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Moon MR, Kachroo P. Distal Extent of Resection in Type A Dissection: Keeping It Simple. Tex Heart Inst J 2024; 51:e238371. [PMID: 38509048 DOI: 10.14503/thij-23-8371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
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Zhong L, Xiong H, Li J, He Y, Zhou H. Early outcomes of Sun's procedure in elderly patients with acute aortic dissection: a single-center retrospective study. J Int Med Res 2022; 50:3000605221109377. [PMID: 35770980 PMCID: PMC9251999 DOI: 10.1177/03000605221109377] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The effect of patient age on the outcome of Sun's procedure for acute type A aortic dissection (ATAAD) remains controversial. We retrospectively investigated the early outcomes of Sun's procedure in elderly patients with ATAAD in our single center. METHODS This study involved 106 patients who underwent Sun's procedure. The patients were divided into the elderly group (≥70 years, n = 17) and younger group (<70 years). Baseline, intraoperative, and postoperative data were compared between the groups. RESULTS The mean age in the elderly and younger groups was 75.7 and 50.7 years, respectively. The type of aortic root operations were not significantly different between the groups. Concomitant surgeries were more frequently performed in the elderly group, but without statistical significance. All intraoperative cardiopulmonary bypass variables as well as the in-hospital and 30-day mortality rates were similar between the groups. The incidences of most postoperative complications were also similar except for a higher incidence of sepsis in the elderly group. CONCLUSIONS Emergency performance of Sun's procedure for patients with ATAAD characterized by dissection and/or entry tear in the aortic arch should not be denied on the basis of advanced age alone. Comparable early in-hospital outcomes can be achieved in elderly patients.
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Affiliation(s)
- Liang Zhong
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Yanta West Road No. 277, Xi'an 710061, China
| | - Hongyan Xiong
- Department of Thoracic & Cardiovascular Surgery, Xi'an Central Hospital of Xi'an Jiaotong University, Xiwu Road No. 16, Xi'an 710003, China
| | - Jing Li
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Yanta West Road No. 277, Xi'an 710061, China
| | - Yong He
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Yanta West Road No. 277, Xi'an 710061, China
| | - Heping Zhou
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Yanta West Road No. 277, Xi'an 710061, China
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Luo ZR, Liao DS, Chen LW. Comparative analysis of postoperative sexual dysfunction and quality of life in type a aortic dissection patients of different ages. J Cardiothorac Surg 2021; 16:117. [PMID: 33933114 PMCID: PMC8088030 DOI: 10.1186/s13019-021-01468-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background To compare postoperative sexual dysfunction (SD) and quality of life (QOL) in Type A Aortic Dissection (AAD) Patients of Different Ages. Methods From January 2018 to December 2019, 204 AAD postoperative survivors in Union Hospital of Fujian Medical University were selected and were divided into young group (less than 50 years old) and elderly group (more than 50 years old). We evaluated SD according to the male International Erectile Dysfunction Index (IIEF-5) and female sexual function index (FSFI). The Short Form 12 Health Survey Questionnaire (SF-12) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were used to investigate the QOL, Quick Inventory Depressive Symptomatology-Self Report (QIDS-SR) and the Beck Depression Inventory-II (BDI-II) to investigate depressive symptoms. Results One hundred seventy-five patients completed all the questionnaire (85.8%). The total SD prevalence rate was 38.9% (68 cases), with 27.4% of the young (20 cases) and 47.1% of the elderly (48 cases). The age of non-SD and SD patients was 49.0 ± 11.5 and 56.9 ± 10.8 years, respectively (P = 0.03). Compared with non-SD patients, the total physical health of SD patients was significantly worse (P = 0.04), however, the mental health was not significantly worse (P = 0.77); the depressive symptoms did not expressed a significant difference between the SD and non-SD groups (QIDS-SR P = 0.15, BDI-II P = 0.06). Total physical health scores in the young SD group did not show significant better than elderly SD group (P = 0.24), however, total mental health scores showed significantly worse (P = 0.04), depressive symptoms scores were significantly higher (QIDS-SR P = 0.03, BDI-II P = 0.04). Conclusion The postoperative AAD SD prevalence of elderly is higher than that of young, and the total physical health of SD patients is poorer than those without SD patients. The young SD patients did not show a significant higher physical health scores than the elderly SD patients, instead, the young SD patients were more psychologically affected than the elderly SD patients, whose mental health was worse, and depression symptoms were more obvious, suggesting that the factors affecting the QOL of postoperative SD patients are related to physical factors, but the young postoperative SD patients mainly affected by psychological factors. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01468-0.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, P. R. China
| | - Dong-Shan Liao
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, P. R. China.
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, P. R. China
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Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study. BMC Cardiovasc Disord 2021; 21:193. [PMID: 33879045 PMCID: PMC8056667 DOI: 10.1186/s12872-021-02002-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 04/11/2021] [Indexed: 02/08/2023] Open
Abstract
Objectives Antegrade cerebral perfusion (ACP) under moderate hypothermic circulatory arrest is used during total aortic arch replacement surgery (TARS) in patients with acute type A aortic dissection, but it is associated with high mortality and morbidity. We hypothesized that combining ACP with retrograde inferior vena caval perfusion (RIVP) improves outcomes. Methods This pilot study was prospective, randomized, controlled and assessor-blinded. Patients scheduled for TARS were randomly treated with either ACP or RIVP + ACP. The primary outcome was a composite of mortality and major complications including paraplegia, postoperative renal failure, severe liver dysfunction, and gastrointestinal complications. Secondary outcomes included neurological complications, length of intubation and requirement of blood products. Results A total of 76 patients were recruited (n = 38 per group). Primary outcome occurred in 23 patients (61%) in the ACP group and 16 (42%) in the RIVP + ACP group (OR: 0.60, 95% CI: 0.21–1.62; p = 0.31). There was a lower incidence of transient neurological deficits in the RIVP + ACP group (26% vs. 58%, OR: 0.26; 95% CI: 0.10–0.67,p = 0.006;). The RIVP + ACP group underwent shorter intubation (25 vs 47 h, p = 0.022) and required fewer blood products (red cells, 3.8 units vs 6.5 units, p = 0.047; platelet: 2.0 units vs 2.0 units, p = 0.023) compared with the ACP group. Conclusions RIVP + ACP may be associated with lower incidence of transient neurological deficits, shorter intubation and less blood transfusion requirement than ACP alone during TARS. Multi-center, randomized trials with larger samples are required to determine whether RIVP + ACP is associated with lower rates of mortality and major complications. Trial registration: Pilot study of a RCT registered in clinicaltrials.gov (NCT03607786), Registered 30 July, 2018—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03607786. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02002-9.
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Impact of time between diagnosis to treatment in Acute Type A Aortic Dissection. Sci Rep 2021; 11:3519. [PMID: 33568755 PMCID: PMC7876041 DOI: 10.1038/s41598-021-83180-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/27/2021] [Indexed: 01/03/2023] Open
Abstract
There is a paucity of data describing the effect of time interval between diagnosis and surgery for Acute Type A Aortic Dissection. We describe our 8-year experience and investigate the impact of time interval between symptom onset, diagnosis and surgery on outcomes. Retrospective single-center study utilizing our Society of Thoracic Surgeons registry and patient records. Subjects were grouped by time interval between radiographic diagnosis and surgical treatment: Group A (0-4 h), Group B (4.1-8 h), Group C (8.1-12 h), and Group D (12.1 + h). Data were analyzed to identify factors associated with mortality and outcomes. 164 patients were included. Overall mortality was 21.3%. Group C had the greatest intervals between symptom onset to diagnosis to surgery, and also the highest mortality (66.7%). Preoperative tamponade, cardiac arrest, malperfusion, elevated creatinine, cardiopulmonary bypass time, and blood transfusions were associated with increased mortality, while distance of referring hospital was not. Time intervals between symptom onset, diagnosis and surgery have a significant effect on mortality. Surgery performed 8-12 h after diagnosis carries the highest mortality, which may be exacerbated by longer interval since symptom onset. Time-dependent effects should be considered when determining optimal strategy especially if inter-facility transfer is necessary.
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McBeth BD, Rosenstein DI. Acute Aortic Dissection With ST Segment Myocardial Infarction Following Masturbation. J Emerg Med 2020; 58:e193-e196. [PMID: 32204992 DOI: 10.1016/j.jemermed.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/04/2019] [Accepted: 01/12/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acute aortic dissection is the most common life-threatening disorder affecting the aorta, and can mimic other disease processes. We describe an unusual presentation of a critically ill patient with initial hematospermia diagnosed with a type A acute aortic dissection. CASE REPORT A 68 year old man presented to a community ED after masturbation and report of blood in his ejaculate, followed by rapid development of severe low back, chest and hip pain with shock. ECG showed evidence of ST segment elevation, but suspicion remained high for thoracic or abdominal aortic catastrophe. Bedside ultrasound demonstrated no pericardial effusion, a severely hypokinetic myocardium and a question of fluid in the left perinephric space. Attempts were made to resuscitate the patient, and an ED chest/abdomen/pelvis CT showed a type A acute thoracic aortic dissection. Unfortunately, the patient remained profoundly unstable, with multiple arrests. He was transferred to a tertiary care facility, but expired shortly after arrival. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: An emergency physician needs to be aware of the myriad of presentations of acute aortic dissection. Although hematospermia was felt ultimately to be an incidental symptom, sexual activity may bring about a significant transient increase in blood pressure, which could contribute to sheer force causing aortic injury. Awareness of this trigger and a careful sensitive history may aid the clinician in early diagnosis.
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Affiliation(s)
- Brian D McBeth
- Department of Emergency Medicine, O'Connor Hospital, San Jose, California
| | - Daniel I Rosenstein
- Department of Urology, Kaiser Permanente Medical Group, San Jose, California
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Ong CS, Nam L, Yesantharao P, Dong J, Canner JK, Teuben RJ, Zhou X, Young A, Suarez-Pierre A, Pasque MK, Lawton JS. The Strongest Risk Factor for Operative Mortality in Acute Type A Aortic Dissection is Acidosis: Validation of Risk Model. Semin Thorac Cardiovasc Surg 2020; 32:674-680. [DOI: 10.1053/j.semtcvs.2020.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 11/11/2022]
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Lin J, Tan Z, Yao H, Hu X, Zhang D, Zhao Y, Xiong J, Dou B, Zhu X, Wu Z, Guo Y, Kang D, Du L. Retrograde Inferior Vena caval Perfusion for Total Aortic arch Replacement Surgery (RIVP-TARS): study protocol for a multicenter, randomized controlled trial. Trials 2019; 20:232. [PMID: 31014386 PMCID: PMC6480889 DOI: 10.1186/s13063-019-3319-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/25/2019] [Indexed: 02/05/2023] Open
Abstract
Background During total aortic arch replacement surgery (TARS) for patients with acute type A aortic dissection, the organs in the lower body, such as the viscera and spinal cord, are at risk of ischemia even when antegrade cerebral perfusion (ACP) is performed. Combining ACP with retrograde inferior vena caval perfusion (RIVP) during TARS may improve outcomes by providing the lower body with oxygenated blood. Methods This study is designed as a multicenter, computer-generated, randomized controlled, assessor-blind, parallel-group study with a superiority framework in patients scheduled for TARS. A total of 636 patients will be randomized on a 1:1 basis to a moderate hypothermia circulatory arrest (MHCA) group, which will receive selective ACP with moderate hypothermia during TARS; or to an RIVP group, which will receive the combination of RIVP and selective ACP under moderate hypothermia during TARS. The primary outcome will be a composite of early mortality and major complications, including paraplegia, postoperative renal failure, severe liver dysfunction, and gastrointestinal complications. All patients will be analyzed according to the intention-to-treat protocol. Discussion This study aims to assess whether RIVP combined with ACP leads to superior outcomes than ACP alone for patients undergoing TARS under moderate hypothermia. This study seeks to provide high-quality evidence for RIVP to be used in patients with acute type A aortic dissection undergoing TARS. Trial registration Clinicaltrials.gov, ID: NCT03607786. Registered on 30 July 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3319-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jing Lin
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Zhaoxia Tan
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Hao Yao
- Cardiovascular Center of the Second Affiliated Hospital, Nanjing Medical University, No. 121, Jiangjiaruan Road, Gulou District, Nanjing, 210000, Jiangsu Province, China
| | - Xiaolin Hu
- Department of Anesthesiology, First Affiliated Hospital of University of South China, No. 151, Yanjiang West Road, Yuexiu District, Guangzhou, 510000, Guangdong Province, China
| | - Dafa Zhang
- Department of Thoracic Cardiovascular Surgery, First Affiliated Hospital, Wannan Medical University, No. 2, Chushan West Road, Jinghu District, Wuhu, 230000, Anhui Province, China
| | - Yuan Zhao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, No. 139, People's Road, Furong District, Changsha, 410000, Hunan Province, China
| | - Jiyue Xiong
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Bo Dou
- Department of Anesthesiology, First Affiliated Hospital of University of South China, No. 151, Yanjiang West Road, Yuexiu District, Guangzhou, 510000, Guangdong Province, China
| | - Xueshuang Zhu
- Department of Thoracic Cardiovascular Surgery, First Affiliated Hospital, Wannan Medical University, No. 2, Chushan West Road, Jinghu District, Wuhu, 230000, Anhui Province, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Deying Kang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Lei Du
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China.
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Alirezaei T, Mozafar M. Successful management of critical iliac artery aneurysm which is unexpectedly accompanied by acute aortic dissection type B: A case report. Clin Case Rep 2018; 6:2048-2052. [PMID: 30455889 PMCID: PMC6230637 DOI: 10.1002/ccr3.1807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/15/2018] [Accepted: 08/20/2018] [Indexed: 12/02/2022] Open
Abstract
Acute aortic dissection with concurrent large aortic aneurysm is a catastrophic condition. Clinicians may be faced with the dilemma of how to manage these patients. This case reports a successful management crisis in a patient with a type B aortic dissection and a large left common iliac artery aneurysm.
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Affiliation(s)
- Toktam Alirezaei
- Cardiology Department of Shohaday‐e‐Tajrish HospitalSBMUTehranIran
| | - Mohamad Mozafar
- Vascular Surgery Department of Shohaday‐e‐Tajrish HospitalSBMUTehranIran
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Waterford SD, Gardner RL, Moon MR. Extent of Aortic Replacement in Type A Dissection: Current Answers for an Endless Debate. Ann Thorac Surg 2018; 106:1246-1250. [DOI: 10.1016/j.athoracsur.2018.03.088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/31/2018] [Accepted: 03/19/2018] [Indexed: 11/16/2022]
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Kurz SD, Falk V, Kempfert J, Gieb M, Ruschinski TM, Kukucka M, Tsokos M, Grubitzsch H, Herbst H, Semmler J, Buschmann C. Insight into the incidence of acute aortic dissection in the German region of Berlin and Brandenburg. Int J Cardiol 2017; 241:326-329. [PMID: 28499667 DOI: 10.1016/j.ijcard.2017.05.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 03/14/2017] [Accepted: 05/05/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Stanford acute type A aortic dissection (ATAAD) is a potentially lethal condition. Epidemiology studies show a statistical incidence in Europe of approximately 2-16 cases/100,000 inhabitants/year. In Germany, the estimated incidence (here subsumed under "thoracic aortic dissection" with 4.63 cases/100,000 inhabitants/year) is mainly extracted from medical death certificates by the German Federal Statistical Office. The prehospital incidence of ATAAD deaths is largely unknown. Since patients often die in the pre-hospital setting, the incidence of ATAAD is therefore likely to be higher than current estimates. MATERIAL AND METHODS For the period from 2010 to 2014, we retrospectively analyzed all in-hospital ATAAD data from two of the largest cardiac surgical centers that treat ATAAD in the Berlin-Brandenburg region. In addition, autopsy reports of all forensic medicine institutes and of one large pathological provider in the region were analyzed to identify additional non-hospitalized ATAAD patients. Based on these findings, the regional incidence of ATAAD was calculated. RESULTS In addition to in-hospital ATAAD patients (n=405), we identified additional 145 lethal ATAAD cases among 14,201 autopsy reports. The total of 550 ATAAD cases led to an estimated incidence of 11.9 cases/100,000 inhabitants/year for the whole Berlin-Brandenburg region. Arterial hypertension, pre-existing aortic dilatation, and hereditary connective tissue disorder were found in, respectively, 62.7%, 10%, and 1.8% of patients. CONCLUSION ATAAD is more frequent than previously reported. Our results show that when patients who die outside of cardiac surgery centers are included, the incidence of ATAAD significantly exceeds the rate reported by the Federal Statistical Office.
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Affiliation(s)
- S D Kurz
- German Heart Institute Berlin, Institute for Anaesthesiology, 13353 Berlin, Germany.
| | - V Falk
- German Heart Institute Berlin, Department of Cardiothoracic and Vascular Surgery, 13353 Berlin, Germany; Charité-Berlin University Medicine, Department of Cardiothoracic Surgery, 10117 Berlin, Germany; German Centre for Cardiovascular Research, Partner Site Berlin, 13353 Berlin, Germany
| | - J Kempfert
- German Heart Institute Berlin, Department of Cardiothoracic and Vascular Surgery, 13353 Berlin, Germany
| | - M Gieb
- German Heart Institute Berlin, Institute for Anaesthesiology, 13353 Berlin, Germany
| | - T M Ruschinski
- German Heart Institute Berlin, Institute for Anaesthesiology, 13353 Berlin, Germany
| | - M Kukucka
- German Heart Institute Berlin, Institute for Anaesthesiology, 13353 Berlin, Germany
| | - M Tsokos
- Charité-Berlin University Medicine, Institute of Legal Medicine and Forensic Sciences, 10559 Berlin, Germany
| | - H Grubitzsch
- Charité-Berlin University Medicine, Department of Cardiothoracic Surgery, 10117 Berlin, Germany
| | - H Herbst
- Vivantes Klinikum Neukölln, Department of Pathology, 13407 Berlin, Germany
| | - J Semmler
- Brandenburg Institute for Forensic Medicine (BLR), 14469 Potsdam, Germany
| | - C Buschmann
- Charité-Berlin University Medicine, Institute of Legal Medicine and Forensic Sciences, 10559 Berlin, Germany
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杜 松, 万 俊, 王 武, 蔡 开, 刘 亚, 毛 向. [Brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique for Stanford type A aortic dissection: analysis of 23 cases]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:102-106. [PMID: 28109108 PMCID: PMC6765753 DOI: 10.3969/j.issn.1673-4254.2017.01.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the clinical outcomes of brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique for treatment of Stanford type A aortic dissection. METHODS Twenty-three patients with Stanford type A aortic dissection requiring arch replacement underwent brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique. The operations were performed within 72 h (20 cases) or 3-14 days (3 cases) after the onset of aortic dissection. RESULTS There was no perioperative death in these cases. The mean extracorporeal circulation time was 209∓52 min, the aortic cross clamp time was 85∓21 min, and the mean chest tube output within the first 24 h after the operation was 570∓263 mL; none of the patients required chest reopening for management of bleeding. Postoperative acute renal failure requiring hemodialysis occurred in 3 cases, transient neurologic dysfunction in 2 cases, paraplegia in case and hematosepsis in 1 case. No such complications as permanent neurologic deficit or postoperative visceral malperfusion occurred in these cases. All the patients survived and were discharged from hospital without experiencing severe complications in the follow-up for 6-18 months. CONCLUSION Brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique is a safe and simple procedure with controllable bleeding and can serve as an optional procedure for aortic arch replacement.
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Affiliation(s)
- 松林 杜
- />南方医科大学南方医院胸心血管外科,广东 广州 510515Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 俊 万
- />南方医科大学南方医院胸心血管外科,广东 广州 510515Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 武军 王
- />南方医科大学南方医院胸心血管外科,广东 广州 510515Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 开灿 蔡
- />南方医科大学南方医院胸心血管外科,广东 广州 510515Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 亚湘 刘
- />南方医科大学南方医院胸心血管外科,广东 广州 510515Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 向辉 毛
- />南方医科大学南方医院胸心血管外科,广东 广州 510515Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Wang W, Duan W, Xue Y, Wang L, Liu J, Yu S, Yi D. Clinical features of acute aortic dissection from the Registry of Aortic Dissection in China. J Thorac Cardiovasc Surg 2014; 148:2995-3000. [PMID: 25433882 DOI: 10.1016/j.jtcvs.2014.07.068] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/15/2014] [Accepted: 07/31/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To establish a systematic registry of aortic dissection in China, assess the clinical features of Chinese patients with acute aortic dissection (AAD), and compare our results with the data published by the International Registry of Acute Aortic Dissection (IRAD). METHODS We established the first Registry of Aortic Dissection in China (Sino-RAD) in 2011. Then we evaluated 1003 patients with AAD in Sino-RAD and compared our results with those reported by IRAD. RESULTS Compared with IRAD, the patients with AAD in Sino-RAD were significantly younger. Also, the ratio of male patients in Sino-RAD was significantly greater for the total cohort and the type A and B cohorts. The overall in-hospital mortality was 10.3% in Sino-RAD. For type A dissection, more patients in Sino-RAD received medical treatment and fewer received surgical treatment. The overall mortality, mortality of medical treatment, and mortality of surgical treatment was lower in Sino-RAD. In type B dissection, fewer patients in Sino-RAD received medical and surgical treatment and more received endovascular treatment. CONCLUSIONS The first Sino-RAD, including 15 large cardiovascular centers throughout China, was established. Our data were compared with those reported by IRAD. We found that, compared with Western populations, Chinese patients with AAD showed 6 differences, including earlier onset, more male patients, a low incidence of hypertension, a low incidence of chest pain, a high incidence of back pain, great differences in the choice of therapeutic strategies, and relatively low in-hospital mortality.
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Affiliation(s)
- Weiguang Wang
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Weixun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Yang Xue
- State Key Laboratory of Military Stomatology, Department of Oral Biology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Ling Wang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Jincheng Liu
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Shiqiang Yu
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
| | - Dinghua Yi
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
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Obied HY, Ghoneim A, Ibrahim MF. Hybrid Approach to Repair Type A Aortic Dissection: Combined Endovascular Superior Mesenteric Artery Stenting and Bentall Procedure. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:156-60. [PMID: 26798735 DOI: 10.12945/j.aorta.2014.14-014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022]
Abstract
A Stanford Type A aortic dissection is a life-threatening surgical emergency that requires emergent surgery. The mortality after repair is high especially if the aortic dissection is complicated by visceral or peripheral malperfusion. We describe a case of a male patient who presented with an aortic dissection involving the ascending aorta, aortic arch, descending thoracic aorta, and the abdominal aorta down to the iliac bifurcation. The dissection also involved the visceral and renal arteries with evidence of superior mesenteric artery (SMA) occlusion. Successful outcome was achieved by endovascular stenting of the patient's SMA, followed by a Bentall procedure. To the best of our knowledge this is the first case report in the English literature of SMA stenting followed by a Bentall procedure to treat acute Type A aortic dissection complicated by SMA occlusion.
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Affiliation(s)
- Hamoud Y Obied
- Adult Cardiac Surgery Department, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ayman Ghoneim
- Adult Cardiac Surgery Department, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohamed F Ibrahim
- Adult Cardiac Surgery Department, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
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15
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Manetta F, Ajakaiye B, Scheinerman SJ, Yu PJ. Case Report and Review of Literature: Late Retrograde Type A Aortic Dissection With Rupture after Repair of Type B Aortic Dissection with a GORE TAG Endovascular Prosthesis. Int J Angiol 2014; 23:147-50. [PMID: 25075169 DOI: 10.1055/s-0034-1373735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Acute aortic dissection is the most common catastrophic condition of the aorta. Treatment options include open surgery and thoracic endovascular aortic reconstruction (TEVAR). We present a late Type A dissection as a complication of the management of descending aortic dissections with TEVAR and a review of the literature. TEVAR of the thoracic aorta is a viable treatment option for the management of complicated descending thoracic aortic dissections. Careful patient selection is necessary as medical therapy successfully treats the majority of uncomplicated Type B dissections. TEVAR should be reserved for patients with complicated Type B dissections or those who fail nonoperative management. Close postoperative monitoring is necessary when TEVAR is performed and should be accompanied by lifelong surveillance. A high level of suspicion is important to identify retrograde Type A dissections in these patients given its rarity and the ambiguity of its clinical presentation.
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Affiliation(s)
- Frank Manetta
- Department of Cardiovascular and Thoracic Surgery, Hofstra-North Shore-LIJ School of Medicine, Hofstra University, Hempstead, New York
| | - Bayo Ajakaiye
- Department of Surgery, Hofstra-North Shore-LIJ School of Medicine, Hofstra University, Hempstead, New York
| | - S Jacob Scheinerman
- Department of Cardiovascular and Thoracic Surgery, Hofstra-North Shore-LIJ School of Medicine, Hofstra University, Hempstead, New York
| | - Pey-Jen Yu
- Department of Cardiovascular and Thoracic Surgery, Hofstra-North Shore-LIJ School of Medicine, Hofstra University, Hempstead, New York
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16
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Siddiqi HK, Eagle KA. Acute aortic dissection in women: challenges and opportunities. Expert Rev Cardiovasc Ther 2014; 11:1527-39. [DOI: 10.1586/14779072.2013.845085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Baumann F, Makaloski V, Diehm N. [Aortic aneurysms and aortic dissection: epidemiology, pathophysiology and diagnostics]. Internist (Berl) 2014; 54:535-42. [PMID: 23558776 DOI: 10.1007/s00108-012-3217-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aortic aneurysms and aortic dissection represent a significant health risk due to the demographic developments and current life styles. The mortality of ruptured aortic aneurysms is up to 80 % and the prevalence of aneurysms varies depending on the localization (thoracic or abdominal). Most commonly affected is the infrarenal abdominal aorta; however, there is evidence that the prevalence is diminishing but in contrast the incidence of thoracic aortic aneurysms is increasing. Aortic dissection is often fatal and is the most common acute aortic disease but the incidence is presumed to be underestimated. The pathogenesis of aortic aneurysms is manifold and is based on an interplay between degenerative, proteolytic and inflammatory processes. An aortic dissection arises from a tear in the intima which results in a separation of the aortic wall layers with infiltration of bleeding and the danger of aortic rupture. Various genetic disorders of connective tissue promote degeneration of the aortic media, most notably Marfan syndrome. Risk factors for aortic aneurysms and aortic dissection are nicotine abuse, arterial hypertension, age and male gender. Aortic aneurysms initially have an uneventful course and as a consequence are mostly discovered incidentally. The clinical course and symptoms of aortic dissection are very much dependent on the section of the aorta affected and the manifestations are manifold. Acute aortic dissection is in 80 % of cases first manifested as sudden extremely severe pain. The diagnostics and subsequent course control can be achieved by a variety of imaging procedures but the modality of choice is computed tomography.
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Affiliation(s)
- F Baumann
- Schweizerisches Herz- und Gefässzentrum, Abteilung für Klinische und Interventionelle Angiologie, Inselspital, Universität Bern, Freiburgstr., 3010 Bern, Schweiz
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18
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De León Ayala IA, Chen YF. Acute aortic dissection: an update. Kaohsiung J Med Sci 2012; 28:299-305. [PMID: 22632884 DOI: 10.1016/j.kjms.2011.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 10/06/2011] [Indexed: 01/21/2023] Open
Abstract
The aorta, which has a complex intrinsic biology and sophisticated mechanical properties for conducting the blood ejected from the left ventricle to the rest of the systemic arterial bed, is the largest and strongest artery in the body. It carries roughly 200 million liters of blood in an average lifetime. Any process that undermines the architecture threatens the structure, stability, and functionality of the aorta. In this regard, acute aortic dissection (AAD) requires special attention because it is the most catastrophic acute illness of the aorta; it has high morbidity and mortality because of potentially fatal complications. AAD has, therefore, become an important topic of recent research, and knowledge about this disease has improved during the past few years. Up-to-date knowledge about the natural history, epidemiology, presentation, physiopathology, evolution, management, follow-up, and long-term outcomes of AAD are summarized in this review.
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19
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Intimal Tears in Thoracic Aortic Dissection: Appearance on MDCT With Virtual Angioscopy. AJR Am J Roentgenol 2012; 198:955-61. [DOI: 10.2214/ajr.11.7327] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Malagoli A, Barbieri A, Veronesi B, Pacini D, Ligabue G, Modena MG. Detection of localized chronic type A aortic dissection: a multimodality imaging approach. J Cardiovasc Med (Hagerstown) 2011; 12:439-40. [DOI: 10.2459/jcm.0b013e328341d04a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Andritsos M, Desai ND, Grewal A, Augoustides JG. Innovations in Aortic Disease Management: The Descending Aorta. J Cardiothorac Vasc Anesth 2010; 24:523-9. [DOI: 10.1053/j.jvca.2010.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Indexed: 11/11/2022]
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