1
|
Titsworth M, Graham NJ, Orelaru F, Ahmad RA, Wu X, Kim KM, Fukuhara S, Patel H, Deeb GM, Yang B. Distal aortic progression following acute type A aortic dissection repair among patients with bicuspid and tricuspid aortic valves. J Thorac Cardiovasc Surg 2024; 168:453-462. [PMID: 36639287 PMCID: PMC10282108 DOI: 10.1016/j.jtcvs.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/22/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The study objective was to analyze long-term growth and outcomes of the distal aorta after open acute type A aortic dissection repair in patients with bicuspid aortic valves or tricuspid aortic valves without connective tissue disease. METHODS From 1996 to 2021, 60 patients with bicuspid aortic valves and 655 patients with tricuspid aortic valves without connective tissue disease underwent open repair for acute type A aortic dissection. Data were collected from the local Society of Thoracic Surgeons database, medical record review, surveys, and the National Death Index and Michigan Death Index (December 12, 2021). RESULTS Compared with the tricuspid aortic valve group, the bicuspid aortic valve group was significantly younger, had more severe aortic insufficiency (33% vs 22%, P = .05), and had less hypertension (67% vs 78%, P = .05). Intraoperatively, patients with bicuspid aortic valves received more aortic root replacements (70% vs 26%, P < .001), less zone 2 aortic arch replacement (8.3% vs 20%, P = .03), and longer median cardiopulmonary bypass (233 vs 214 minutes, P = .05) and aortic crossclamp (184 vs 141 minutes, P < .001) times. The average annual aortic arch growth rate (0.23 mm/year vs 0.39 mm/year, P = .52) and descending aorta growth rate (0.61 mm/year vs 0.79 mm/year, P = .39) were similar between the bicuspid aortic valve and tricuspid aortic valve groups. The bicuspid aortic valve group had lower annual abdominal aorta growth (0.51 mm/year vs 0.68 mm/year, P = .03). The cumulative incidence of reoperation for the distal aorta (9.7% vs 16.0%, P = .77) was similar between the bicuspid aortic valve and tricuspid aortic valve groups. The 10-year survival was higher in the bicuspid aortic valve group (75.4% vs 66.0%, P = .03). CONCLUSIONS Patients with bicuspid aortic valves could be treated similarly as patients with tricuspid aortic valves without connective tissue disease in the setting of open acute type A aortic dissection repair.
Collapse
Affiliation(s)
- Marc Titsworth
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | | | - Felix Orelaru
- Department of General Surgery, St Joseph Mercy, Ann Arbor, Mich
| | | | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Karen M Kim
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | | | - Himanshu Patel
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
| |
Collapse
|
2
|
Feier H, Grigorescu A, Braescu L, Falnita L, Sintean M, Luca CT, Mocan M. Systematic Innominate Artery Cannulation Strategy in Acute Type A Aortic Dissection: Better Perfusion, Better Results. J Clin Med 2023; 12:jcm12082851. [PMID: 37109188 PMCID: PMC10141089 DOI: 10.3390/jcm12082851] [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: 03/20/2023] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: Arterial cannulation in type A acute aortic dissection (TAAAD) is still subject to debate. We describe a systematic approach of using the innominate artery for arterial perfusion (2) Methods: The hospital records of 110 consecutive patients with acute TAAAD operated on between January 2014 and December 2022 were retrospectively analyzed. The effect of the cannulation site on early and late mortality, as well as on cardio-pulmonary perfusion indices (lactate and base excess levels, and cooling and rewarming speed) were investigated. (3) Results: There was a significant difference in early mortality (8.82% vs. 40.79%, p < 0.01) but no difference in long-term survival beyond the first 30 days. Using the innominate artery enabled the use of approximately 20% higher CPB flows (2.73 ± 0.1 vs. 2.42 ± 0.06 L/min/m2 BSA, p < 0.01), which resulted in more rapid cooling (1.89 ± 0.77 vs. 3.13 ± 1.62 min/°C/m2 BSA, p < 0.01), rewarming (2.84 ± 1.36 vs. 4.22 ± 2.23, p < 0.01), lower mean base excess levels during CPB (-5.01 ± 2.99 mEq/L vs. -6.66 ± 3.37 mEq/L, p = 0.01) and lower lactate levels at the end of the procedure (4.02 ± 2.48 mmol/L vs. 6.63 ± 4.17 mmol/L, p < 0.01). Postoperative permanent neurologic insult (3.12% vs. 20%, p = 0.02) and acute kidney injury (3.12% vs. 32.81%, p < 0.01) were significantly reduced. (4) Conclusions: systematic use of the innominate artery enables better perfusion and superior results in TAAAD repair.
Collapse
Affiliation(s)
- Horea Feier
- Institute for Cardiovascular Diseases, 300310 Timisoara, Romania
- Department of Cardiology, University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andrei Grigorescu
- Institute for Cardiovascular Diseases, 300310 Timisoara, Romania
- Department of Cardiology, University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Laurentiu Braescu
- Institute for Cardiovascular Diseases, 300310 Timisoara, Romania
- Department of Cardiology, University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Lucian Falnita
- Institute for Cardiovascular Diseases, 300310 Timisoara, Romania
- Department of Cardiology, University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Sintean
- Institute for Cardiovascular Diseases, 300310 Timisoara, Romania
| | - Constantin Tudor Luca
- Institute for Cardiovascular Diseases, 300310 Timisoara, Romania
- Department of Cardiology, University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mihaela Mocan
- Department of Internal Medicine, University of Medicine and Pharmacy Iuliu Hatieganu, 400012 Cluj-Napoca, Romania
| |
Collapse
|
3
|
Luc JGY, Preventza O. Optimal Extent of Repair for Acute Type I Aortic Dissection-Frozen Elephant Trunk? How Long and Why? AORTA (STAMFORD, CONN.) 2022; 10:169-174. [PMID: 36521808 PMCID: PMC9754864 DOI: 10.1055/s-0042-1756664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Acute Type A dissection is a life-threatening condition requiring urgent surgical treatment. The operative technique involves repairs of a variety of distal extents of the transverse aortic arch and the downstream aorta. We review the evidence surrounding the extent of repair for acute Type A aortic dissection and describe our approach to this disease.
Collapse
Affiliation(s)
- Jessica G. Y. Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas,Address for correspondence Ourania Preventza, MD, MBA Division of Cardiothoracic Surgery, Michael E. DeBakey Department of SurgeryBCM 390, One Baylor Plaza, Baylor College of Medicine, Houston, TX 77030
| |
Collapse
|
4
|
Significance of systolic-phase imaging on full-phase ECG-gated CT angiography to detect intimal tears in aortic dissection. Heart Vessels 2022; 37:1947-1956. [PMID: 35569067 PMCID: PMC9515039 DOI: 10.1007/s00380-022-02093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/27/2022] [Indexed: 12/03/2022]
Abstract
Purpose For patients with aortic dissection (AD) and intramural hematoma (IMH), the optimal cardiac phase to detect intimal tears (IT) and ulcer-like projections (ULP) on retrospective electrocardiogram (ECG)-gated computed tomography angiography (CTA) remains unclear. The purpose of this study was to compare the accuracy of retrospective ECG-gated CTA for detecting IT in AD and ULP in IMH between each cardiac phase. Materials and methods A total of 75 consecutive patients with AD and IMH of the thoracic aorta were enrolled in this single-center retrospective study. The diagnostic performance to detect IT and ULP in the thoracic aortic regions (including the ascending aorta, aortic arch, and proximal and distal descending aorta) was compared in each cardiac phase on retrospective ECG-gated CTA. Results In the systolic phase (20%), the accuracy, sensitivity, and specificity to detect IT in AD was 64% (95% confidence interval [CI] 56–72%), 69% (95%CI 60–78%), and 25% (95%CI 3.3–45%), respectively. In the diastolic phase (70%), the accuracy, sensitivity, and specificity to detect IT in AD was 52% (95%CI 43–60%), 52% (95%CI 42–61%), and 50% (95%CI 25–75%), respectively. The accuracy to detect IT in AD on ECG-gated CTA was significantly higher in the systolic phase than that in the diastolic phase (P = 0.025). However, there were no differences in the accuracy (83%; 95%CI 78–89%), sensitivity (71%; 95%CI 62–80%), or specificity (100%; 95%CI 100%) to detect ULP in IMH between the cardiac cycle phases. Conclusion Although it is currently recommended for routine diagnosis of AD and IMH, single-diastolic-phase ECG-gated CTA has risk to miss some IT in AD that are detectable in the systolic phase on full-phase ECG-gated CTA. This information is critical for determining the optimal treatment strategy for AD.
Collapse
|
5
|
Mehta CK, Son AY, Chia MC, Budd AN, Allen BD, Vassallo P, Hoel AW, Brady WJ, Nable JV. Management of acute aortic syndromes from initial presentation to definitive treatment. Am J Emerg Med 2021; 51:108-113. [PMID: 34735967 DOI: 10.1016/j.ajem.2021.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute aortic syndromes comprise a spectrum of diseases including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcers. Early diagnosis, rapid intervention, and multidisciplinary team care are vital to efficiently manage time-sensitive aortic emergencies, mobilize appropriate resources, and optimize clinical outcomes. OBJECTIVE This comprehensive review outlines the multidisciplinary team approach from initial presentation to definitive interventional treatment and post-operative care. DISCUSSION Acute aortic syndromes can be life-threatening and require prompt diagnosis and aggressive initiation of blood pressure and pain control to prevent subsequent complications. Early time to diagnosis and intervention are associated with improved outcomes. CONCLUSIONS A multidisciplinary team can help promptly diagnose and manage aortic syndromes.
Collapse
Affiliation(s)
- Christopher K Mehta
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America.
| | - Andre Y Son
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America
| | - Matthew C Chia
- Division of Vascular Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America
| | - Ashley N Budd
- Department of Anesthesiology, Northwestern Medicine, Chicago, IL, United States of America
| | - Bradley D Allen
- Department of Radiology, Northwestern Medicine, Chicago, IL, United States of America
| | - Patricia Vassallo
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America
| | - Andrew W Hoel
- Division of Vascular Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America
| | - William J Brady
- Departments of Emergency Medicine and Internal Medicine, University of Virginia, Charlottesville, VA, United States of America
| | - Jose V Nable
- Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington D.C., United States of America
| |
Collapse
|
6
|
Neurologic complications of diseases of the aorta. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:221-239. [PMID: 33632441 DOI: 10.1016/b978-0-12-819814-8.00028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Neurologic complications of diseases of the aorta are common, as the brain and spinal cord function is highly dependent on the aorta and its branches for blood supply. Any disease impacting the aorta may have significant impact on the ability to deliver oxygenated blood to the central nervous system, resulting in ischemia-and if prolonged-cerebral and spinal infarct. The breadth of pathology affecting the aorta is diverse and neurologic complications can vary dramatically based on the location, severity, and underlying etiology. This chapter outlines the major pathology of the aorta while highlighting the associated neurologic complications. This chapter covers the entire spectrum of neurologic complications associated with aortic disease by beginning with a detailed overview of the spinal cord vascular anatomy followed by a discussion of the most common aortic pathologies affecting the nervous system, including aortic aneurysm, aortic dissection, aortic atherosclerosis, inflammatory and infectious aortopathies, congenital abnormalities, and aortic surgery.
Collapse
|
7
|
Li L, Zhou J, Hao X, Zhang W, Yu D, Xie Y, Gu J, Zhu T. The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients. Front Med (Lausanne) 2020; 7:557044. [PMID: 33178711 PMCID: PMC7593546 DOI: 10.3389/fmed.2020.557044] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/16/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Acute kidney injury (AKI) is a common complication of cardiac surgery, which could lead to increased morbidity and mortality. Acute type A aortic dissection (AAAD) is a life-threatening cardiac disease and can be closely related to post-operative AKI. However, data on the incidence of AKI defined by the newest Kidney Disease: Improving Global Outcomes (KDIGO) criteria and in-hospital mortality of a homogeneous population who underwent AAAD are limited. We aimed to investigate the incidence of AKI defined by the KDIGO criteria and the risk factors associated with the outcomes among AAAD-induced AKI patients. Methods: We reviewed 335 patients who underwent surgical treatment for AAAD between March 2009 and June 2016. We screened the patients' AKI status and analyzed probably risk factors of AKI and in-hospital mortality. Independent-sample t-test or Chi-square test was performed to identify differences between AKI and non-AKI groups and survivors with AKI and non-survivors with AKI, respectively. The logistic regression model was applied to identify independent risk factors. Results: AKI occurred in 71.94% of AAAD patients, including 85 stage 1 (35.26%), 77 stage 2 (31.95%), and 79 stage 3 (32.78%) patients. The in-hospital mortality rate was 21.16%. Logistic regression analysis showed that the body mass index, chronic kidney disease, chronic liver disease, cardiopulmonary bypass duration, red blood cell transfusion, and hypoproteinemia were the independent significant risk factors of the occurrence of post-operative AKI. The risk factors associated with in-hospital mortality among AAAD-induced AKI patients included AKI stage (odds ratio (OR), 3.322), deep hypothermic circulatory arrest (OR, 2.586), lactic acidosis (OR, 3.407), and continuous renal replacement therapy (OR, 3.156). Conclusion: For AAAD patients undergoing surgery, AKI was a common complication, and it increased patients' mortality risk. Therefore, identifying the risk factors of AKI and preventing post-operative AKI are important for improving the post-operative outcomes of AAAD patients. Clinical Trial Registration: ChiCTR, ChiCTR1900021290. Registered 12 February 2019, http://www.chictr.org.cn/showproj.aspx?proj=35795.
Collapse
Affiliation(s)
- Linji Li
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China.,Department of Anesthesiology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Jiaojiao Zhou
- Division of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Xuechao Hao
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Weiyi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Deshui Yu
- Department of Anesthesiology, The Second People's Hospital of Yibin, Yibin, China
| | - Ying Xie
- Department of Anesthesiology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Jun Gu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| |
Collapse
|
8
|
Ikeno Y, Yokawa K, Koda Y, Gotake Y, Henmi S, Nakai H, Yamanaka K, Inoue T, Tanaka H, Okita Y. The fate of the downstream aorta after open aortic repair for acute DeBakey type I aortic dissection: total arch replacement with elephant trunk technique versus non-total arch replacement†. Eur J Cardiothorac Surg 2020; 55:966-974. [PMID: 30481293 DOI: 10.1093/ejcts/ezy381] [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: 08/14/2018] [Revised: 09/26/2018] [Accepted: 10/08/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the fate of the downstream aorta following open aortic repair for acute DeBakey type I aortic dissection comparing total arch replacement (TAR) with the elephant trunk (ET) technique versus non-total arch replacement (non-TAR). METHODS From October 1999 to December 2016, 267 patients underwent open repair for acute DeBakey type I aortic dissection. A tear-oriented strategy was mainly used to determine the extent of graft replacement. Hospital mortality was 10.0% (12/120 patients) in the TAR group and 17.0% (25/147 patients) in the non-TAR group (P = 0.070). Late outcomes were compared in 230 hospital survivors (TAR: n = 108 and non-TAR: n = 122). Mean follow-up was 6.5 ± 4.6 years. The aortic diameters were measured at 4 levels, across 6 time points using computed tomography. RESULTS Freedom from additional aortic surgery for distal dilation was significantly better in the TAR group than the non-TAR group (TAR: 97.5 ± 1.8% at 5 years and non-TAR: 88.2 ± 3.4% at 5 years, P = 0.045). Freedom from a distal aortic event was also significantly better in the TAR group compared with the non-TAR group (TAR: 97.2 ± 1.6% at 5 years and non-TAR: 80.7 ± 4.2% at 5 years, P = 0.013). In the non-TAR group, the aortic arch diameter significantly increased (P < 0.001). Significant aortic remodelling occurred at the proximal descending aorta in the TAR with ET group (P < 0.001). CONCLUSIONS The TAR with ET reduced the need for additional distal aortic repair compared to non-TAR. TAR with ET prevented unfavourable aortic growth in both the aortic arch and the proximal descending aorta.
Collapse
Affiliation(s)
- Yuki Ikeno
- Department of Cardiovascular Surgery, Kobe University School of Medicine, Kobe, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, Kobe University School of Medicine, Kobe, Japan
| | - Yojiro Koda
- Department of Cardiovascular Surgery, Kobe University School of Medicine, Kobe, Japan
| | - Yasuko Gotake
- Department of Cardiovascular Surgery, Kobe University School of Medicine, Kobe, Japan
| | - Soichiro Henmi
- Department of Cardiovascular Surgery, Kobe University School of Medicine, Kobe, Japan
| | - Hidekazu Nakai
- Department of Cardiovascular Surgery, Kobe University School of Medicine, Kobe, Japan
| | - Katsuhiro Yamanaka
- Department of Cardiovascular Surgery, Kobe University School of Medicine, Kobe, Japan
| | - Takeshi Inoue
- Department of Cardiovascular Surgery, Kobe University School of Medicine, Kobe, Japan
| | - Hiroshi Tanaka
- Department of Cardiovascular Surgery, Kobe University School of Medicine, Kobe, Japan
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Kobe University School of Medicine, Kobe, Japan
| |
Collapse
|
9
|
Thornhill R, Shih W, Amen MI, John MM, Floridia R, Razzouk AJ, Rabkin DG. Likelihood of Aortic Valve Preservation During Repair of Acute Type A Aortic Dissection. Am Surg 2020; 86:1710-1716. [PMID: 32865003 DOI: 10.1177/0003134820947373] [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: 11/15/2022]
Abstract
BACKGROUND We sought risk factors for replacement of the aortic valve with or without the root (AVR/root) in the setting of acute type A aortic dissection (ATAD) repair. METHODS All ATAD repairs at our institution from January 2005 to June 2018 were reviewed. Baseline characteristics were recorded. For patients with aortic valve preservation, we documented the degree of aortic insufficiency (AI) postoperatively and on subsequent echocardiograms when available. Logistic regression was used to determine the association between preoperative characteristics and the odds ratio of AVR/root. RESULTS 206 patients underwent repair of ATAD. Thirty-four were excluded for no documented AI grading. Forty-six underwent AVR/root during repair of the ATAD (including 40 root replacements). Of 126 that did not undergo AVR/root, 42 (33.33%) had follow-up echocardiograms at a median of 68 months postoperatively, 2 required reintervention for valve insufficiency. An increase in the degree of AI, bicuspid valve morphology, size of the aortic root, and connective tissue disorder was significantly associated with increased risk of AVR/root. Of 130 patients without connective tissue disorder, bicuspid aortic valve, aortic root aneurysm or intimal root tear, the rate of valve preservation was 65/65 (100%), 25/29 (86.2%), and 22/40 (55%) for those presenting with mild, moderate, and severe AI, respectively. CONCLUSION The degree of preoperative AI, bicuspid valve morphology, size of the aortic root, and connective tissue disorder significantly correlate with the failure of aortic valve preservation in patients with ATAD. The vast majority of tricuspid valves in patients without connective tissue disorder or aortic root pathology can be salvaged.
Collapse
Affiliation(s)
- Rosanne Thornhill
- 4608 Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Wendy Shih
- School of Public Health, Research Consulting Group, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Marvin I Amen
- 4608 Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Mohan M John
- 4608 Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Rosario Floridia
- 4608 Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Anees J Razzouk
- 4608 Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - David G Rabkin
- 4608 Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| |
Collapse
|
10
|
Thornhill R, Shih W, Amen MI, John MM, Floridia R, Razzouk AJ, Rabkin DG. Likelihood of Aortic Valve Preservation During Repair of Acute Type A Aortic Dissection. Am Surg 2020; 86:415-421. [PMID: 32684042 DOI: 10.1177/0003134820918251] [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: 11/16/2022]
Abstract
BACKGROUND We sought risk factors for replacement of the aortic valve with or without the root (AVR/root) in the setting of acute type A aortic dissection (ATAD) repair. METHODS All ATAD repairs at our institution from January 2005 to June 2018 were reviewed. Baseline characteristics were recorded. For patients with aortic valve preservation we documented the degree of aortic insufficiency (AI) postoperatively and on subsequent echocardiograms when available. Logistic regression was used to determine the association between preoperative characteristics and the odds ratio of AVR/root. RESULTS A total of 206 patients underwent repair of ATAD. Thirty-four were excluded for no documented AI grading. Forty-six underwent AVR/root during repair of the ATAD (including 40 root replacements). Of 126 that did not undergo AVR/root, 42 (33.33%) had follow-up echocardiograms at a median of 68 months postoperatively and 2 required reintervention for valve insufficiency. Increase in degree of AI, bicuspid valve morphology, size of the aortic root, and connective tissue disorder were significantly associated with increased risk of AVR/root. Of 130 patients without connective tissue disorder, bicuspid aortic valve, aortic root aneurysm, or intimal root tear, the rate of valve preservation was 65/65 (100%), 25/29 (86.2%), and 22/40 (55%) for those presenting with mild, moderate, and severe AI, respectively. DISCUSSION Degree of preoperative AI, bicuspid valve morphology, size of the aortic root, and connective tissue disorder significantly correlate with failure of aortic valve preservation in patients with ATAD. The vast majority of tricuspid valves in patients without connective tissue disorder or aortic root pathology can be salvaged.
Collapse
Affiliation(s)
- Rosanne Thornhill
- 4608 Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Wendy Shih
- School of Public Health, Research Consulting Group, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Marvin I Amen
- 4608 Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Mohan M John
- 4608 Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Rosario Floridia
- 4608 Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Anees J Razzouk
- 4608 Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - David G Rabkin
- 4608 Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| |
Collapse
|
11
|
Yanagaki S, Ueda T, Masuda A, Ota H, Onaka Y, Kojima M, Hattori T, Mihara W, Takase K. Detection of the intimal tear in aortic dissection and ulcer-like projection in intramural hematoma: usefulness of full-phase retrospective ECG-gated CT angiography. Jpn J Radiol 2020; 38:1036-1045. [PMID: 32710132 PMCID: PMC7591413 DOI: 10.1007/s11604-020-01008-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/15/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE To compare the accuracy of non-electrocardiogram (ECG)-gated CT angiography (CTA), single-diastolic-phase ECG-gated CTA, and full-phase ECG-gated CTA in detecting the intimal tear (IT) in aortic dissection (AD) and ulcer-like projection (ULP) in intramural hematoma (IMH). MATERIALS AND METHODS A total of 81 consecutive patients with AD and IMH of the thoracic aorta were included in this single-center retrospective study. Non-ECG-gated CTA, single-diastolic-phase ECG-gated CTA, and full-phase ECG-gated CTA were used to detect the presence of the IT and ULP in thoracic aortic regions including the ascending aorta, aortic arch, and proximal and distal descending aorta. RESULTS The accuracy of detecting the IT and ULP was significantly greater using full-phase ECG-gated CTA (88% [95% CI: 100%, 75%]) than non-ECG-gated CTA (72% [95% CI: 90%, 54%], P = 0.001) and single-diastolic-phase ECG-gated CTA (76% [95% CI: 93%, 60%], P = 0.008). CONCLUSION Full-phase ECG-gated CTA is more accurate in detecting the IT in AD and ULP in IMH, than non-ECG-gated CTA and single-diastolic-phase ECG-gated CTA.
Collapse
Affiliation(s)
- Satoru Yanagaki
- Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
| | - Takuya Ueda
- Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| | - Atsuro Masuda
- Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| | - Hideki Ota
- Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| | - Yuta Onaka
- Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| | - Masatoshi Kojima
- Department of Radiology, Seikeikai Chiba Medical Center, 1-7-1, Minami-cho, Chuo-ku, Chiba, 260-0842, Japan
| | - Takashi Hattori
- Departments of Cardiovascular Surgery, Seikeikai Chiba Medical Center, 1-7-1, Minami-cho, Chuo-ku, Chiba, 260-0842, Japan
| | - Wahei Mihara
- Departments of Cardiovascular Surgery, Seikeikai Chiba Medical Center, 1-7-1, Minami-cho, Chuo-ku, Chiba, 260-0842, Japan
| | - Kei Takase
- Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| |
Collapse
|
12
|
Berdajs DA, Koechlin L, Reid G, Grob F, Gahl B, Schurr U, Reuthebuch O, Eckstein F. Modified frozen elephant trunk procedure as standard approach in acute type A aortic dissection: A propensity-weighted analysis. J Thorac Cardiovasc Surg 2020; 163:1754-1761.e3. [PMID: 32798027 DOI: 10.1016/j.jtcvs.2020.05.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate whether the modified frozen elephant trunk (mFET) procedure provides comparable outcome compared with the standard approach for DeBakey type I aortic dissection. METHODS From November 2008 to December 2018, 262 (mean age 62.7 ± 12.4 years) patients with acute DeBakey type I aortic dissection were included. mFET was performed in 100 (38.2%) patients and isolated ascending aorta and hemiarch replacement (iAoA) were performed in 162 (61.8%). Outcome analyses included in-hospital mortality, stroke rate, incidence of composite cardiovascular events, survival, freedom from aorta-related intervention, as well as freedom from neurologic event. Inverse probability of treatment weighting was applied. RESULTS After inverse probability of treatment weighting, in-hospital mortality was greater in the iAoA group. The incidence of cardiac cause of death, new postoperative renal failure, as well as stroke rate were similar in both groups. The survival at 1 year, 3 years, and 4 years was 84%, 81%, and 77%, respectively, in the iAoA group and 91%, 86%, and 86%, P = .025, respectively, in the mFET group. Cause-specific HR for aortic reoperation 1.03 (confidence interval [CI], 0.43-2.48, P = .95) and neurovascular event 2.72 (CI, 0.62-11.93, P = .19) was similar in 2 groups. Subhazard ratio (sHR) for mortality as competing outcome for aorta-related reintervention sHR of 0.52 (CI, 0.32-0.86, P = .011) and neurologic event sHR of 0.45 (95% CI, 0.26-0.76, P = .003) was significantly lower in mFET. CONCLUSIONS The mFET procedure as surgical treatment modality for DeBakey type I acute aortic dissection may be considered as viable alternative with beneficial mid-term outcome.
Collapse
Affiliation(s)
- Denis A Berdajs
- Department of Cardiac Surgery, University Hospital, Basel, Switzerland.
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital, Basel, Switzerland
| | - Gregory Reid
- Department of Cardiac Surgery, University Hospital, Basel, Switzerland
| | - Flurin Grob
- Department of Cardiac Surgery, University Hospital, Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital, Basel, Switzerland
| | - Ulrich Schurr
- Department of Cardiac Surgery, University Hospital, Basel, Switzerland
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital, Basel, Switzerland
| | | |
Collapse
|
13
|
Qiu J, Wu J, Xie E, Luo X, Chen JF, Gao W, Jiang W, Qiu J, Zhao R, Yu C. Surgical Management and Outcomes of the Aortic Root in Acute Type A Aortic Dissection. Ann Thorac Surg 2020; 110:136-143. [DOI: 10.1016/j.athoracsur.2019.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/16/2019] [Accepted: 10/02/2019] [Indexed: 01/09/2023]
|
14
|
Xie L, Xu Y, Huang G, Ye M, Hu X, Shu S, Lynn H. MHCA with SACP versus DHCA in Pediatric Aortic Arch Surgery: A Comparative Study. Sci Rep 2020; 10:4439. [PMID: 32157148 PMCID: PMC7064562 DOI: 10.1038/s41598-020-61428-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/24/2020] [Indexed: 12/31/2022] Open
Abstract
The safety and efficacy of selective antegrade cerebral perfusion (SACP) in children undergoing aortic arch surgery are unclear. In this retrospective analysis, we compared moderate hypothermic circulatory arrest (MHCA; n = 61) plus SACP vs deep hypothermic circulatory arrest (DHCA; n = 53) in children undergoing aortic arch surgery during a period from January 2008 to December 2017. Demographic characteristics and the underlying anomalies were comparable between the two groups. The MHCA + SACP group had shorter cardiopulmonary bypass (CPB) time (146.9 ± 40.6 vs 189.6 ± 41.2 min for DHCA; p < 0.05) and higher nasopharyngeal temperature (26.0 ± 2.1 vs 18.9 ± 1.6 °C; p < 0.01). The MHCA + SACP group had lower rate of neurologic complications (3/61 vs 10/53 for DHCA; p < 0.05) but not complications in other organ systems. The MHCA + SACP group also had less 24-hour chest drainage (median, interquartile rage: 28.9, 12.6–150.0 vs 47.4, 15.2–145.0 ml/kg for DHCA; p < 0.05), shorter duration of postoperative mechanical ventilation (35.0, 15.4–80.3 vs 94.0, 42.0–144.0 h; p < 0.01), and shorter stay in intensive care unit (3.9, 3.0–7.0 vs 7.7, 5.0–15.0 d; p < 0.05). In regression analysis, in-hospital mortality was associated with longer CPB time. In conclusion, MHCA + SACP is associated with better short-term outcomes in children receiving aortic arch surgery under CPB.
Collapse
Affiliation(s)
- Ling Xie
- Department of Anesthesiology, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Yan Xu
- Department of Anesthesiology, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Guijin Huang
- Department of Anesthesiology, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Mao Ye
- Department of Anesthesiology, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Xiao Hu
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Shiyu Shu
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, China.
| | - Harness Lynn
- Division of Cardiac Surgery, Johns Hopkins Hospital, School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
15
|
Wu ZN, Guan XL, Xu SJ, Wang XL, Li HY, Gong M, Zhang HJ. Does preoperative serum creatinine affect the early surgical outcomes of acute Stanford type A aortic dissection? J Chin Med Assoc 2020; 83:266-271. [PMID: 31990819 DOI: 10.1097/jcma.0000000000000264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute Stanford type A aortic dissection is a lethal disease requiring surgery. Evidence regarding the effects of preoperative creatinine in mortality is limited, and few studies have evaluated the effect of postoperative dialysis treatment on it. METHODS In this cohort study, we continuously recruited 632 surgical patients who were treated for acute type A aortic dissection in our hospital between January 2015 and May 2017. The preoperative level of serum creatinine was measured. All patients were followed up after surgery for 30 days to determine early mortality. RESULTS The 30-day mortality after surgery increased with elevated levels of preoperative serum creatinine. Median (interquartile range) serum creatinine levels in survivors were 9.61 μmol/dL (7.28-12.62 μmol/dL) versus 13.41 μmol/dL (10.28-20.63 μmol/dL) in death (p < 0.01). Adjusted odds ratios for increasing per μmol/dL serum creatinine were 1.09 (95% confidence interval, 1.03-1.15). We also found that the effect of preoperative creatinine on 30-day mortality was diminished by dialysis treatment after surgery. CONCLUSION Preoperative serum creatinine predicts outcome in patients undergoing surgery for Stanford type A aortic dissection, and postoperative dialysis treatment can reduce its hazard.
Collapse
Affiliation(s)
- Zi-Ning Wu
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| | - Xin-Liang Guan
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| | - Shi-Jun Xu
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| | - Xiao-Long Wang
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| | - Hai-Yang Li
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| | - Ming Gong
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| | - Hong-Jia Zhang
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| |
Collapse
|
16
|
Dohle DS, El Beyrouti H, Brendel L, Pfeiffer P, El-Mehsen M, Vahl CF. Survival and reinterventions after isolated proximal aortic repair in acute type A aortic dissection. Interact Cardiovasc Thorac Surg 2019; 28:981-988. [PMID: 30715366 DOI: 10.1093/icvts/ivz011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/22/2018] [Accepted: 12/11/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Conventional treatment for acute type A dissection is the replacement of the ascending aorta. This study demonstrates the results of a conventional approach with isolated proximal repair combined with concomitant endovascular procedures. METHODS Replacement of the ascending aorta with or without an open distal anastomosis was defined as isolated proximal repair and was performed in 562/588 patients between January 2004 and June 2017. A total of 68% were DeBakey type I and 32% were DeBakey type II aortic dissections. Concomitant procedures were thoracic endovascular aortic repair (3.6%); visceral, renal and iliac stents (2%); and peripheral bypasses (1.1%). Mean follow-up was 4.6 ± 3.5 years with a 98% follow-up rate. Early and long-term survival, reintervention rates and risk factors were analysed. RESULTS Overall, the in-hospital mortality rate was 10.7%, 5.6% in DeBakey type II and 13% in DeBakey type I aortic dissection (P = 0.008). Risk factors for in-hospital mortality were age [odds ratio (OR) 1.03], chronic obstructive lung disease (OR 3.98), coronary artery disease (OR 2.19), Penn class BC (OR 15.41) and cardiopulmonary bypass time (OR 1.01). The 5- and 10-year survival rates, including in-hospital mortality, were 71% and 54% for type I and 73% and 65% for type II aortic dissection, respectively (P = 0.14). Freedom from reintervention after 5 and 10 years was 96% and 94% for DeBakey type II aortic dissection and 86% and 78% for type I (P < 0.001). CONCLUSIONS Combined with concomitant endovascular procedures, good short- and long-term results can be achieved in DeBakey type I and II aortic dissection. The reintervention rate is higher in DeBakey type I but can be managed open and endovascularly with good results.
Collapse
Affiliation(s)
- Daniel-Sebastian Dohle
- Department of Cardiothoracic and Vascular Surgery, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
| | - Hazem El Beyrouti
- Department of Cardiothoracic and Vascular Surgery, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
| | - Lena Brendel
- Department of Cardiothoracic and Vascular Surgery, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
| | - Philipp Pfeiffer
- Department of Cardiothoracic and Vascular Surgery, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
| | - Mohammed El-Mehsen
- Department of Cardiothoracic and Vascular Surgery, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
| | - Christian-Friedrich Vahl
- Department of Cardiothoracic and Vascular Surgery, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
| |
Collapse
|
17
|
He J, Peng J, Li W, Zheng D, Cai S, Xu W, Huang J, Fan X. "Aorta-clamp" technique for surgical repair of acute type A aortic dissection-5 min circulatory arrest at 30 °C. J Thorac Dis 2019; 11:4717-4724. [PMID: 31903261 PMCID: PMC6940206 DOI: 10.21037/jtd.2019.10.47] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Deep hypothermic circulatory arrest (HCA), which causes perioperative complications, is the foundation of surgical treatment for acute type A aortic dissection (AAAD). To extensively replace the dissected aorta and avoid the negative impacts of HCA, we developed an "aorta-clamp" technique and examined its efficacy in repairing AAAD. Methods From November 2014 to August 2016, we recruited 59 consecutive patients (51.3±10.9 years) with AAAD into this study. We performed total arch replacement combined with an elephant trunk implantation using the "aorta-clamp" technique under a 30 °C HCA with continual bilateral antegrade cerebral perfusion. Results The average HCA time was 4.9±1.0 min. Twenty-three patients had increased serum creatinine (sCr) before surgery, suggesting an AAAD-associated acute kidney injury (AKI). The sCr level returned to normal in five patients after operation and in 15 before discharge. Six patients (10.2%) with preoperative AKI required postoperative dialysis, and two of these patients (3.4%) died of multiple organ failure. Two patients (3.4%) required re-exploration due to bleeding. One patient (1.7%) exhibited temporary neurologic deficits. There were no late deaths. Computed tomography (CT) examination confirmed the patency of the anastomotic sites and thrombus obliteration of the residual false lumen. Conclusions Using the "aorta-clamp" technique with continual bilateral antegrade cerebral perfusion, total arch replacement combined with an elephant trunk implantation can be performed under five minutes of mild (30 °C) HCA. Our data suggest that this technique for the surgical repair of AAAD is a safe, feasible and effective surgical approach with satisfactory early outcomes.
Collapse
Affiliation(s)
- Jie He
- Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, China.,Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jihai Peng
- Department of Rehabilitation, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wei Li
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Dingwen Zheng
- Department of Cardiovascular Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Shihao Cai
- Department of Cardiovascular Surgery, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen 361005, China
| | - Wenliu Xu
- Department of Cardiothoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jinsong Huang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xiaoping Fan
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| |
Collapse
|
18
|
Zhu C, Piao H, Wang Y, Wang T, Li D, Xu R, Zhu Z, Li B, Zhang Y, Liu K. A New Aortic Root Reinforcement Technique for Acute Type A Aortic Dissection Surgery. Int Heart J 2019; 60:1131-1136. [DOI: 10.1536/ihj.18-609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Cuilin Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Hulin Piao
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Yong Wang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Tiance Wang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Dan Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Rihao Xu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Zhicheng Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Bo Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Yixin Zhang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Kexiang Liu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| |
Collapse
|
19
|
Open aortic arch surgery: the gold standard method. Indian J Thorac Cardiovasc Surg 2019; 35:130-135. [PMID: 33061078 DOI: 10.1007/s12055-018-0732-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022] Open
Abstract
Aortic arch pathologies are complex and treating them requires close team collaboration and technical skills to provide safe outcomes with low morbidity and mortality rates. Such challenges are facing both aortic and vascular surgeons. Open aortic arch repair has been the standard method of practice in all cases of aortic arch pathologies for the last four decades since the very first successful published case series by Griepp et al. during 1975. However, since then, repair of multi-segmented thoracic aortic pathologies has been explored through endovascular techniques; this is with or without open repair as a one-stage procedure especially in high-risk and elderly patients. Although the role of endovascular techniques in thoracoabdominal aorta is well established, its utilization as solo technique in aortic arch pathologies remains debatable. In this review, we highlight current evidences behind using open, endovascular, and hybrid procedures in aortic arch surgery.
Collapse
|
20
|
Fan PY, Chen CY, Lee CC, Liu KS, Wu VCC, Fan PC, Chang MY, Chang JCH, Tian YC, Chen SW. Impact of renal dysfunction on surgical outcomes in patients with aortic dissection. Medicine (Baltimore) 2019; 98:e15453. [PMID: 31096441 PMCID: PMC6531256 DOI: 10.1097/md.0000000000015453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Preoperative renal dysfunction is associated with mortality in patients who undergo coronary artery bypass graft and valve surgery. However, the role of preoperative renal dysfunction in type A aortic dissection (TAAD) remains unclear. This study aimed to evaluate the impact of preoperative renal dysfunction on the outcome of surgical intervention in patients with TAAD.We retrospectively studied the outcomes of 159 patients with TAAD who were treated at a tertiary referral hospital between 2005 and 2010. The demographics and surgical details of patients were analyzed according to their renal function. Risk factors for outcomes were analyzed using multivariable logistic regression. Thirty-two of the patients (20.1%) had preoperative serum creatinine of 1.5 mg/dL or more. The multivariable logistic regression model revealed independent risk factors of in-hospital mortality to be renal dysfunction (odds ratio [OR], 3.79; 95% confidence interval [CI], 1.64-8.77), preoperative shock (OR, 8.75; 95% CI, 2.83-27.02), and bypass time (OR, 1.008; 95% CI, 1.003-1.013). In addition, patients with renal dysfunction exhibited a lower 90-day survival rate than did patients without the condition (P of log-rank test = .005).Preoperative renal dysfunction may have a critical role in the surgical outcomes of patients with TAAD. Additional large-scale investigations are warranted.
Collapse
Affiliation(s)
- Pei-Yi Fan
- Kidney Research Center, Department of Critical Care Nephrology, Division of Nephrology, Chang Gung Memorial Hospital, Linkou Branch
| | - Chao-Yu Chen
- Kidney Research Center, Department of Critical Care Nephrology, Division of Nephrology, Chang Gung Memorial Hospital, Linkou Branch
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Critical Care Nephrology, Division of Nephrology, Chang Gung Memorial Hospital, Linkou Branch
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University
| | - Kuo-Sheng Liu
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Pei-Chun Fan
- Kidney Research Center, Department of Critical Care Nephrology, Division of Nephrology, Chang Gung Memorial Hospital, Linkou Branch
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University
| | - Ming-Yang Chang
- Kidney Research Center, Department of Critical Care Nephrology, Division of Nephrology, Chang Gung Memorial Hospital, Linkou Branch
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University
| | - Jason Chih-Hsiang Chang
- Kidney Research Center, Department of Critical Care Nephrology, Division of Nephrology, Chang Gung Memorial Hospital, Linkou Branch
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University
| | - Ya-Chung Tian
- Kidney Research Center, Department of Critical Care Nephrology, Division of Nephrology, Chang Gung Memorial Hospital, Linkou Branch
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University
| | - Shao-Wei Chen
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
| |
Collapse
|
21
|
Chen SK, Qiu ZH, Fang GH, Wu XJ, Chen LW. Reported outcomes after aortic valve resuspension for acute type A aortic dissection: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2019; 29:331-338. [PMID: 31220275 DOI: 10.1093/icvts/ivz080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/16/2019] [Accepted: 02/21/2019] [Indexed: 12/14/2022] Open
Abstract
AbstractIn the majority of patients presenting with acute type A aortic dissection (AAD) complicated by aortic valve insufficiency, the aortic valve (AV) can be preserved by AV resuspension. A meta-analysis was performed to investigate the outcomes following AV resuspension for AAD. A systematic literature search for publications reporting outcomes after AV resuspension in AAD published between January 1998 and June 2018 was conducted. Early outcome events and linearized occurrence rates for late outcome events were derived. The retrieval process yielded 18 unique studies involving 3295 patients with a total of 17 532 patient-years (pt-yrs). Pooled early mortality was 15.5% [95% confidence interval (95% CI) 11.5–19.4%, I2 = 91.9%], and the linearized late mortality rate was 3.21%/pt-yrs (95% CI 2.49–3.77, I2 = 29%). The linearized occurrence rates for aortic root reintervention was 1.4%/pt-yrs (95% CI 0.88–1.79, I2 = 48%); for recurrent significant aortic valve insufficiency (>2+), it was 1.12%/pt-yrs (95% CI 0.79–1.45, I2 = 68%); and for endocarditis, it was 0.01%/pt-yrs (95% CI 0–0.04, I2 = 7%). The composite rate of thromboembolism and bleeding was 1.41%/pt-yrs (95% CI 0.18–2.63, I2 = 82%). A more recent surgical period was associated with a decreased hazard of reoperation on the aortic root (P < 0.001). Requirement of AV resuspension alone in AAD is a risk factor for mortality. The long-term durability of AV resuspension is excellent, with low rates of endocarditis and thromboembolism and bleeding. Root reoperation hazard has become acceptable in recent years. Preoperative aortic valve insufficiency grade exceeding 2+ is a predictor for root reoperation.
Collapse
Affiliation(s)
- Shuang-Kun Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhi-Huang Qiu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Guan-Hua Fang
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Xi-Jie Wu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Liang-Wan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| |
Collapse
|
22
|
Suzuki T, Asai T, Kinoshita T. Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians Without Patient Selection. Ann Thorac Surg 2019; 107:1146-1153. [DOI: 10.1016/j.athoracsur.2018.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022]
|
23
|
How Much Malperfusion Is Too Much in Acute Type A Aortic Dissections? J Clin Med 2019; 8:jcm8030304. [PMID: 30836607 PMCID: PMC6462918 DOI: 10.3390/jcm8030304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/12/2019] [Accepted: 02/27/2019] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Malperfusion is a central limiting factor in the setting of acute Type A aortic dissections (AAAD). We sought to find preoperative metabolic acidosis thresholds that might influence decision-making in this setting. (2) Methods: We retrospectively reviewed consecutive patients operated on with AAAD between January 2002 and December 2017. We analyzed preoperative variables that might influence early and long-term outcomes, with particular emphasis on malperfusion markers. (3) Results: Our sample consisted of 153 patients, most of them male (69.2%), with a mean age of 55.89 ± 12.8 years. Malperfusion was present in 20.9% of cases: peripheric 25, renal 7, cerebral 4, and mesenteric 3. Cardiogenic shock was present in 18.9% of patients. Logistic regression revealed entry site (odds ratio (OR) = 2.83, p = 0.03), cardiogenic shock (OR = 3.30, p = 0.03), prebypass pH (OR = 0.93, p = 0.02) as independent risk factors for early death (<30 days). Receiver operating characteristic (ROC) analysis identified a prebypass pH of 7.25 as a cutpoint for an unfavourable early outcome. Patients whose prebypass pH was ≤7.25 had a 2.98 higher relative risk (65.7% vs. 22%, p < 0.001). Prebypass pH 7.25 (hazard ratio (HR) = 4.00, p < 0.01) and entry site (HR = 2.10, p = 0.04) were independent predictors of early phase survival (<30 days), while long-term survival (>30 days) was determined by age >65 years (HR = 3.12, p = 0.02). (4) Conclusions: Patients with a prebypass pH ≤ 7.25 have an unacceptably high early mortality after AAAD repair. Those patients might benefit from a two-stage approach.
Collapse
|
24
|
Latt KK, Vasiliyev KN, Bayandin NL, Stupin VA. [Risk factors of surgical treatment of acute aortic dissection type A (in Russian only)]. Khirurgiia (Mosk) 2019:15-20. [PMID: 30938353 DOI: 10.17116/hirurgia201903115] [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: 06/09/2023]
Abstract
AIM To evaluate risk factors of surgical treatment of acute aortic dissection type A. MATERIAL AND METHODS Retrospective analysis included 100 patients with acute aortic dissection type A who underwent surgery in 2007-2017. Patients were divided into 2 groups: group I (survivors, n=79) and group II (unfavorable outcomes, n=21). RESULTS Postoperative in-hospital mortality was 21% (21/100). Preoperative risk factors were cardiac tamponade (p=0.0001), aortic rupture (p=0.0001), impaired coronary blood flow (p=0.0001), renal malperfusion (p=0.0001). Prolonged cardiopulmonary bypass (156.1±37.9 min vs 205.7±91.2 min), surgery time (5.0±1.1 vs. 6.8±2.5 h, p=0.0009) and deep hypothermia (26.1±4.6 min vs 22.4±4.4 min) were the main intraoperative risk factors influencing surgical outcomes in patients who underwent aortic arch repair. Multiple organ failure (p=0.0001), sepsis (p=0.0007), severe postoperative bleeding (p=0.0010) and disseminated intravascular coagulation (p=0.0001) were the main predictors of advanced mortality in postoperative period. CONCLUSION Timely surgical treatment in case of cardiac tamponade and aortic rupture is essential to improve survival in patients with acute aortic dissection. Advanced aortic repair including hemi- or total arch replacement should be comprehensively measured because such procedures may be followed by increased postoperative morbidity and mortality after emergency aortic surgery.
Collapse
Affiliation(s)
- K K Latt
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - K N Vasiliyev
- Filatov Municipal Clinical Hospital #15, Moscow, Russia
| | - N L Bayandin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - V A Stupin
- Pirogov Russian National Research Medical University, Moscow, Russia
| |
Collapse
|
25
|
Naeem SS, Sodha NR, Sellke FW, Ehsan A. Impact of Packed Red Blood Cell and Platelet Transfusions in Patients Undergoing Dissection Repair. J Surg Res 2018; 232:338-345. [DOI: 10.1016/j.jss.2018.06.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/31/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
|
26
|
Morshuis WJ. Why to be cautious with the use of the frozen elephant trunk in acute type A aortic dissection. J Vis Surg 2018; 4:73. [PMID: 29780719 DOI: 10.21037/jovs.2018.03.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/16/2018] [Indexed: 11/06/2022]
Affiliation(s)
- William J Morshuis
- Department Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
27
|
Qiao F, Su C, Han Q, Tan M, Wang J, Liu Y, Lu F, Han L, Xu Z. Hybrid Reconstruction of the Aortic Arch Using a Double-Branched Stent-Graft in a Canine Model. J INVEST SURG 2018; 32:491-500. [PMID: 29469632 DOI: 10.1080/08941939.2018.1436206] [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: 10/18/2022]
Abstract
Purpose: To report the results of a hybrid approach to aortic arch repair using an innovative unibody double-branched stent graft in a canine model.Materials and methods: The stent-graft system consists of two parts: the main body and two branches for reconstruction of the supra-arch branches. There is a 2-cm-long suturing portion at the proximal end of the main body. Twenty adult German sheep dogs underwent a hybrid surgical treatment to place the stent-grafts into the proximal descending aorta and the supra-arch branches. Outcomes were assessed by operative mortality, complications, imaging studies, and histomorphometric analyses.Results: Placement of the stent-graft was performed successfully in all dogs without complications. One dog died of respiratory failure due to early extubation. The other dogs survived to 6 months without complications, at which time they were sacrificed. The mean cardiopulmonary bypass time was 80.3 ± 7.3 mins and hypothermic circulatory arrest time was 10.7 ± 1.9 min. The average blood loss was 373.5 mL. At 6 months, postoperative aortic imaging indicated that the main body and branches of the stent-graft were fully open and in satisfactory position. No migration, deformation, or endovascular leakage was observed. Histomorphometric results showed normal arrangement of medial and adventitial elastic fibers, moderately proliferated intima, with or without neo-microvessels, and microscopic morphological changes in internal elastic lamina.Conclusions: These results demonstrate that it is possible and safe to reconstruct the aortic arch with the novel open-branched stent-graft placement.
Collapse
Affiliation(s)
- Fan Qiao
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Cunhua Su
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.,Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing, Jiangsu Province, China
| | - Qingqi Han
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Mengwei Tan
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jun Wang
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fanglin Lu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
28
|
Fleischman F, Elsayed RS, Cohen RG, Tatum JM, Kumar SR, Kazerouni K, Mack WJ, Barr ML, Cunningham MJ, Hackmann AE, Baker CJ, Starnes VA, Bowdish ME. Selective Aortic Arch and Root Replacement in Repair of Acute Type A Aortic Dissection. Ann Thorac Surg 2017; 105:505-512. [PMID: 29103584 DOI: 10.1016/j.athoracsur.2017.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 05/27/2017] [Accepted: 07/10/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Controversy exists regarding the optimal extent of repair for type A aortic dissection. Our approach is to replace the ascending aorta, and only replace the aortic root or arch when intimal tears are present in those areas. We examined intermediate outcomes with this approach to acute type A aortic dissection repair. METHODS Between March 2005 and October 2016, 195 patients underwent repair of acute type A aortic dissection. Repair was categorized by site of proximal and distal anastomosis and extent of repair. Mean follow-up was 31.0 ± 30.9 months. Kaplan-Meier analysis was used to assess survival. Multiple variable Cox proportional hazards modeling was utilized to identify factors associated with overall mortality. RESULTS Overall survival was 85.1%, 83.9%, 79.1%, and 74.4% at 6, 12, 36, and 60 months, respectively. Eight patients required reintervention. The cumulative incidence of aortic reintervention at 1 year with death as a competing outcome was 3.95%. Multiple variable regression analysis identified factors such as age, preoperative renal failure, concomitant thoracic endograft, postoperative myocardial infarction and sepsis, and need for extracorporeal membrane oxygenation as predictive of overall mortality. Neither proximal or distal extent of repair, nor need for reintervention affected overall survival (proximal: hazard ratio 1.63, 95% confidence interval: 0.75 to 3.51, p = 0.22; distal: hazard ratio 1.12, 95% confidence interval: 0.43 to 2.97, p = 0.81; reintervention: hazard ratio 0.03, 95% confidence interval: 0.002 to 0.490, p < 0.01). CONCLUSIONS A selective approach to root and arch repair in acute type A aortic dissection is safe. If aortic reintervention is needed, survival does not appear to be affected.
Collapse
Affiliation(s)
- Fernando Fleischman
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Ramsey S Elsayed
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Robbin G Cohen
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - James M Tatum
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - S Ram Kumar
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Kayvan Kazerouni
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Wendy J Mack
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Mark L Barr
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Mark J Cunningham
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Amy E Hackmann
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Craig J Baker
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Vaughn A Starnes
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Michael E Bowdish
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
| |
Collapse
|
29
|
Shemirani H, Mirmohamadsadeghi A, Mahaki B, Farhadi S, Badalabadi RM, Bidram P, Badalabadi MM. Evaluation of Acute Aortic Dissection Type a Factors and Comparison the Postoperative Clinical Outcomes between Two Surgical Methods. Adv Biomed Res 2017; 6:85. [PMID: 28808651 PMCID: PMC5539669 DOI: 10.4103/2277-9175.210662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Although aortic dissection is a rare disease, it causes high level of mortality. If ascending aorta gets involved in this disease, it is known as type A. According to small number of studies about this disease in Iran, this study conducted to detect the factors related to acute aortic dissection type A, its surgery consequences and the factors affecting them. MATERIALS AND METHODS In this historical cohort study, all patients having acute aortic dissection type A referring to Chamran Hospital from 2006 to 2012 were studied. The impact of two surgical methods including antegrade cerebral perfusion (ACP) and retrograde cerebral one (RCP) on surgical and long-term mortality and recurrence of dissection was determined. The relation of mortality rate and hemodynamic instability before surgery, age more than 70 years old, ejection fraction lower than 50%, prolonged cardiopulmonary bypass pump (CPBP) time and excessive blood transfusion, was assessed. RESULTS Surgery and long-term mortality and recurrence of dissection were 35.3%, 30.8% and 30.4%. Surgical and long-term death in the patients being operated by ACP method was lower than those one being operated by RCP (P < 0.001). Excessive blood transfusion and unstable hemodynamic condition had significant effect on surgical mortality (P = 0.014, 0.030, respectively). CPBP time and unstable hemodynamic condition affected long-term mortality significantly (P = 0.002). CONCLUSION The result found that ACP is the preferable kind of surgery in comparison with RCP according to the surgical and long-term mortality.
Collapse
Affiliation(s)
- Hasan Shemirani
- Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Behzad Mahaki
- Department of Biostatistics, School of Public Health, University of Medical Sciences, Isfahan, Iran
| | - Sadaf Farhadi
- Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Peyman Bidram
- Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | |
Collapse
|
30
|
Sultan I, Wallen TJ, Habertheuer A, Siki M, Arnaoutakis GJ, Bavaria J, Szeto WY, Milewski R, Vallabhajosyula P. Concomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling. J Card Surg 2017; 32:581-592. [DOI: 10.1111/jocs.13192] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ibrahim Sultan
- University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | | | | | - Mary Siki
- University of Pennsylvania Medical Center; Philadelphia Pennsylvania
| | | | - Joseph Bavaria
- University of Pennsylvania Medical Center; Philadelphia Pennsylvania
| | - Wilson Y. Szeto
- University of Pennsylvania Medical Center; Philadelphia Pennsylvania
| | - Rita Milewski
- University of Pennsylvania Medical Center; Philadelphia Pennsylvania
| | | |
Collapse
|
31
|
|
32
|
Narayan P, Rogers CA, Benedetto U, Caputo M, Angelini GD, Bryan AJ. Malperfusion rather than merely timing of operative repair determines early and late outcome in type A aortic dissection. J Thorac Cardiovasc Surg 2017; 154:81-86. [PMID: 28420536 DOI: 10.1016/j.jtcvs.2017.03.041] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/23/2017] [Accepted: 03/08/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although generally better outcomes are reported in patients undergoing early repair of type A aortic dissection, patients who survive the first 48 hours self-select themselves toward better outcomes as well. Malperfusion is another important determinant of outcome in these patients. The aim of this study was to examine the hypothesis that malperfusion, not the timing of operation, is the dominant determinant of outcome in repair of type A aortic dissection. METHODS A total of 205 patients underwent operative repair of acute type A aortic dissection in our hospital over a 17-year period. The time from symptom onset to surgical repair was reliably established in 152 cases. Patients were grouped into those who had undergone surgery within 12 hours of symptom onset (early surgery group; n = 72 [47%]) and those who underwent surgery beyond 12 hours of symptom onset (late surgery group; n = 80 [53%]). RESULTS Thirty-day mortality was similar in the 2 groups (early surgery: 19.4% [95% confidence interval [CI] 12.0%-30.6%]; late surgery: 13.8% [95% CI, 7.9%-23.5%]; P = .08). The log-rank test for equality of survivor functions was 0.08. However, malperfusion with hemodynamic compromise was more common in the early surgery group (47% vs 31%; P = .029) and was identified as an independent predictor of long-term mortality (hazard ratio, 2.65; 95% CI, 1.21-5.79; P = .014). CONCLUSIONS Malperfusion at presentation rather than timing of intervention is the major risk factor of death both in the hospital and at long-term follow-up in patients undergoing surgery for type A aortic dissection.
Collapse
Affiliation(s)
- Pradeep Narayan
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Chris A Rogers
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Alan J Bryan
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
| |
Collapse
|
33
|
Yamauchi T, Kubota S, Ohata T, Hasegawa K, Ueda H. Enlargement of aortic arch vessels after surgical repair of type A aortic dissection. J Vasc Surg 2017; 65:669-675. [PMID: 28073667 DOI: 10.1016/j.jvs.2016.09.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/30/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Information on the growth rate of the diameter of the residual dissected supra-aortic trunk after surgical repair of type A aortic dissection is limited. METHODS We retrospectively reviewed 95 consecutive postsurgical patients with type A aortic dissection (acute, 91; chronic, 4) between 2005 and 2016 who were followed up with computed tomography. The diameter of the residual dissected supra-aortic trunk was measured by axial images and multiplanar reformatting, and the growth rate was calculated. RESULTS The mean age was 67.2 ± 12.8 years (range, 34-89 years). Forty-one brachiocephalic arteries (43%), 14 left common carotid arteries (15%), and 7 left subclavian arteries (10%) exhibited residual dissection. The diameter of the residual dissected branch with a patent false lumen (FL) gradually increased over time, whereas that with a thrombosed FL decreased and reached a plateau. The growth rate of brachiocephalic, left common carotid, and left subclavian arteries with a patent FL was 1.3 ± 1.2, 0.8 ± 0.3, and 0.6 ± 0.4 mm/y, respectively. One patient required surgical intervention for dilation of the brachiocephalic artery 8 years postoperatively. Multivariate analysis showed that male sex was an independent risk factor for a patent FL in the brachiocephalic artery (P = .0431; odds ratio, 2.04). CONCLUSIONS A residual dissected supra-aortic trunk with a thrombosed FL seems to be a benign condition. However, long-term follow-up is necessary for patients with a patent FL of residual dissected supra-aortic trunk, which might occasionally require surgical intervention.
Collapse
Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, KKR Sapporo Medical Center, Sapporo, Japan.
| | - Suguru Kubota
- Department of Cardiovascular Surgery, KKR Sapporo Medical Center, Sapporo, Japan
| | - Toshihiro Ohata
- Department of Cardiovascular Surgery, KKR Sapporo Medical Center, Sapporo, Japan
| | - Kosei Hasegawa
- Department of Cardiovascular Surgery, KKR Sapporo Medical Center, Sapporo, Japan
| | - Hideki Ueda
- Department of Cardiovascular Surgery, Chiba Graduate School of Medicine, Chiba City, Japan
| |
Collapse
|
34
|
Gunn TM, Stamou SC, Kouchoukos NT, Lobdell KW, Khabbaz K, Patzelt LH, Hagberg RC. Techniques of Proximal Root Reconstruction and Outcomes Following Repair of Acute Type A Aortic Dissection. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2016; 4:33-41. [PMID: 27757401 DOI: 10.12945/j.aorta.2016.14.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 02/04/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The goal of this study was to compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute Type A aortic dissection, including aortic valve (AV) resuspension, aortic valve replacement (AVR), and a root replacement procedure. METHODS All patients who underwent acute Type A aortic dissection repair between January 2000 and October 2010 at four academic institutions were compiled from each institution's Society of Thoracic Surgeons Database. This included 189 patients who underwent a concomitant aortic valve (AV) procedure; 111, 21, and 57 patients underwent AV resuspension, AVR, and the Bentall procedure, respectively. The median age of patients undergoing a root replacement procedure was significantly younger than the other two groups. Early clinical outcomes and 10-year actuarial survival rates were compared. Trends in outcomes and surgical techniques throughout the duration of the study were also analyzed. RESULTS The operative mortality rates were 17%, 29%, and 18%, for AV resuspension, AVR, and root replacement, respectively. Operative mortality (p = 0.459) was comparable between groups. Hemorrhage related re-exploration did not differ significantly between groups (p = 0.182); however, root replacement procedures tended to have decreased rates of bleeding when compared to AVR (p = 0.067). The 10-year actuarial survival rates for the AV resuspension, Bentall, and AVR groups were 72%, 56%, and 36%, respectively (log-rank p = 0.035). CONCLUSIONS The 10-year actuarial survival was significantly lower in those receiving AVR compared to those receiving root replacement procedures or AV resuspension. Operative mortality was comparable between the three groups.
Collapse
Affiliation(s)
- Tyler M Gunn
- Department of Cardiothoracic Surgery, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Sotiris C Stamou
- Department of Cardiothoracic Surgery, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nicholas T Kouchoukos
- Division of Cardiothoracic Surgery, Missouri Baptist Medical Center, Saint Louis, Missouri, USA
| | - Kevin W Lobdell
- Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Kamal Khabbaz
- Division of Cardiothoracic Surgery, Department of Surgery and The Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence H Patzelt
- Thoracic and Cardiovascular Surgery, Spectrum Health, Fred and Lena Meijer Heart and Vascular Institute, Grand Rapids, Michigan, USA
| | - Robert C Hagberg
- Department of Cardiac Surgery, Hartford Hospital, Hartford, Connecticut, USA
| |
Collapse
|
35
|
Di Bartolomeo R, Leone A, Di Marco L, Pacini D. When and how to replace the aortic arch for type A dissection. Ann Cardiothorac Surg 2016; 5:383-8. [PMID: 27563552 DOI: 10.21037/acs.2016.07.07] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Acute type A aortic dissection (AAAD) remains one of the most challenging diseases in cardiothoracic surgery and despite numerous innovations in medical and surgical management, early mortality remains high. The standard treatment of AAAD requires emergency surgery of the proximal aorta, preventing rupture and consequent cardiac tamponade. Resection of the primary intimal tear and repair of the aortic root and aortic valve are well-established surgical principles. However, the dissection in the aortic arch and descending untreated aorta remains. This injury is associated with the risk of subsequent false lumen dilatation potentially progressing to rupture, true lumen compression and distal malperfusion. Additionally, the dilatation of the aortic arch, the presence of a tear and retrograde dissection can all be considered indication for a total arch replacement in AAAD. In such cases a more aggressive strategy may be used, from the classic aortic arch operation to a single stage frozen elephant trunk (FET) technique or a two-stage approach such as the classical elephant trunk (ET) or the recent Lupiae technique. Although these are all feasible solutions, they are also complex and time demanding techniques requiring experience and expertise, with an in the length of cardiopulmonary bypass and both myocardial and visceral ischemia. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. Moreover, a correct assessment of the anatomy of the dissection, through the preoperative angio CT scan, in addition to the clinical condition of the patients, remain the decision points for the best arch repair strategy to use in AAAD.
Collapse
Affiliation(s)
- Roberto Di Bartolomeo
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Leone
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luca Di Marco
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
36
|
Berretta P, Patel HJ, Gleason TG, Sundt TM, Myrmel T, Desai N, Korach A, Panza A, Bavaria J, Khoynezhad A, Woznicki E, Montgomery D, Isselbacher EM, Di Bartolomeo R, Fattori R, Nienaber CA, Eagle KA, Trimarchi S, Di Eusanio M. IRAD experience on surgical type A acute dissection patients: results and predictors of mortality. Ann Cardiothorac Surg 2016; 5:346-51. [PMID: 27563547 DOI: 10.21037/acs.2016.05.10] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Type A acute aortic dissection (TAAD) is a disease that has a catastrophic impact on a patient's life and emergent surgery represents a key goal of early treatment. Despite continuous improvements in imaging techniques, medical therapy and surgical management, early mortality in patients undergoing TAAD repair still remains high, ranging from 17% to 26%. In this setting, the International Registry of Acute Aortic Dissection (IRAD), the largest worldwide registry for acute aortic dissection, was established to assess clinical characteristics, management and outcomes of TAAD patients. The present review aimed to evaluate and comment on outcomes of TAAD surgery as reported from IRAD series.
Collapse
Affiliation(s)
- Paolo Berretta
- Division of Cardiac Surgery, G. Mazzini Hospital, Teramo, Italy
| | - Himanshu J Patel
- Cardiac Surgery, University of Michigan Health System, Ann Arbor, USA
| | - Thomas G Gleason
- Division of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Thoralf M Sundt
- Thoracic Aortic Center, Massachusetts General Hospital, Boston, USA
| | - Truls Myrmel
- Department of Thoracic and Cardiovascular Surgery, Tromsø University Hospital, Tromsø, Norway
| | - Nimesh Desai
- Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Amit Korach
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Antonello Panza
- Department of Cardiology and Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Joe Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Ali Khoynezhad
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Elise Woznicki
- Cardiovascular Center, University of Michigan Health System, Ann Arbor, USA
| | - Dan Montgomery
- Cardiovascular Center, University of Michigan Health System, Ann Arbor, USA
| | | | - Roberto Di Bartolomeo
- Department of Cardiac Surgery, S.Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Rossella Fattori
- Interventional Cardiology Unit, San Salvatore Hospital, Pesaro, Italy
| | - Christoph A Nienaber
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Trust, London, UK
| | - Kim A Eagle
- Cardiovascular Center, University of Michigan Health System, Ann Arbor, USA
| | - Santi Trimarchi
- Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato, Italy
| | | |
Collapse
|
37
|
Hata M, Orime Y, Wakui S, Nakamura T, Hinoura R, Akiyama K. Efficacy of limited proximal arch replacement for type A acute aortic dissection with critical complications. Gen Thorac Cardiovasc Surg 2016; 64:651-656. [DOI: 10.1007/s11748-016-0688-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
|
38
|
Berretta P, Di Eusanio M. Descending endograft for DeBakey type 1 aortic dissection: pro. Ann Cardiothorac Surg 2016; 5:222-6. [PMID: 27386410 DOI: 10.21037/acs.2016.03.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The surgical management of patients with DeBakey type 1 acute aortic dissection (DBT1-AAD) represents a major challenge for aortic surgeons. It has been demonstrated that the distal false lumen remains patent in about 70% to 80% of patients undergoing DBT1-AAD surgery and that a patent false lumen worsens the prognosis. In order to improve long term outcomes and reduce the frequency of late aneurysm formation and reoperation, a more aggressive primary operation involving total arch replacement (TAR) and concomitant antegrade stenting of the descending thoracic aorta (DTA) with a frozen elephant trunk (FET) has been introduced. Such extensive operations, however, remain controversial due to their increased technical complexity and perceived higher operative mortality and morbidity. This perspective article will overview the rationale behind, and the potential advantages and current evidence for, FET surgery in acute aortic dissection.
Collapse
Affiliation(s)
- Paolo Berretta
- Division of Cardiac Surgery, G. Mazzini Hospital, Teramo, Italy
| | | |
Collapse
|
39
|
Narayan P, Rogers CA, Caputo M, Angelini GD, Bryan AJ. Ascending Aorta or Arch Surgery: Is Previous Cardiac Surgery a Risk Factor? Asian Cardiovasc Thorac Ann 2016; 14:14-9. [PMID: 16432112 DOI: 10.1177/021849230601400105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgery on the ascending aorta ± arch is a challenge. The risks involved in such operations after previous cardiac surgery were assessed in elective and emergency settings in a single institution. Over a 10-year period, 29 patients underwent replacement of the ascending aorta ± arch following previous cardiac surgery. In 12 patients (41.4%), the procedure was carried out on an emergency basis. Thirteen had previous replacement of the ascending aorta and 16 had previous valve replacement with or without coronary artery bypass; 4 patients were undergoing a 3rd cardiac operation. Concomitant procedures included coronary artery bypass in 2, arch replacement in 4, and descending aortic replacement in one. The overall in-hospital mortality was 13.8% (4/29) vs. 12.4% (33/267) in primary procedures. Mortality in elective repeat surgery was 5.9% (1/17) vs. 25% (3/12) in emergency re-operations. The incidences of permanent stroke (3.4%) and renal failure (3.4%) were similar to first-time operations. Elective re-operation for ascending aorta ± arch repair can be accomplished with acceptable mortality and morbidity. Outcomes in emergency cases carry a higher early mortality but still conform to contemporary expectations and are similar to emergency first-time aortic surgery.
Collapse
Affiliation(s)
- Pradeep Narayan
- Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom
| | | | | | | | | |
Collapse
|
40
|
Omura A, Miyahara S, Yamanaka K, Sakamoto T, Matsumori M, Okada K, Okita Y. Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement. J Thorac Cardiovasc Surg 2016; 151:341-8. [DOI: 10.1016/j.jtcvs.2015.03.068] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/08/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
|
41
|
Tochii M, Takami Y, Hattori K, Ishikawa H, Ishida M, Higuchi Y, Takagi Y. Early and Late Outcomes of Surgical Repair for Stanford A Acute Aortic Dissection in Octogenarians. Circ J 2016; 80:2468-2472. [DOI: 10.1253/circj.cj-16-0918] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masato Tochii
- Department of Cardiovascular Surgery, Fujita Health University
| | | | - Koji Hattori
- Department of Cardiovascular Surgery, Fujita Health University
| | | | - Michiko Ishida
- Department of Cardiovascular Surgery, Fujita Health University
| | - Yoshiro Higuchi
- Department of Cardiovascular Surgery, Fujita Health University
| | - Yasushi Takagi
- Department of Cardiovascular Surgery, Fujita Health University
| |
Collapse
|
42
|
|
43
|
Stöger G, Ríos M, Battellini R, Bracco D, Kotowicz V. Complex Reoperation for Late Complications After Acute Type A Aortic Dissection Surgery. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2015; 3:195-8. [PMID: 27390749 DOI: 10.12945/j.aorta.2015.15.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 10/06/2015] [Indexed: 11/18/2022]
Abstract
The correct management of acute Type A dissection continues to be a challenge. The primary goal is to save the patient´s life. However, the decision regarding the surgical approach determines possible later complications. We present the case of a 59-year-old female patient with a past history of emergent surgery for acute Type A dissection treated by supracoronary ascending and aortic valve replacement 19 years previously. Later, in a second endovascular approach, the descending aorta was treated by a thoracic endoprosthesis. During follow-up a dilated aortic root and a Type I endoleak were observed, and complex reoperation was required. We performed a total aortic arch replacement with a 4-branched graft and a complete aortic root replacement using the Cabrol technique for the reinsertion of the coronary arteries. The mechanical aortic normally functioning valve was preserved. The patient was discharged 30 days postoperatively.
Collapse
Affiliation(s)
- Guillermo Stöger
- Department of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Matías Ríos
- Department of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Roberto Battellini
- Department of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Bracco
- Department of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Vadim Kotowicz
- Department of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
44
|
Rice RD, Sandhu HK, Leake SS, Afifi RO, Azizzadeh A, Charlton-Ouw KM, Nguyen TC, Miller CC, Safi HJ, Estrera AL. Is Total Arch Replacement Associated With Worse Outcomes During Repair of Acute Type A Aortic Dissection? Ann Thorac Surg 2015; 100:2159-65; discussion 2165-6. [DOI: 10.1016/j.athoracsur.2015.06.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 11/25/2022]
|
45
|
Nishida H, Tabata M, Fukui T, Takanashi S. Surgical Strategy and Outcome for Aortic Root in Patients Undergoing Repair of Acute Type A Aortic Dissection. Ann Thorac Surg 2015; 101:1464-9. [PMID: 26627176 DOI: 10.1016/j.athoracsur.2015.10.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/13/2015] [Accepted: 10/01/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study evaluated the relevance of our indication of aortic root operations for acute type A aortic dissection and compared early and long-term outcomes of emergency type A aortic dissection operations between patients who underwent aortic root operations and those who did not. METHODS We retrospectively reviewed 316 consecutive patients who underwent emergency aortic operations for acute type A aortic dissection between January 2009 and September 2013. We performed simultaneous aortic root operations when the aortic root diameter was greater than 45 mm or an intimal tear was present in the aortic root, or both. After this indication, we performed aortic repair involving the aortic root in 40 patients (aortic root replacement [ARR] group, 12.7%) and not involving the aortic root in 276 patients (non-ARR group, 87.3%). We analyzed early and long-term outcomes, including late aortic root events. RESULTS In-hospital mortality was 12.5% (5 of 40) in the ARR group and 4.7% (13 of 276) in non-ARR group (p = 0.05). Overall survival at 3 and 5 years was 84.8% and 84.8%, respectively in ARR group and was 91.9% and 91.9%, respectively, in the non-ARR group (p = 0.078). Late aortic root events, defined as aortic root dilatation (≥ 3 mm/y), reoperation of the aortic root, aortic regurgitation (moderate or higher), and pseudoaneurysm, were observed in no patients in the ARR group and in 32 patients (11.6%) in the non-ARR group (p = 0.029). In the non-AAR group, dissection of 2 or more aortic sinuses was the only independent predictor of a late aortic root event (hazard ratio, 2.20; 95% confidence interval, 1.08 to 4.61; p = 0.03). CONCLUSIONS Simultaneous aortic root operations significantly reduced the incidence of late aortic root events. The dissection of 2 or more sinuses of Valsalva was associated with a late aortic root event in patients who did not undergo aortic root operations.
Collapse
Affiliation(s)
- Hidefumi Nishida
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| |
Collapse
|
46
|
Kalkan ME, Kalkan AK, Gündeş A, Yanartaş M, Oztürk S, Gurbuz AS, Ozturk D, Iyigun T, Akcakoyun M, Emiroglu MY, Tuncer MA, Koksal C. Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection. Perfusion 2015; 32:321-327. [PMID: 26467992 DOI: 10.1177/0267659115590625] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: The inflammatory process has been reported to be associated with aortic dissection (AD) from the development to the prognosis. The aim of the study was to investigate a relationship between the neutrophil to lymphocyte ratio (NLR) and in-hospital outcomes in patients with acute aortic dissection (AAD) who underwent surgical repair. Methods: One hundred and eighty-four patients who were admitted with the diagnosis of type A AAD who underwent surgical repair at two large tertiary hospitals. According to their NLR, 91 patients had high NLR (>6.0) and 93 patients had low NLR (⩽6.0). Results: The frequency of major bleeding, hospital-related infection, multi-organ dysfunction and mortality in hospital were higher in the high NLR group compared to the low NLR group. NLR, WBC count and operation duration were found to be independent predictors for in-hospital mortality. Conclusions: The novel inflammatory marker NLR may be used to predict worse outcomes and hospital mortality in patients with AAD treated by surgical repair.
Collapse
Affiliation(s)
- Mehmet Emin Kalkan
- Kartal Kosuyolu Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Ali Kemal Kalkan
- Mehmet Akif Ersoy Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Ahmet Gündeş
- Mersin University School of Medicine, Cardiology Department, Mersin, Turkey
| | - Mehmed Yanartaş
- Kartal Kosuyolu Education and Research Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Semi Oztürk
- Kartal Kosuyolu Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Ahmet Seyfeddin Gurbuz
- Kartal Kosuyolu Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Derya Ozturk
- Mehmet Akif Ersoy Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Taner Iyigun
- Mehmet Akif Ersoy Education and Research Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Mustafa Akcakoyun
- Kartal Kosuyolu Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Mehmet Yunus Emiroglu
- Kartal Kosuyolu Education and Research Hospital, Cardiology Department, Istanbul, Turkey
| | - Mehmet Altuğ Tuncer
- Kartal Kosuyolu Education and Research Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| | - Cengiz Koksal
- Kartal Kosuyolu Education and Research Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
| |
Collapse
|
47
|
Total Arch Replacement Versus More Conservative Management in Type A Acute Aortic Dissection. Ann Thorac Surg 2015; 100:88-94. [DOI: 10.1016/j.athoracsur.2015.02.041] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 02/08/2015] [Accepted: 02/12/2015] [Indexed: 11/20/2022]
|
48
|
Ariyaratnam P, Loubani M, Griffin SC, Cowen ME, Vijayan A, Jarvis MA, Cale AR. Complex aortic surgery in a regional center in the United Kingdom. Should the United Kingdom now adopt a United States–style supercenter model? J Thorac Cardiovasc Surg 2014; 148:1428-1434.e1. [DOI: 10.1016/j.jtcvs.2014.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/14/2013] [Accepted: 01/10/2014] [Indexed: 11/16/2022]
|
49
|
Ansari E, Blehm A, Boeken U, Lichtenberg A. Successful acute type A aortic dissection repair in a nonagenarian. Heart Surg Forum 2014; 17:E178-9. [PMID: 25002397 DOI: 10.1532/hsf98.2014329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Surgical repair in older patients with acute type A aortic dissection (ATAAD) evokes a higher peri- and postoperative mortality, it therefore remains controversial in nonagenarians. The authors present a case of a surgically managed ATAAD in a nonagenerian, a 94-year-old man presented with an uncomplicated ATAAD, necessitating emergency surgical repair. The subsequent postoperative course was uneventful, and the patient was discharged after uncomplicated recovery. Aggressive surgical approach should be feasable in select nonagenarian patients with ATAAD, depending on the clinical presention and prior patient history.
Collapse
Affiliation(s)
- Edward Ansari
- Department of Cardiovascular Surgery, Heinrich Heine University, Medical Faculty, Moorenstrasse 5, 40225 Dusseldorf, Germany, Europe
| | - Alexander Blehm
- Department of Cardiovascular Surgery, Heinrich Heine University, Medical Faculty, Moorenstrasse 5, 40225 Dusseldorf, Germany, Europe
| | - Udo Boeken
- Department of Cardiovascular Surgery, Heinrich Heine University, Medical Faculty, Moorenstrasse 5, 40225 Dusseldorf, Germany, Europe
| | - Arthur Lichtenberg
- Department of Cardiovascular Surgery, Heinrich Heine University, Medical Faculty, Moorenstrasse 5, 40225 Dusseldorf, Germany, Europe
| |
Collapse
|
50
|
Preventza O, Cervera R, Cooley DA, Bakaeen FG, Mohamed AS, Cheong BY, Cornwell L, Simpson KH, Coselli JS. Acute type I aortic dissection: Traditional versus hybrid repair with antegrade stent delivery to the descending thoracic aorta. J Thorac Cardiovasc Surg 2014; 148:119-25. [DOI: 10.1016/j.jtcvs.2013.07.055] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/21/2013] [Accepted: 07/26/2013] [Indexed: 11/15/2022]
|