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Isa H, Kanamori T, Miyatani K, Tsutsui M, Ushioda R, Yamanaka S, Kamiya H. Cardiopulmonary resuscitation at operating room entry in acute aortic dissection type A patients: is surgery contraindicated? Front Surg 2024; 11:1404825. [PMID: 38948478 PMCID: PMC11211526 DOI: 10.3389/fsurg.2024.1404825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/03/2024] [Indexed: 07/02/2024] Open
Abstract
Background This study aimed to compare the short-term outcomes of surgical treatment for acute type A aortic dissection between patients undergoing cardiopulmonary arrest at the time of entry into the operating room and patients who received successful preoperative cardiopulmonary resuscitation before entering the operating room or patients who had cardiopulmonary arrest on the operating room table after entering the operating room without cardiopulmonary arrest. In the present study, we focused on the circulatory status at the time of entering the operating room because it is economically and emotionally difficult to cease intervention once the patient has entered the operating room, where surgeons, anesthesiologists, nurses, and perfusionists are already present, all necessary materials are packed off and cardiopulmonary bypass have already been primed. Methods Twenty (5.5%) of 362 patients who underwent surgical treatment for acute type A aortic dissection between January 2016 and March 2022 had preoperative cardiopulmonary arrest. To compare the early operative outcomes, the patients were divided into the spontaneous circulation group (n = 14, 70.0%) and the non-spontaneous circulation group (n = 6, 30.0%) based on the presence or absence of spontaneous circulation upon entering the operating room. The primary endpoint was postoperative 30-day mortality. The secondary endpoints included in-hospital complications and persistent neurological disorders. Results Thirty-day mortality was 65% (n = 13/20) in the entire cohort; 50% (n = 7/14) in the spontaneous circulation group and 100% (n = 6/6) in the non-spontaneous circulation group. The major cardiopulmonary arrest causes were aortic rupture and cardiac tamponade (n = 16; 80.0%), followed by coronary malperfusion (n = 4; 20.0%). Seven patients (50.0%) survived in the spontaneous circulation group, and none survived in the non-spontaneous circulation group (P = .044). Five survivors walked unaided and were discharged home; the remaining two were comatose and paraplegic. Conclusions The outcomes were extremely poor in patients with acute type A aortic dissection who had preoperative cardiopulmonary arrest and received ongoing cardiopulmonary resuscitation at entry into the operating room. Therefore, surgical treatment might be contraindicated in such patients.
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Affiliation(s)
- Hideki Isa
- Department of Cardiovascular Surgery, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Taro Kanamori
- Department of Cardiovascular Surgery, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Kazuki Miyatani
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Masahiro Tsutsui
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Ryohei Ushioda
- Department of Cardiovascular Surgery, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shota Yamanaka
- Department of Cardiovascular Surgery, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
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Sheng W, Xia W, Niu Z, Yang H. Incidence of Acute Kidney Injury and Risk Factors of Prognosis in Patients with Acute Stanford Type A Aortic Dissection. Ann Thorac Cardiovasc Surg 2023; 29:249-255. [PMID: 37005281 PMCID: PMC10587477 DOI: 10.5761/atcs.oa.22-00242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/06/2023] [Indexed: 04/03/2023] Open
Abstract
PURPOSE We aimed to investigate the prognosis and impact of postoperative acute kidney injury (AKI) in acute Stanford type A aortic dissection (ATAAD) patients, and to analyze the predictors of short- and medium-term survival. METHODS A total of 192 patients who underwent ATAAD surgery were included between May 2014 and May 2019. Perioperative data of these patients were analyzed. All of the discharged patients were followed up for 2 years. RESULTS Postoperative AKI was identified in 43 of 192 patients (22.4%). The two-year survival rate of patients with AKI after discharge was 88.2% and that without AKI was 97.2%.The difference was statistically significant (χ2 = 5.355, log-rank P = 0.021). Cox hazards regression showed that age (hazard ratio [HR], 1.070; P = 0.002), cardiopulmonary bypass (CPB) time (HR, 1.026; P = 0.026), postoperative AKI (HR, 3.681; P = 0.003), and red blood cell transfusion (HR, 1.548; P = 0.001) were independent risk factors for the short- and medium-term total mortality of ATAAD patients. CONCLUSION The incidence of postoperative AKI is high in ATAAD, and the mortality of patients with AKI increases significantly within 2 years. Age, CPB time, and red blood cell transfusion were also independent risk factors for short-and medium-term prognoses.
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Affiliation(s)
- Wei Sheng
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China
| | - Wei Xia
- Department of Cardiology, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China
| | - Zhaozhuo Niu
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China
| | - Haiqin Yang
- Department of Mental Intervention, Qingdao Preferential Hospital, Qingdao, Shandong, China
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Maze Y, Tokui T, Murakami M, Nakamura B, Inoue R, Hirano R, Hirano K. Clinical outcomes of limited repair and conservative approaches in older patients with acute type A aortic dissection. J Cardiothorac Surg 2022; 17:78. [PMID: 35428343 PMCID: PMC9013093 DOI: 10.1186/s13019-022-01819-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 04/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background Surgical indication and the selection of surgical procedures for acute type A aortic dissection in older patients are controversial; therefore, we aimed to examine the surgical outcomes of acute type A aortic dissection in older patients. Methods From January 2012 through December 2019, 174 patients underwent surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the older (≥ 80 years old) and below-80 (≤ 79 years old) age groups. Additionally, we compared the outcomes between the surgical and conservative treatment groups. Results The primary entry was found in the ascending aorta in 51.6% and 32.8% of the older and below-80 groups, respectively (p = 0.049). Ascending or hemiarch replacement was performed in all older group patients and 57.3% of the below-80 group patients (total arch replacement was performed in the remaining 42.7%; p < 0.001). Hospital mortality rates were similar in both groups. The significant risk factors for hospital mortality were age, preoperative intubation, cardiopulmonary bypass time, and postoperative stroke. The 5-year survival rates were 48.4% ± 10.3% (older group) and 86.7% ± 2.9% (below-80 group; p < 0.001). The rates of freedom from aortic events at 5 years were 86.9% ± 8.7% (older group) and 86.5% ± 3.9% (below-80 group; p = 0.771). The 5-year survival rate of the conservative treatment subgroup was 19.2% ± 8.0% in the older group, which was not significantly different from that of the surgical treatment subgroup (p = 0.103). Conclusion The surgical approach did not achieve a significant survival advantage over conservative treatment and may not always be a reasonable treatment of choice for older patients.
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Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up. J Clin Med 2021; 10:jcm10225370. [PMID: 34830651 PMCID: PMC8625674 DOI: 10.3390/jcm10225370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predictive of undesirable outcome to help guide perioperative management. Methods: We performed retrospective analysis of 394 cases of AAAD who underwent repair in our institution between 2001 and 2018. A combined endpoint of parameters was defined as (1) 30-day versus hospital mortality, (2) new neurological deficit, (3) new acute renal insufficiency requiring postoperative renal replacement, and (4) prolonged mechanical ventilation with need for tracheostomy. Results: Total survival/ follow-up time averaged 3.2 years with follow-up completeness of 94%. Endpoint was reached by 52.8%. Those had higher EuroSCORE II (7.5 versus 5.5), higher incidence of coronary artery disease (CAD) (9.2% versus 3.2%), neurological deficit (ND) upon presentation (26.4% versus 11.8%), cardiopulmonary resuscitation (CPR) (14.4% versus 1.6%) and intubation (RF) before surgery (16.9% versus 4.8%). 7-day mortality was 21.6% versus 0%. Hospital mortality 30.8% versus 0%. Conclusions: This 15-year follow up shows, that unfavorable postoperative clinical outcome is related to ND, CAD, CPR and RF on arrival.
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Chen B, Wei M. Exploration of Simplified Intraluminal TEVAR Technique for the Treatment of Aortic Arch Disease. Braz J Cardiovasc Surg 2021; 36:365-371. [PMID: 34387974 PMCID: PMC8357392 DOI: 10.21470/1678-9741-2020-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The positional relationship between the three branches of the aortic arch was determined in normal people. This study provides data to support the customization of aortic arch stents and simplifies intraluminal treatment. Methods: From January 2019 to August 2019, 120 patients who met the inclusion criteria were examined by CT angiography. The ratio of the distance from the midpoint of the three-branch opening onto the anterior wall to the cross-sectional diameter of the aortic arch was calculated. The positional relationship among the three-branch openings was obtained and the data were analyzed statistically. Results: The three-branch openings were not in a straight line. The positional relationship among the three-branch openings was divided into four types, which were not statistically different between sex and age (P>0.05). Conclusion: By measuring the opening position of the three aortic branches, the positional relationship among the three branches was defined to provide a theoretical basis for the design of intraluminal stents and simplified intracavity thoracic endovascular aortic repair (TEVAR) technology.
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Affiliation(s)
- Bailang Chen
- Division of Cardiovascular Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Minxin Wei
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
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Zong Q, Ge M, Chen T, Chen C, Wang Z, Wang D. Risk factors and long-term outcomes of acute kidney injury complication after type A acute aortic dissection surgery in young patients. J Cardiothorac Surg 2020; 15:315. [PMID: 33059693 PMCID: PMC7560008 DOI: 10.1186/s13019-020-01365-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify risk factors and long-term outcomes of acute kidney injury (AKI) in young patients who underwent type A acute aortic dissection (TA-AAD) emergency surgeries. METHODS This retrospective study enrolled 121 consecutive patients less than 40 years old who received TA-AAD emergency surgeries between January 2014 to December 2018 in Nanjing Drum Tower hospital. The diagnosis of AKI was made based on the KDIGO criteria. Multivariable regression analysis was performed to identify risk factors for postoperative AKI. Kaplan-Meier curves were generated to compare long-term outcomes between patients with and without AKI complication after TA-AAD surgeries. RESULTS Among all enrolled patients, AKI occurred in 51 patients (42.1%) and renal replacement therapy (RRT) was required in 15 patients (12.4%). The development of postoperative AKI was associated with increased 30-day mortality (P = 0.041), longer ICU stay time (P < 0.001) and hospital stay time (P = 0.006). Multivariable analysis indicated that elevated preoperative serum cystatin C (sCyC) (OR = 6.506, 95% CI: 1.852-22.855, P = 0.003) was the only independent risk factor for developing AKI. The areas under the receiver-operating characteristic curve (AUC) of preoperative sCyC was 0.800 (95% CI: 0.719, 0.882). Preoperative sCyC had a sensitivity of 64.7% and a specificity of 83.8% in diagnosing postoperative AKI with a cut-off value of 0.895 mg/L. In addition, our data suggested there was no difference discovered regarding long-term cumulative survival rate between patients with and without AKI during a median 29 months follow-up period. CONCLUSIONS Postoperative AKI after TA-AAD surgeries was relatively common in young patients and associated with increased short-term mortality. Elevated preoperative sCyC was identified as an independent risk factor for AKI with potential diagnostic merit.
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Affiliation(s)
- Qiuyan Zong
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Min Ge
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Tao Chen
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Cheng Chen
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Zhigang Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Dongjin Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
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Aoyama T, Kunisawa S, Fushimi K, Sawa T, Imanaka Y. Comparison of surgical and conservative treatment outcomes for type a aortic dissection in elderly patients. J Cardiothorac Surg 2018; 13:129. [PMID: 30563552 PMCID: PMC6299624 DOI: 10.1186/s13019-018-0814-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
Background In recent years, surgical outcomes have improved, and positive reports on surgery for type A aortic dissection (AAD) in the elderly are increasing. However, the difference between surgical and conservative treatments in the elderly remains unclear. Therefore, we conducted this study to determine whether surgery should be performed for Stanford (AAD) in elderly patients. Methods Data of patients aged 80 years or older who were hospitalized for AAD from April 2014 to March 2016 were extracted from the Japanese national inpatient database. Outcome measures were all-cause in-hospital death, stroke, acute kidney injury and tracheotomy, and composite adverse events (consisting of all-cause in-hospital death, stroke, acute kidney injury, and tracheotomy), and we compared them between surgical and conservative treatments using propensity score matching. Results The study cohort included 3258 patients, with 845 matched pairs (1690 patients) in the propensity score matching. All-cause in-hospital death was significantly lower in the surgical treatment group than in the conservative treatment group before and after matching (15.6% vs. 51.1%, p < 0.001; 16.7% vs. 31.6%, p < 0.001, respectively); however, there was no significant difference in composite adverse events after matching (36.0%, conservative vs. 37.2%, surgical; p = 0.65), and adjusted odds ratio was 1.06 and 95% confidence interval was 0.86–1.29 (p = 0.61) with reference to conservative treatment. Conclusions All-cause in-hospital death among elderly patients with AAD was significantly lower in patients treated surgically than in those undergoing conservative treatment. However, there was no significant difference between the two groups in the event-free survival, which is important for the elderly. These findings may be used in the consideration of treatment course for elderly patients with AAD. Electronic supplementary material The online version of this article (10.1186/s13019-018-0814-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takeshi Aoyama
- Department of Anesthesiology, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.,Department of Anesthesiology, Omihachiman Community Medical Center, Shiga, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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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
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