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Sakamoto SI, Murata T, Maeda M, Hiromoto A, Yamaguchi T, Suzuki K, Ishii Y. Safety and outcomes of surgical treatment of atrial fibrillation in emergency surgery cases. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02027-9. [PMID: 38607606 DOI: 10.1007/s11748-024-02027-9] [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: 12/28/2023] [Accepted: 03/24/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Recent developments in surgical devices, including left atrial appendage closure, have enabled surgeons to perform aggressive operations for atrial fibrillation (AF). However, the outcomes of AF surgery in emergent cases have not been extensively studied. OBJECTIVE AND METHODS The present study aimed to investigate the effectiveness of AF surgery in emergency surgery cases associated with cardiovascular events. We enrolled 18 patients who underwent various types of AF surgery due to emergencies, including acute aortic dissection (n = 6), acute myocardial infarction (n = 5), bleeding due to perforation from radiofrequency catheter ablation (n = 4), acute mitral regurgitation (n = 2), and cardiac tumor (n = 1). Four and ten patients underwent the full maze procedure and pulmonary vein isolation, respectively. Ganglionated plexi ablation was also performed in three patients as part of a combined procedure. The left atrial appendage was solely closed in four patients. RESULTS There was no surgical mortality or major adverse cardiac and cerebrovascular events in our patient series. The rates of freedom of recurrence of AF or atrial tachycardia at 1 and 3 years were 92.9% and 82.5%, respectively. After a mean follow-up period of 46.7 ± 25.8 months, no thromboembolism events were observed in the patients. Furthermore, no cardiovascular death was recorded. CONCLUSION The surgical procedures for AF are safe and effective in cases requiring emergency surgery.
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Affiliation(s)
- Shun-Ichiro Sakamoto
- Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan.
| | - Tomohiro Murata
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Motohiro Maeda
- Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan
| | - Atsushi Hiromoto
- Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan
| | - Takako Yamaguchi
- Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan
| | - Kenji Suzuki
- Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan
| | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
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Yaşar E, Duman ZM, Timur B, Bayram M, Kaplan MC, Kadiroğulları E. Fate of the Patent False Lumen of the Descending Aorta After Surgical Treatment for Acute Type 1 Aortic Dissection. Braz J Cardiovasc Surg 2023; 38:e20220257. [PMID: 37801681 PMCID: PMC10552773 DOI: 10.21470/1678-9741-2022-0257] [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: 07/10/2022] [Accepted: 05/15/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the factors affecting false lumen patency in the descending thoracic aorta among patients who underwent surgery for acute type 1 aortic dissection. METHODS A total of 112 patients with acute type 1 aortic dissection, with the flap below the diaphragm level, underwent surgery between January 2010 and September 2019. Of these, 60 patients who were followed up for ≥ 12 months and whose computed tomography scans were available were included in this study. The patients were divided into two groups: group I, consists of patent false lumen (n=36), and group II, consists of thrombosed false lumen (n=24). Demographic data, operative techniques, postoperative descending aortic diameters, reintervention, and late mortality were compared between the two groups. RESULTS The mean follow-up period of all patients was 37.6±26.1 months (range: 12-104). The diameter increase in the proximal and distal descending aorta was significantly higher in the patent false lumen group (5.3±3.7 mm vs. 3.25±2.34 mm; P=0.015; 3.1±2.52 mm vs. 1.9±1.55 mm; P=0.038, respectively). No significant difference in terms of hypertension was found between the two groups during the follow-up period (21 patients, 58.3% vs. 8 patients, 33.3%; P=0.058). A total of 29 patients (48.3%) were found to be hypertensive in the postoperative period. CONCLUSION After surgical treatment for acute type 1 aortic dissection, patients should be monitored closely, regardless of whether the false lumen is patent or thrombosed. Mortality and reintervention can be seen in patients with patent false lumen during follow-up.
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Affiliation(s)
- Emre Yaşar
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zihni Mert Duman
- Department of Cardiovascular Surgery, Cizre State Hospital,
Şırnak, Turkey
| | - Barış Timur
- Department of Cardiovascular Surgery, Istanbul Dr. Siyami Ersek
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Bayram
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Can Kaplan
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ersin Kadiroğulları
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Gong X, Lang Q, Qin C, Meng W, Xiao Z. The effect of postoperative anticoagulation on acute aortic dissection: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1173945. [PMID: 37234372 PMCID: PMC10206123 DOI: 10.3389/fcvm.2023.1173945] [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: 02/25/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Background and aim The evolution of the false lumen after the repair of acute aortic dissection has been linked to numerous adverse clinical outcomes, including increased late mortality and a higher risk of reoperation. Despite the widespread use of chronic anticoagulation in patients who have undergone repair for acute aortic dissection, the effects of this therapy on false lumen evolution and its subsequent consequences are yet to be fully understood. This meta-analysis aimed to investigate the impact of postoperative anticoagulation on patients with acute aortic dissection. Methods In PubMed, Cochrane Libraries, Embase, and Web of Science, we performed a systematic review of nonrandomized studies, comparing outcomes with postoperative anticoagulation vs. non-anticoagulation on aortic dissection. We investigated the status of false lumen (FL), aorta-related death, aortic reintervention, and perioperative stroke in aortic dissection patients with anticoagulation and non-anticoagulation. Results After screening 527 articles, seven non-randomized studies were selected, including a total of 2,122 patients with aortic dissection. Out of these patients, 496 received postoperative anticoagulation while 1,626 served as controls. Meta-analyses of 7 studies revealed significantly higher FL patency in Stanford type A aortic dissection (TAAD) postoperative anticoagulation with an OR of 1.82 (95% CI: 1.22 to 2.71; Z = 2.95; I²=0%; P = 0.93). Moreover, there was no statistically significant difference between the two groups in aorta-related death, aortic reintervention, and perioperative stroke with an OR of 1.31 (95% CI: 0.56 to 3.04; Z = 0.62; I² = 0%; P = 0.40), 0.98 (95% CI: 0.66 to 1.47; Z = 0.09; I² = 23%; P = 0.26), 1.73 (95% CI: 0.48 to 6.31; Z = 0.83; I² = 8%; P = 0.35), respectively. Conclusions Postoperative anticoagulation was associated with higher FL patency in Stanford type A aortic dissection patients. However, there was no significant difference between the anticoagulation and non-anticoagulation groups in terms of aorta-related death, aortic reintervention, and perioperative stroke.
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Affiliation(s)
- Xiangfeng Gong
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qianlei Lang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyi Qin
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
- Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Meng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
- Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenghua Xiao
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
- Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, China
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Heuts S, Schalla S, Ramaekers MJFG, Bidar E, Mihl C, Wildberger JE, Adriaans BP. Imaging surveillance for complications after primary surgery for type A aortic dissection. HEART (BRITISH CARDIAC SOCIETY) 2022; 109:96-101. [PMID: 35321890 DOI: 10.1136/heartjnl-2022-320881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023]
Abstract
Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires emergency surgery to avert fatal outcome. Conventional surgical procedures comprise excision of the entry tear and replacement of the proximal aorta with a synthetic vascular graft. In patients with DeBakey type I dissection, this approach leaves a chronically dissected distal aorta, putting them at risk for progressive dilatation, dissection propagation and aortic rupture. Therefore, ATAAD survivors should undergo serial imaging for evaluation of the aortic valve, proximal and distal anastomoses, and the aortic segments beyond the distal anastomosis. The current narrative review aims to describe potential complications in the early and late phases after ATAAD surgery, with focus on their specific imaging findings.
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Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands
| | - Simon Schalla
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Mitch J F G Ramaekers
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Casper Mihl
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Bouke P Adriaans
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Limburg, The Netherlands
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Vendramin I, Piani D, Lechiancole A, Sponga S, Di Nora C, Londero F, Muser D, Onorati F, Bortolotti U, Livi U. Hemiarch Versus Arch Replacement in Acute Type A Aortic Dissection: Is the Occam's Razor Principle Applicable? J Clin Med 2021; 11:jcm11010114. [PMID: 35011856 PMCID: PMC8745476 DOI: 10.3390/jcm11010114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/25/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM OF THE STUDY In patients with acute Type A aortic dissection (A-AAD) whether repair should be limited to ascending aorta/hemiarch replacement or extended to include the aortic arch is still debated. We have analyzed our experience to compare outcomes of patients with A-AAD treated with these 2 different surgical strategies. METHODS From 2006 to 2020, a total of 213 patients have undergone repair of A-AAD at our Center; in 163 of them ascending aorta/hemiarch replacement (Group 1) and in 75 ascending aorta and arch replacement (Group 2) were performed. The primary endpoint was early survival and secondary endpoints late survival, freedom from late complications and reoperations. Patients were compared according to era of operation: 2006 to 2013 (Era 1) and 2014 to 2020 (Era 2). RESULTS Overall hospital mortality was 12% and 5% in Group 1 and 2; mortality remained stable in Era 1 and 2 for Group 1 (15%), while it decreased from 8% to 1% in Group 2 patients (p = 0.24). Actuarial survival at 5 and 10 years is 72 ± 4% and 49 ± 5% in Group 1 and 77 ± 6% and 66 ± 9% in Group 2 (p = 0.073). Actuarial freedom from reoperation in the entire series is 94 ± 2% and 92 ± 3% at 5 and 10 years. Freedom from reoperation at 5 and 10 years is 92 ± 2% and 89 ± 3% in Group 1 and 98 ± 1% at all intervals in Group 2 (p = 0.068). CONCLUSIONS An aggressive approach to A-AAD provides superior long-term results without increasing mortality. Furthermore, arch replacement during A-AAD repair represents a more stable solution with lower incidence of late aortic-related complications. Immediate aortic arch replacement should be considered in the treatment of A-AAD especially in experienced centers.
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Affiliation(s)
- Igor Vendramin
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
- Correspondence: ; Tel.: +39-432-552431; Fax: +39-432-552975
| | - Daniela Piani
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
| | - Andrea Lechiancole
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
| | - Sandro Sponga
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
| | - Concetta Di Nora
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
| | - Francesco Londero
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
| | - Daniele Muser
- Division of Cardiology, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy;
| | - Francesco Onorati
- Division of Cardiac Surgery, Azienda Ospedaliero-Universitaria di Verona, 37100 Verona, Italy;
| | - Uberto Bortolotti
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
| | - Ugolino Livi
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
- Division of Cardiac Surgery, Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy
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Vendramin I, Lechiancole A, Piani D, Sponga S, Di Nora C, Muser D, Bortolotti U, Livi U. An Integrated Approach for Treatment of Acute Type A Aortic Dissection. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111155. [PMID: 34833373 PMCID: PMC8621250 DOI: 10.3390/medicina57111155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Abstract
Background and objective: We reviewed a single-institution experience to verify the impact of surgery during different time intervals on early and late results in the treatment of patients with type A acute aortic dissection (A-AAD). Materials and Methods: From 2004 to 2021, a total of 258 patients underwent repair of A-AAD; patients were equally distributed among three periods: 2004-2010 (Era 1, n = 90), 2011-2016 (Era 2, n = 87), and 2017-2021 (Era 3, n = 81). The primary end-point was to assess whether through the years changes in indications, surgical strategies and techniques and increasing experience have influenced early and late outcomes of A-AAD repair. Results: Axillary artery cannulation was almost routinely used in Eras 2 (86%) and 3 (91%) while one femoral artery was mainly cannulated in Era 1 (91%) (p < 0.01). Retrograde cerebral perfusion was predominantly used in Era 1 (60%) while antegrade cerebral perfusion was preferred in Eras 2 (94%,) and 3 (100%); (p < 0.01). There was a significant increase of arch replacement procedures from Era 1 (11%) to Eras 2 (33%) and 3 (48%) (p < 0.01). A frozen elephant trunk was mainly performed in Era 3. Hospital mortality was 13% in Era 1, 11% in Era 2, and 4% in Era 3 (p = 0.07). Actuarial survival at 3 years is 74%, in Era 1, 78% in Era 2, and 89% in Era 3 (p = 0.05). Conclusions: With increasing experience and a more aggressive approach, including total arch replacement, repair of A-AAD can be performed with low operative mortality in many patients. Patient care and treatment by a specific team organization allows a faster diagnosis and referral for surgery allowing to further improve early and late outcomes.
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Affiliation(s)
- Igor Vendramin
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
| | - Andrea Lechiancole
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
| | - Daniela Piani
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
| | - Sandro Sponga
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
| | - Concetta Di Nora
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
| | - Daniele Muser
- Cardiothoracic Department, Division of Cardiology, University Hospital of Udine, 33100 Udine, Italy;
| | - Uberto Bortolotti
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
| | - Ugolino Livi
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
- Department of Medical Area (DAME), Division of Cardiac Surgery, University of Udine, 33100 Udine, Italy
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Bozinovski J. Commentary: Clear as blood: Anticoagulation, false lumen patency, and outcomes in acute aortic dissection. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01410-0. [PMID: 34666909 DOI: 10.1016/j.jtcvs.2021.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Affiliation(s)
- John Bozinovski
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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DeAnda A, Yates SG. Commentary: Aortic dissection and chronic oral anticoagulation: An IlLUMENating perspective? J Thorac Cardiovasc Surg 2021:S0022-5223(21)01397-0. [PMID: 34657712 DOI: 10.1016/j.jtcvs.2021.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Abe DeAnda
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, UTMB-Galveston, Galveston, Tex.
| | - Sean G Yates
- Division of Transfusion Medicine and Hemostasis, Department of Pathology, UT Southwestern, Dallas, Tex
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