiac ischemic time was 132 ± 60 minutes. Lowest body temperature was 24.6°C ± 3.2°C. Replacement of the ascending aorta (zone I) was performed in 69% of patients, and total arch replacement (zone 0 to zone II, III-) was performed in 29% of patients. The aortic valve was replaced in 7.9% of patients and repaired in 4.4% of patients. RESULTS The 30-day mortality was 9.2%, and in-hospital mortality was 11%. The number of operations has increased through the study periods. The in-hospital mortality has been stable or in a decreasing trend. Major complications consisted of stroke in 12% of patients, new hemodialysis in 7.3% of patients, spinal cord ischemia in 3.9% of patients, and prolonged ventilation in 15% of patients. CONCLUSIONS Approximately 30,000 patients with acute aortic dissection in the recent 6 years (2013 - 2018) underwent open surgery according to the nationwide Japanese database. The number of operations has increased, and in-hospital mortality has been stable or in a decreasing trend. Although the early outcomes are acceptable, there is still room for improvement in patients with preoperative comorbidities.
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Morgant MC, Malapert G, Bernard C, Laubriet A, Pujos C, Varin T, Lansac E, Bouchot O. Aortic root remodeling with external annuloplasty for acute type A aortic dissection: Midterm results. J Card Surg 2020; 36:1770-1778. [PMID: 33032374 DOI: 10.1111/jocs.15095] [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: 07/31/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the role of aortic root remodeling with external aortic annuloplasty (ARREAA) in acute type A aortic dissection (AAAD). METHODS From May 2011 to May 2020, 59 patients out of 240 with AAAD underwent ARREAA. Data were retrospectively collected and analyzed. RESULTS The mean age was 61.4 ± 8.6 years and 43 patients were males (73%). Hemiarch and total arch replacement were performed in 37 (62.7%) and 14 (23.7%) patients. An aortic valvuloplasty was performed in seven patients (11.8%). Five patients (8.5%) required coronary artery bypass graft. Re-exploration for bleeding was required in six patients (10.1%). The 30-day mortality rate was 18.6%. Preoperative hemodynamic instability (odds ratio [OR] = 8.57, 95% confidence interval [CI] = 1.57-46.71; p = 0.013), consciousness disorder (OR = 19.18, 95% CI = 3.02-121.72]; p = 0.002) or myocardial ischemia (OR = 6.28, 95% CI = 1.27-31.10; p = 0.013) were significantly associated with postoperative mortality. No patient was reoperated for aortic valve during the postoperative period. One patient suffered a stroke postoperatively with partial recovery. Kidney failure requiring temporary dialysis occurred in 12 patients (20.3%). At discharge, a transthoracic echocardiogram showed moderate aortic regurgitation (AR; grade 2) in two patients. During follow-up (mean = 58.4 ± 32.4 months), three patients died. The rate of mortality was 6.2%. Actuarial survival at 5 years was 76.3%. No patient required reoperation on the proximal aorta or aortic valve. At 4 years, freedom from any aortic valve or root reintervention and AR > 2 were both 100%. CONCLUSION In a center with expertise in valve-sparing procedures, ARREAA is a reasonable option in the surgical management of AAAD in selected patients. This technique stabilizes the aortic annulus and preserves root anatomy for durable outcomes.
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Affiliation(s)
| | - Ghislain Malapert
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Chloé Bernard
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Aline Laubriet
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Charline Pujos
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Thomas Varin
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Mutualist Montsouris Institute, Paris, France
| | - Olivier Bouchot
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
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Qin W, Su C, Li L, Carmichael M, Huang F, Chen X. Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?-insights from single center experience. J Cardiothorac Surg 2020; 15:183. [PMID: 32703274 PMCID: PMC7379362 DOI: 10.1186/s13019-020-01234-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes. METHODS From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n = 41) and total arch replacement + stent elephant trunk implantation (TAR+SET, n = 62). RESULTS There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR+SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality (P = 0.04). The overall survival rates at 5-year follow-up were 82.5 ± 6.0% in LAR group and 75.2 ± 5.6% in TAR+SET group, but with no difference (p = 0.151). The freedom from adverse aortic events at 5-year was 84.3 ± 6.5% in LAR group versus 97.9 ± 2.1% in TAR+SET group, with a statistical difference (p = 0.03). CONCLUSION These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.
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Affiliation(s)
- Wei Qin
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, Jiangsu, 210006, P.R. China
| | - Cunhua Su
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, Jiangsu, 210006, P.R. China
| | - Liangpeng Li
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, Jiangsu, 210006, P.R. China
| | - Michael Carmichael
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, Jiangsu, 210006, P.R. China
| | - Fuhua Huang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, Jiangsu, 210006, P.R. China.
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, Jiangsu, 210006, P.R. China.
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