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Li C, Yu J, Shang L, Yang Z, Deng X, An R, Xu J. Risk prediction of postoperative permanent stroke in acute type A aortic dissection patients with severe common carotid artery stenosis using brain CT perfusion. Heliyon 2024; 10:e36740. [PMID: 39263105 PMCID: PMC11386277 DOI: 10.1016/j.heliyon.2024.e36740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 08/16/2024] [Accepted: 08/21/2024] [Indexed: 09/13/2024] Open
Abstract
Rationale and objectives To explore the feasibility and predictive utility for neurological outcomes of brain computed tomography perfusion (CTP) for surgically treated acute type A aortic dissection patients with severe common carotid artery stenosis. Materials and methods Consecutive acute type A aortic dissection patients with severe common carotid artery stenosis undergoing preoperative brain computed tomography perfusion and surgery at our center were examined in retrospect. Brain perfusion was assessed using parameters including cerebral blood flow, cerebral blood volume, mean transmit time, time to maximum, penumbra volume and infarct core volume. Univariable and multivariable regression analyses were performed to identify clinical and imaging predictors associated with postoperative permanent stroke. Results Out of 44 patients included, 19 patients (43.2 %) presented with postoperative permanent stroke. Univariable analysis revealed that internal carotid artery dissection, cerebral blood flow of the affected side, cerebral blood volume of the affected side, and penumbra volume were implicated in postoperative permanent stroke. Multivariable analysis further showed that cerebral blood flow of the affected side was an independent indicator of a permanent stroke following surgery (odds ratio: 0.820, 95 % confidence interval: 0.684-0.982; p = 0.012). The area under the receiver operating characteristic curve was 0.867 (95 % confidence interval: 0.764-0.970), and the optimal cut-off value was 45.6mL/100 mL/min. Conclusion Cerebral blood flow of the affected side was an independent indicator of permanent stroke following surgery in acute type A aortic dissection patients with severe common carotid artery stenosis. Brain CTP could be a helpful modality for quantitative evaluation of cerebral malperfusion and neurological prognostication.
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Affiliation(s)
- Chengxiang Li
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, China
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military University, 127 Changle West Road, Xi'an, China
| | - Jing Yu
- Department of Radiology, Xijing Hospital, Fourth Military University, 127 Changle West Road, Xi'an, China
| | - Lei Shang
- Department of Health Statistics, Fourth Military Medical University, 169Changle West Road, Xi'an, China
| | - Ziqi Yang
- Department of Radiology, Xijing Hospital, Fourth Military University, 127 Changle West Road, Xi'an, China
| | - Xiwei Deng
- Department of Radiology, Xijing Hospital, Fourth Military University, 127 Changle West Road, Xi'an, China
| | - Rui An
- Department of Radiology, Xijing Hospital, Fourth Military University, 127 Changle West Road, Xi'an, China
| | - Jian Xu
- Department of Radiology, Xijing Hospital, Fourth Military University, 127 Changle West Road, Xi'an, China
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He K, Qin X, Li M, Bian L, Yue H, Liang W, Wu Z. Two surgical strategies (early carotid reperfusion vs. Central aortic repair-first) of acute type a aortic dissection complicated with cerebral malperfusion syndrome: a meta-analysis and systematic review. BMC Cardiovasc Disord 2024; 24:239. [PMID: 38714966 PMCID: PMC11075335 DOI: 10.1186/s12872-024-03910-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE Cerebral malperfusion (CM) is a common comorbidity in acute type A aortic dissection (ATAAD), which is associated with high mortality and poor neurological prognosis. This meta-analysis investigated the surgical strategy of ATAAD patients with CM, aiming to compare the difference in therapeutic effectiveness between the central repair-first and the early reperfusion-first according to clinical outcomes. METHODS The meta-analysis and systematic review was conducted based on studies sourced from the PubMed, Embase, and Cochrane literature database, in which cases of ATAAD with CM underwent surgical repair were included. Data for baseline characteristics, mortality, survival were extracted, and risk ratio (RR) values and the pooled mortality were calculated. RESULTS A total of 17 retrospective studies were analyzed, including 1010 cases of ATAAD with CM underwent surgical repair. The pooled early mortality in early reperfusion group was lower (8.1%; CI, 0.02 to 0.168) than that in the central repair group (16.2%; CI, 0.115 to 0.216). The pooled long-term mortality was 7.9% in the early reperfusion cohort and 17.4% the central repair-first cohort, without a statistically significant heterogeneity (I [2] = 51.271%; p = 0.056). The mean time of symptom-onset-to-the-operation-room in all the reports was 8.87 ± 12.3 h. CONCLUSION This meta-analysis suggested that early reperfusion-first may achieved better outcomes compared to central repair-first in ATAAD patients complicated with CM to some extent. Early operation and early restoration of cerebral perfusion may reduce the occurrence of some neurological complications. TRIAL REGISTRATION The meta-analysis was registered in the International Prospective Register of Systematic Reviews database (No. CRD CRD42023475629) on Nov. 8th, 2023.
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Affiliation(s)
- Kang He
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaoli Qin
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Mei Li
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Longrong Bian
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Honghua Yue
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Weitao Liang
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Zhong Wu
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China.
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Wang LF, Li Y, Jin M, Li HB, Zhang N, Gong M, Zhang HJ, Liu YY, Lai YQ. FL% is associated with the severity of acute DeBakey type I aortic dissection in patients undergoing frozen elephant trunk and total arch replacement. Front Surg 2024; 11:1329771. [PMID: 38655210 PMCID: PMC11035816 DOI: 10.3389/fsurg.2024.1329771] [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: 10/29/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Objectives The diameter, area, and volume of the true lumen and false lumen (FL) have been measured in previous studies to evaluate the extent of DeBakey type I aortic dissection. However, these indicators have limitations because of the irregular shapes of the true and false lumens and the constant oscillation of intimal flap during systole and diastole. The ratio of arch lengths seems to be a more reliable indicator. FL% was defined as the ratio of the arch length of FL to the circumference of the aorta at the different levels of the aorta. The purpose of this article was to investigate whether FL% is a predictor of the severity of acute DeBakey type I aortic dissection in patients undergoing frozen elephant trunk (FET) and total arch replacement. Methods In this retrospective observational study, we analyzed a total of 344 patients with acute DeBakey type I aortic dissection that underwent FET and total arch replacement at our center from October 2015 to October 2019. The patients were divided into two groups by cluster analysis according to the perioperative course. Binary logistic regression analyses were performed to determine whether FL% could predict the severity of acute DeBakey type I aortic dissection. The area under the receiver operating characteristic curve (AUROC) was used to assess the power of the multivariate logistic regression model for the severity of acute DeBakey type I aortic dissection. Results The patients in the ultra-high-risk group (109 patients) had significantly more severe clinical comorbidities and complications than the patients in the high-risk group (235 patients). The ascending aortic FL% [odds ratio (OR), 11.929 (95% CI: 1.421-100.11); P = 0.022], location of initial tear [OR, 0.68 (95% CI: 0.47-0.98); P = 0.041], the degree of left iliac artery involvement [OR, 1.95 (95% CI: 1.15-3.30); P = 0.013], and the degree of right coronary artery involvement [OR, 1.46 (95% CI: 1.01-2.12); P = 0.045] on preoperative computed tomography angiography were associated with the severity of acute DeBakey type I aortic dissection. The AUROC value of this multivariate logistic regression analysis was 0.940 (95% CI: 0.914-0.967; P < 0.001). The AUROC value of ascending aortic FL% was 0.841 (95% CI: 0.798-0.884; P < 0.001) for the severity of acute DeBakey type I aortic dissection in patients undergoing FET and total arch replacement. Conclusions Ascending aortic FL% was validated as an essential radiologic index for assessing the severity of acute DeBakey type I aortic dissection in patients undergoing FET and total arch replacement. Higher values of ascending aortic FL% were more severe.
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Affiliation(s)
- Long-Fei Wang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu Li
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Mu Jin
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hai-Bin Li
- Department of Cardiac Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ming Gong
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong-Jia Zhang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu-Yong Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yong-Qiang Lai
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Deng C, Tang H, Li J, Li Z, Shen K, Zhang Z, Jiang B, Tan L. Development and validation of a prediction model for postoperative ischemic stroke following total arch replacement and frozen elephant trunk under mild hypothermia. Heliyon 2024; 10:e25925. [PMID: 38390179 PMCID: PMC10881848 DOI: 10.1016/j.heliyon.2024.e25925] [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: 08/08/2023] [Revised: 12/28/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
Background Early identification of postoperative ischemic stroke among patients with acute DeBakey type I aortic dissection (ADIAD) is of great significance to taking timely effective treatment. We aimed to develop and validate a prediction model for postoperative ischemic stroke in ADIAD patients who underwent total arch replacement (TAR) and frozen elephant trunk (FET) under mild hypothermia. Methods ADIAD patients who underwent TAR and FET between January 2017 and April 2023 were enrolled in our study. Preoperative and intraoperative variables were selected using pairwise comparisons, the Least Absolute Shrinkage and Selection Operator (LASSO), and logistic regression to construct a prediction model for postoperative ischemic stroke. The accuracy and calibration of the model were assessed using 1000 bootstrap resamples for internal validation, with the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow test. The AUC was also used to evaluate the model's accuracy in the validation cohort. Results The development cohort included 246 patients. The mean [standard deviation (SD)] age of patients in the cohort was 50.7 (11.2) years, 196 (79.7%) were men, and 22 (8.9%) were diagnosed with postoperative ischemic stroke. The validation cohort included 73 patients with a mean (SD) age of 52.5 (11.9) years, 58 (79.5%) were men and 3 (4.1%) were diagnosed with postoperative ischemic stroke. Three variables out of the initial 40 potential predictors were included in the final prediction model: the platelet count [odd ratio (OR), 0.992; 95% confidence interval (CI), 0.983-1.000], the presence of innominate artery dissection (OR, 3.400; 95% CI, 1.027-11.260), and the flow of selective cerebral perfusion (OR, 0.147; 95% CI, 0.046-0.469). The mean AUC in the development cohort was 0.77 (95% CI, 0.68-0.87), and calibration was checked with the Hosmer-Lemeshow test (P = 0.78). In the validation cohort, the AUC was 0.98 (95% CI, 0.94-1.00). A prediction model and a clinical impact curve were developed for practical purposes. Conclusions In this study, we have developed a prediction model with competent discriminative ability and calibration. This model can be used for early assessment of the risk of postoperative ischemic stroke in patients with ADIAD following TAR and FET under mild hypothermia.
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Affiliation(s)
- Chao Deng
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Hao Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Jingyu Li
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Zhenxiong Li
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Kangjun Shen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Zhiwei Zhang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Bo Jiang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Ling Tan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
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Zhao H, Li C, Duan W, Wei D, Xue R, Wei M, Chang Y, Shang L, Lin S, Xu J, Zheng M. Neurological prognosis in surgically treated acute aortic dissection with brain computed tomography perfusion. Eur J Cardiothorac Surg 2024; 65:ezad437. [PMID: 38175783 DOI: 10.1093/ejcts/ezad437] [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: 09/02/2023] [Revised: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES The aim of this study was to explore the prognostic value of brain computed tomography perfusion (CTP) for postoperative new stroke in acute type A aortic dissection (ATAAD) patients. METHODS Patients with ATAAD and suspected cerebral malperfusion who underwent brain CTP and surgical repair were retrospectively analysed. Brain perfusion was quantified mainly with the averaged cerebral blood flow. Significant clinical and imaging findings were identified through univariable and multivariable regression analysis. Furthermore, the added prognostic benefit of perfusion parameters was confirmed with the receiver operating characteristic curves in the entire cohort and subgroup analysis. RESULTS The incidence of postoperative new stroke was 30.8% (44/143). The independent adjusted predictors of postoperative new stroke included an impaired averaged cerebral blood flow (ml/100 ml/min) (odds ratio: 0.889; P < 0.001), severe stenosis (odds ratio: 5.218; P = 0.011) or occlusion (odds ratio: 14.697; P = 0.048) of the true lumen in common carotid artery (CCA), hypotension on admission (odds ratio: 9.644; P = 0.016) and a longer surgery time (odds ratio: 1.593; P = 0.021). The area under the receiver operating characteristic curves significantly improved after adding perfusion parameters to clinical and computed tomography angiography characteristics (P = 0.048). This benefit was more pronounced in patients with severe stenosis or occlusion in CCA true lumen (P = 0.004). CONCLUSIONS Brain CTP could be a useful prognostic tool for surgically treated ATAAD patients and especially beneficial in patients with severe stenosis or occlusion of the CCA true lumen.
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Affiliation(s)
- Hongliang Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chengxiang Li
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Weixun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military University, Xi'an, China
| | - Dong Wei
- Department of Neurology, Xijing Hospital, Fourth Military University, Xi'an, China
| | - Ruijia Xue
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Mengqi Wei
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yingjuan Chang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lei Shang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, China
| | - Shushen Lin
- Department of Computed Tomography, Siemens Healthineers Ltd, Shanghai, China
| | - Jian Xu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Zhao H, Li C, Jin Z, Duan W, Shang L, Chang Y, Xu J, Ren J, Lin S, Wang Y, Zhu L, Wang G, Chen X, He C, Zheng M. Risk prediction of preoperative acute ischemic stroke in acute type A aortic dissection. Eur Radiol 2023; 33:7250-7259. [PMID: 37178204 DOI: 10.1007/s00330-023-09691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/17/2023] [Accepted: 03/09/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To predict preoperative acute ischemic stroke (AIS) in acute type A aortic dissection (ATAAD). METHODS In this multi-center retrospective study, 508 consecutive patients diagnosed as ATAAD between April 2020 and March 2021 were considered for inclusion. The patients were divided into a development cohort and two validation cohorts based on time periods and centers. Clinical data and imaging findings obtained were analyzed. Univariable and multivariable logistic regression analyses were performed to identify predictors associated with preoperative AIS. The performance of resulting nomogram was evaluated in discrimination and calibration on all cohorts. RESULTS A total of 224 patients were in the development cohort, 94 in the temporal validation cohort, and 118 in the geographical validation cohort. Six predictors were identified: age, syncope, D-dimer, moderate to severe aortic valve insufficiency, diameter ratio of true lumen in ascending aorta < 0.33, and common carotid artery dissection. The nomogram established showed good discrimination (area under the receiver operating characteristic curve [AUC], 0.803; 95% CI: 0.742, 0.864) and calibration (Hosmer-Lemeshow test p = 0.300) in the development cohort. External validation showed good discrimination and calibration abilities in both temporal (AUC, 0.778; 95% CI: 0.671, 0.885; Hosmer-Lemeshow test p = 0.161) and geographical cohort (AUC, 0.806; 95% CI: 0.717, 0.895; Hosmer-Lemeshow test p = 0.100). CONCLUSIONS A nomogram, based on simple imaging and clinical variables collected on admission, showed good discrimination and calibration abilities in predicting preoperative AIS for ATAAD patients. KEY POINTS • A nomogram based on simple imaging and clinical findings may predict preoperative acute ischemic stroke in patients with acute type A aortic dissection in emergencies. • The nomogram showed good discrimination and calibration abilities in validation cohorts.
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Affiliation(s)
- Hongliang Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, China
| | - Chengxiang Li
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, China
| | - Zhenxiao Jin
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military University, 127 Changle West Road, Xi'an, China.
| | - Weixun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military University, 127 Changle West Road, Xi'an, China
| | - Lei Shang
- Department of Health Statistics, Fourth Military Medical University, 127 Changle West Road, Xi'an, China
| | - Yingjuan Chang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, China
| | - Jingji Xu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, China
| | - Jialiang Ren
- GE Healthcare China, 2 Yongchang North Road, Beijing, China
| | - Shushen Lin
- Siemens Healthineers Ltd., 278 Zhou Zhugong Road, Shanghai, China
| | - Yan Wang
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Urumqi, China
| | - Li Zhu
- Department of Radiology, General Hospital of Ningxia Medical University, 804 Shengli Road, Yinchuan, China
| | - Gang Wang
- Department of Radiology, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, China
| | - Xin Chen
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, China
| | - Chao He
- Department of Radiology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, 5 Weiyang West Road, Xianyang, China
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, China.
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Sun J, Xue C, Zhang J, Yang C, Ren K, Zhu H, Zhang B, Li X, Zhao H, Jin Z, Liu J, Duan W. Extra-anatomic revascularization and a new cannulation strategy for preoperative cerebral malperfusion due to severe stenosis or occlusion of supra-aortic branch vessels in acute type A aortic dissection. Heliyon 2023; 9:e18251. [PMID: 37539273 PMCID: PMC10395476 DOI: 10.1016/j.heliyon.2023.e18251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/05/2023] Open
Abstract
Objectives Acute type A aortic dissection (ATAAD) with severe stenosis or occlusion of the true lumen of aortic arch branch vessels often leads to an increased incidence of severe postsurgical neurological complications and mortality rate. In this study, we aimed to introduce our institutional extra-anatomic revascularization and cannulation strategy with improved postoperative outcomes for better management of patients with cerebral malperfusion in the setting of ATAAD. Methods Twenty-eight patients with ATAAD complicated by severe stenosis or occlusion of the aortic arch branch vessels, as noted on combined computed tomography angiography of the aorta and craniocervical artery, between January 2021 and June 2022 were included in this study. Basic patient characteristics, surgical procedures, hospitalization stays, and early follow-up results were analyzed. Results The median follow-up duration was 16.5 months (interquartile range: 11.5-20.5), with a 100% completion rate. The 30-day mortality rates was 7.1% (2/28 patients); two patients had multiple cerebral infarctions on preoperative computed tomography and persistent coma. Postoperative transient neurological dysfunction occurred in 10.7% (3/28) of the patients, and no new permanent neurological dysfunction occurred. Of all the patients, 3.6% (1/28) had novel acute renal failure. No other deaths, secondary surgeries, or serious complications occurred during the early follow-up period. Conclusions Use of extra-anatomic revascularization and a new cannulation strategy before cardiopulmonary bypass is safe and feasible and may reduce the high incidence of postoperative neurological complications in patients with ATAAD and cerebral malperfusion.
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Affiliation(s)
- Jingwei Sun
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Chao Xue
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Jinglong Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Chen Yang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Kai Ren
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Hanzhao Zhu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Bin Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Xiayun Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Hongliang Zhao
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Zhenxiao Jin
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Jincheng Liu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Weixun Duan
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
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Christodoulou KC, Karangelis D, Efenti GM, Sdrevanos P, Browning JR, Konstantinou F, Georgakarakos E, Mitropoulos FA, Mikroulis D. Current knowledge and contemporary management of non-A non-B aortic dissections. World J Cardiol 2023; 15:244-252. [PMID: 37274377 PMCID: PMC10237007 DOI: 10.4330/wjc.v15.i5.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/10/2023] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
Non-A non-B aortic dissection (AAD) is an infrequently documented condition, comprising of only a small proportion of all AADs. The unique anatomy of the aortic arch and the failure of the existing classifications to adequately define individuals with non-A non-B AAD, have led to an ongoing controversy around the topic. It seems that the clinical progression of acute non-A non-B AAD diverges from the typical type A and B dissections, frequently leading to serious complications and thus mandating early intervention. Currently, the available treatment methods in the surgical armamentarium are conventional open, endovascular techniques and combined hybrid methods. The optimum approach is tailored in every individual case and may be determined by the dissection’s location, extent, the aortic diameter, the associated complications and the patient’s status. The management of non-A non-B dissections still remains challenging and a unanimous consensus defining the gold standard treatment has yet to be reached. In an attempt to provide further insight into this perplexing entity, we performed a minireview of the literature, aiming to elucidate the epidemiology, clinical course and the optimal treatment modality.
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Affiliation(s)
- Konstantinos C Christodoulou
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Dimos Karangelis
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | | | | | - Jennifer R Browning
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Fotis Konstantinou
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | | | - Dimitrios Mikroulis
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
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Stenting in Brain Hemodynamic Injury of Carotid Origin Caused by Type A Aortic Dissection: Local Experience and Systematic Literature Review. J Pers Med 2022; 13:jpm13010058. [PMID: 36675719 PMCID: PMC9861720 DOI: 10.3390/jpm13010058] [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: 12/09/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
In this study, we report our local experience of type A aortic dissections in patients with cerebral malperfusion treated with carotid stenting before or after aortic surgery, and present a systematic literature review on these patients treated either with carotid stenting (CS) before or after aortic surgery (AS) or with aortic and carotid surgery alone (ACS). We report on patients treated in our center with carotid stenting for brain hemodynamic injury of carotid origin caused by type A dissection since 2018, and a systematic review was conducted in PubMed for articles published from 1990 to 2021. Out of 5307 articles, 19 articles could be included with a total of 80 patients analyzed: 9 from our center, 29 patients from case reports, and 51 patients from two retrospective cohorts. In total, 8 patients were treated by stenting first, 72 by surgery first, and 7 by stenting after surgery. The mean age; initial NIHSS score; time from symptom onset to treatment; post-treatment clinical improvement; post-treatment clinical worsening; mortality rate; follow-up duration; and follow-up mRS were, respectively, for each group (local cohort, CS before AS, ACS, CS after AS): 71.2 ± 5.3 yo, 65.5 ± 11.0 yo; 65.3 ± 13.1 yo, 68.7 ± 5.8 yo; 4 ± 8.4, 11.3 ± 8.5, 14.3 ± 8.0, 0; 11.8 ± 14.3 h, 21 ± 39.3 h, 13.6 ± 17.8 h, 13 ± 17.2 h; 56%, 71%, 86%, 57%; 11%, 28%, 0%, 14%; 25%, 12.3%, 14%, 33%; 5.25 ± 2.9 months, 54 months, 6.8 ± 3.8 months, 14 ± 14.4 months; 1 ± 1; 0.25 ± 0.5, 1.3 ± 0.8, 0.68 ± 0.6. Preoperative carotid stenting for hemodynamic cerebral malperfusion by true lumen compression appears to be feasible, and could be effective and safe, although there is still a lack of evidence due to the absence of comparative statistical analysis. The literature, albeit growing, is still limited, and prospective comparative studies are needed.
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10
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Inoue T, Omura A, Chomei S, Nakai H, Yamanaka K, Inoue T, Okada K. Early and late outcomes of type A acute aortic dissection with common carotid artery involvement. JTCVS OPEN 2022; 10:1-11. [PMID: 36004235 PMCID: PMC9390160 DOI: 10.1016/j.xjon.2022.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022]
Abstract
Objective The relationship between common carotid artery (CCA) involvement in acute type A aortic dissection (ATAAD) and postoperative outcomes remains unclear. We investigated outcomes and described our current advanced strategy. Methods Of 492 patients who underwent surgical repair for ATAAD between September 1999 and February 2021, CCA involvement was identified in 114. Eighty of these 114 patients (70.2%) were classified as having a thrombosed CCA and 34 (29.8%) were classified as nonthrombosed. To prevent postoperative cerebral malperfusion, we initiated a strategy of early reperfusion and direct reconstruction of dissected and thrombosed CCAs regardless of neurologic symptoms. Results Fifty-five patients (48.2%) showed preoperative neurologic symptoms. No significant differences between the thrombosed and nonthrombosed groups were seen in postoperative mortality (20.0% vs 11.8%; P = .421) or frequency of postoperative modified Rankin scale (mRS) score ≥5 (30.0% vs 17.6%; P = .245). The rate of postoperative neurologic deficit was significantly higher (48.8% vs 23.5%; P = .013) and long-term survival rate was significantly lower (5 years; 59.1 ± 6.3% vs 77.9 ± 7.4%; 10 years: 50.0 ± 7.9% vs 72.3 ± 8.7%; P = .041) in the thrombosed group. Risk factors for mRS ≥5 from multivariable analysis included occluded thrombosed CCA, preoperative coma, preoperative shock, and prolonged operation time. Fifteen patients were treated with the early reperfusion and direct reconstruction strategy; postoperative mortality 13.3% (2 patients). No patients showed cerebral reperfusion syndrome. Conclusions In patients with CCA involvement, a thrombosed false lumen, especially an occluded CCA, resulted in worse outcomes regardless of preoperative neurologic symptoms. Further study is needed to evaluate the efficacy of the current strategy.
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WANG J, XIE J, MENG X, GONG X. Comparison of CT and MRI in imaging diagnosis of aortic dissection. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.23621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Junmin XIE
- Affiliated Hospital of Hebei University, China
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12
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Zhao H, Xu Z, Zhu Y, Xue R, Wang J, Ren J, Wang W, Duan W, Zheng M. The Construction of a Risk Prediction Model Based on Neural Network for Pre-operative Acute Ischemic Stroke in Acute Type A Aortic Dissection Patients. Front Neurol 2021; 12:792678. [PMID: 35002934 PMCID: PMC8734591 DOI: 10.3389/fneur.2021.792678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: To establish a pre-operative acute ischemic stroke risk (AIS) prediction model using the deep neural network in patients with acute type A aortic dissection (ATAAD). Methods: Between January 2015 and February 2019, 300 ATAAD patients diagnosed by aorta CTA were analyzed retrospectively. Patients were divided into two groups according to the presence or absence of pre-operative AIS. Pre-operative AIS risk prediction models based on different machine learning algorithm was established with clinical, transthoracic echocardiography (TTE) and CTA imaging characteristics as input. The performance of the difference models was evaluated using the receiver operating characteristic (ROC), precision-recall curve (PRC) and decision curve analysis (DCA). Results: Pre-operative AIS was detected in 86 of 300 patients with ATAAD (28.7%). The cohort was split into a training (211, 70% patients) and validation cohort (89, 30% patients) according to stratified sampling strategy. The constructed deep neural network model had the best performance on the discrimination of AIS group compare with other machine learning model, with an accuracy of 0.934 (95% CI: 0.891-0.963), 0.921 (95% CI: 0.845-0.968), sensitivity of 0.934, 0.960, specificity of 0.933, 0.906, and AUC of 0.982 (95% CI: 0.967-0.997), 0.964 (95% CI: 0.932-0.997) in the training and validation cohort, respectively. Conclusion: The established risk prediction model based on the deep neural network method may have the big potential to evaluate the risk of pre-operative AIS in patients with ATAAD.
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Affiliation(s)
- Hongliang Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ziliang Xu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yuanqiang Zhu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ruijia Xue
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jing Wang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | | | | | - Weixun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Luo C, Qi R, Zhong Y, Chen S, Liu H, Guo R, Ge Y, Sun L, Zhu J. Early and Long-Term Follow-Up for Chronic Type B and Type Non-A Non-B Aortic Dissection Using the Frozen Elephant Trunk Technique. Front Cardiovasc Med 2021; 8:714638. [PMID: 34595221 PMCID: PMC8476759 DOI: 10.3389/fcvm.2021.714638] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background: This study aimed to evaluate the early and long-term outcomes of a single center using a frozen elephant trunk (FET) procedure for chronic type B or non-A non-B aortic dissection. Methods: From February 2009 to December 2019, 79 patients diagnosed with chronic type B or non-A non-B aortic dissection who underwent the FET procedure were included in the present study. We analyzed operation mortality and early and long-term outcomes, including complications, survival and interventions. Results: The operation mortality rate was 5.1% (4/79). Spinal cord injury occurred in 3.8% (3/79), stroke in 2.5% (2/79), and acute renal failure in 5.1% (4/79). The median follow-up time was 53 months. The overall survival rates were 96.2, 92.3, 88.0, 79.8, and 76.2% at 1/2, 1, 3, 5 and 7 years, respectively. Moreover, 79.3% of patients did not require distal aortic reintervention at 7 years. The overall survival in the subacute group was superior to that in the chronic group (P = 0.047). Conclusion: The FET technique is a safe and feasible approach for treating chronic type B and non-A non-B aortic dissection in patients who have contraindications for primary endovascular aortic repair. The technique combines the advantages of both open surgical repair and endovascular intervention, providing comparable early and long-term follow-up outcomes and freedom from reintervention.
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Affiliation(s)
- Congcong Luo
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruidong Qi
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongliang Zhong
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Suwei Chen
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hao Liu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rutao Guo
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yipeng Ge
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lizhong Sun
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Cho T, Uchida K, Kasama K, Machida D, Minami T, Yasuda S, Matsuki Y, Suzuki S, Masuda M. Brachiocephalic artery dissection is a marker of stroke after acute type A aortic dissection repair. J Card Surg 2021; 36:902-908. [PMID: 33442891 DOI: 10.1111/jocs.15322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Postoperative stroke is a serious unsolved complication after acute type A aortic dissection (ATAAD) repair. We investigated the incidence and risk factors of stroke, and hypothesized that dissection of supra-aortic vessels is an important risk factor of this morbidity. METHODS Between 2012 and 2019, 202 (56% men, median age 68 years) patients with ATAAD underwent surgical repair. Clinical data, image findings, method of circulatory support, and repair technique were retrospectively investigated to explore the risk factor of postoperative stroke. RESULTS Of the 202 patients, operative mortality was 6% and the incidence of postoperative stroke was 12% (n = 25). Brachiocephalic artery (BCA) dissection was associated with a higher risk of stroke (odds ratio, 3.89; 95% confidence interval, 1.104-13.780; p = .035) having no relation to the presence or absence of left common carotid artery dissection. Preoperative malperfusion syndrome, circulatory arrest time, isolated cerebral perfusion time, repair technique (total arch replacement), and femoral artery perfusion alone were not related to the incident rate of postoperative stroke. Stroke occurred in both hemispheres, regardless of the laterality of carotid artery dissection. CONCLUSION BCA dissection was an independent risk factor of stroke after ATAAD repair.
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Affiliation(s)
- Tomoki Cho
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Keiji Uchida
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Keiichiro Kasama
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Daisuke Machida
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tomoyuki Minami
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shota Yasuda
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Shinichi Suzuki
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
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15
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Total arch replacement and frozen elephant trunk for acute type A aortic dissection. J Thorac Cardiovasc Surg 2020; 164:1400-1409.e3. [PMID: 33341270 DOI: 10.1016/j.jtcvs.2020.10.135] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The present study aimed to evaluate the outcomes of total aortic arch replacement with proximalization of distal anastomosis using the frozen elephant trunk technique with the J Graft FROZENIX (Japan Lifeline, Tokyo, Japan) and Gelweave Lupiae (Vascutek Terumo Inc, Scotland, United Kingdom) graft (distal anastomosis performed in zones 1 and 2) in patients with acute Stanford type A acute aortic dissection. METHODS A total of 50 patients underwent total aortic arch replacement using the frozen elephant trunk technique, deploying the J Graft FROZENIX into zone 1 or 2 (zone 1: n = 17, zone 2: n = 33) in combination with the Gelweave Lupiae graft for acute Stanford type A acute aortic dissection. Patient characteristics, intraoperative data, and early and midterm outcomes were analyzed. RESULTS The overall in-hospital mortality rate was 4% (2 patients). The in-hospital mortality rate in patients with visceral malperfusion was 11% (1/9). There were no patients with paraplegia and stent graft-induced new entry. Resection or closure of the most proximal entry tear was achieved in 100% of 42 patients who had postoperative computed tomography. The overall survival was 87.9%, 84.1%, and 84.1% at 1, 2, and 3 years, respectively. However, 1 patient required endovascular extension for the dilatation of the descending thoracic aorta 4 months after the initial surgery. CONCLUSIONS Total aortic arch replacement with the frozen elephant trunk technique (zone 1-2) and Gelweave Lupiae graft was safe and effective in simplifying surgery for acute Stanford type A acute aortic dissection.
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Giambuzzi I, Mastroiacovo G, Roberto M, Pirola S, Alamanni F, Cavallotti L, Bonalumi G. Preoperative neurological dysfunctions: what is their meaning in patients presenting with acute type A aortic dissection? Minerva Cardioangiol 2020; 68:511-517. [PMID: 32524808 DOI: 10.23736/s0026-4725.20.05230-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Type A aortic dissection (AAD) is a life-threatening disease with very high mortality. The gold standard treatment is surgical, as medical treatment has been proven to be ineffective. It is still unclear the role of preoperative neurological dysfunction in the prognosis of the patient. Therefore, the choice of performing surgery in patients with neurological symptoms is still left to the surgeon at the time of the diagnosis. The aim of this study is to make a narrative review of the current literature about the management of patients with neurological symptoms in AAD patients. EVIDENCE ACQUISITION A bibliographical research was performed on PubMed, looking for papers containing the words: "((preoperative neurological symptoms in type a aortic dissection) OR brain injury type A aortic dissection) AND ("2010"[Date - Publication]: "3000"[Date - Publication])". A total of 35 papers were found. EVIDENCE SYNTHESIS A total of 6 papers were chosen to be reviewed. All of them concluded that even patients with severe neurological symptoms (up to comatose state) had a good chance to recover neurological functions after surgery if treated in the first hours from the onset of symptoms. Interestingly, a hemorrhagic stroke was rarely found. CONCLUSIONS Preoperative neurological dysfunction have been long considered a contraindication to surgery. Nevertheless, several authors show neurological and survival good results in patients with preoperative neurological dysfunction. They also stress the importance of surgical timing finding in 5 to 10 hours the surgical time limit to improve neurological dysfunction. A preoperative neurological dysfunction could be considered a strong advice towards surgical intervention. It is time to change and consider prompt surgery not only for survival but also for cerebral protection.
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Affiliation(s)
- Ilaria Giambuzzi
- Unit of Heart Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy -
| | | | - Maurizio Roberto
- Unit of Heart Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Sergio Pirola
- Unit of Heart Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | | | - Laura Cavallotti
- Unit of Heart Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Giorgia Bonalumi
- Unit of Heart Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
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