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Salem M, Salib M, Friedrich C, Salem M, Puehler T, Schoettler J, Schoeneich F, Cremer J, Haneya A. Influence of Age on Postoperative Neurological Outcomes after Surgery of Acute Type A Aortic Dissection. J Clin Med 2021; 10:jcm10081643. [PMID: 33921536 PMCID: PMC8068896 DOI: 10.3390/jcm10081643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acute type A aortic dissection (AAAD) is considered a fatal disease which requires an emergent surgical intervention. This study focuses onthe neurological outcome after surgical repair in cases of AAAD in comparison between elderly and young patients. METHODS a retrospective analysis of 368 consecutive patients who underwent emergency surgery of ascending aorta in moderate hypothermic circulatory arrest (MHCA) (20-24 °C) and antegrade cerebral perfusion after AAAD between 2001 and 2016. Patients were divided into two groups: those aged 75 years and older (68 (18.5%)) and those younger than 75 years (300 (81.5%)). RESULTS Comparing both groups, average age was 79.0 ± 3.2 vs. 59.2 ± 10.7 years (p < 0.001); female gender represents 58.8% of elderly patients vs. 28.7% in younger patients (p < 0.001). Intraoperatively, cardiopulmonary bypass time (155 min (131; 187) vs. 171 min (137; 220); p = 0.012), cross-clamping time (79 min (60; 105) vs. 93 min (71; 134); p = 0.001] and circulatory arrest time (29 min (22; 40) vs. 33 min (26; 49); p = 0.011) were significantly shorter in elderly than younger group. Postoperatively, there was no significant difference in delirium (11.8% vs. 20.5%; p = 0.0968) or stroke (11.8% vs. 16.1%; p = 0.369). The 30-day mortality was satisfactory for both groups but significantly higher in the elderly group (27.9% vs. 14.3%; p = 0.007). CONCLUSION The current study concluded that surgical treatment of AAAD in elderly patients can be applied safely without increasing risk of neurological complication. However, minimizing operation time may help limit the occurrence of postoperative neurological complication.
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Affiliation(s)
- Mohamed Salem
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
- Correspondence: ; Tel.: +49-431500-67089
| | - Michael Salib
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Christine Friedrich
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Mostafa Salem
- Department of Cardiology and Angiology, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany;
| | - Thomas Puehler
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Jan Schoettler
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Felix Schoeneich
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Jochen Cremer
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Assad Haneya
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
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Salem M, Friedrich C, Thiem A, Huenges K, Puehler T, Cremer J, Haneya A. Risk Factors for Mortality in Acute Aortic Dissection Type A: A Centre Experience Over 15 Years. Thorac Cardiovasc Surg 2020; 69:322-328. [PMID: 32559807 DOI: 10.1055/s-0040-1710002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Acute aortic dissection Type A (AADA) is still associated with a high mortality rate and frequent postoperative complications. This study was designed to evaluate the risk factors for mortality in AADA patients. PATIENTS AND METHODS This retrospective analysis included 344 consecutive patients who underwent surgery for AADA in moderate hypothermic circulatory arrest (20-24°C nasopharyngeal) between 2001 and 2016. RESULTS The 30-day mortality rate was 18%. Nonsurvivors were significantly older (65.7 ± 12.0 years vs. 62.0 ± 12.5 years; p = 0.034) with significantly higher Euro-score II [15.4% (6.6; 23.0) vs. 4.63% (2.78; 9.88); p < 0.001)]. Intraoperatively, survivors had statistically shorter cardiopulmonary bypass times [163 (134; 206) vs. 198 min (150; 245); p = 0.001]. However, the hypothermic circulatory arrest time was similar between both groups. Postoperatively, the incidence of acute kidney injury (AKI) (55.9 vs. 15.2%; p < 0.001), stroke (27.9 vs. 12.1%; p = 0.002) and sepsis (18.0 vs. 2.1%; p < 0.001) were significantly higher among nonsurvivors. The multi-variable logistic regression confirmed that older age, previous cardiac surgery, preoperative cardiopulmonary resuscitation (CPR), blood transfusion and postoperative acute kidney injury (AKI) were independent risk factors for mortality. CONCLUSION Our analysis suggested that the reason for mortality was multifactorial, especially age, previous cardiac surgery, CPR, transfusion, as well as postoperative AKI were considered risk factors for mortality.
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Affiliation(s)
- Mohamed Salem
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Christine Friedrich
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Alexander Thiem
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Katharina Huenges
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Thomas Puehler
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
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Bruno VD, Chivasso P, Guida G, Vohra HA. Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis. Ann Cardiothorac Surg 2016; 5:257-64. [PMID: 27563539 DOI: 10.21037/acs.2016.06.03] [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
BACKGROUND The results of surgical treatment of type A aortic dissection (AAD) in the elderly are controversial and aggravated by a higher operative mortality rate. The studies published in this subset of patients are mainly retrospective analyses or small samples from international registries. We sought to investigate this topic by conducting a contemporary meta-analysis of the most recent observational studies. METHODS A systematic literature search was conducted for any study published in the last five years on aortic dissection treated surgically in patients 70 years and older. A pooled risk-ratio meta-analysis has been conducted three main post-operative outcomes: short-term mortality, stroke and acute kidney injury. RESULTS A total of 11 retrospective observational studies have been included in the quantitative meta-analysis. Pooled meta-analysis showed an increased risk of short term mortality for the elderly population [relative risk (RR) =2.25; 95% CI, 1.79-2.83; I (2)=0%; P<0.0001], and this has been confirmed in a sub-analysis of patients 80 years and older. The risk of having stroke (RR =1.15; 95% CI, 0.89-1.5; I (2)=0%; P=0.28) and acute kidney injury (RR =0.79; 95% CI, 0.5-1.25, I (2)=14%, P=0.31) after surgery were comparable to the younger cohort of patients. CONCLUSIONS Although affected by an increased risk of short-term mortality in the elderly, surgical repair remains the treatment of choice for AAD. The main post-operative outcomes are comparable to younger patients and the mid-term survival rates are acceptable.
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Affiliation(s)
- Vito D Bruno
- Cardiac Surgery Department, Bristol Heart Institute, Bristol, UK
| | | | - Gustavo Guida
- Cardiac Surgery Department, Bristol Heart Institute, Bristol, UK
| | - Hunaid A Vohra
- Cardiac Surgery Department, Bristol Heart Institute, Bristol, UK
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Rahimi-Barfeh A, Grothusen C, Haneya A, Schöttler J, Eide AM, Erdmann M, Friedrich C, Hoffmann G, Cremer J, Schoeneich F. Transatrial Cannulation of the Left Ventricle for Acute Type A Aortic Dissection: A 5-Year Experience. Ann Thorac Surg 2016; 101:1753-8. [PMID: 26794889 DOI: 10.1016/j.athoracsur.2015.10.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 09/30/2015] [Accepted: 10/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute type A aortic dissection (AAD) is a life-threatening disorder with a high rate of mortality and complications. All cannulation techniques currently used to establish arterial flow for cardiopulmonary bypass are associated with a considerable risk of organ malperfusion, stroke, or access site trauma. Here, we report the impact of transatrial cannulation of the left ventricle on patient outcome after surgical treatment of AAD. METHODS Between 2010 and 2013, 46 patients underwent emergency surgery for AAD using transatrial cannulation of the left ventricle. Their outcome was retrospectively compared with that of 73 age- and sex-matched patients operated on for AAD between 2006 and 2010 before introduction of the new technique. RESULTS No differences concerning preoperative details were found. Arterial flow before 2010 was established after preparation of the femoral artery in 46 patients (63.0%) or by direct cannulation of the ascending aorta in 27 patients (37.0%). Operation times were significantly lower in the transatrial cannulation group (271.2 ± 75.4 versus 308.3 ± 78.2; p = 0.02). Postoperatively, we observed a significantly reduced stroke rate in the group with transatrial cannulation (6.5% versus 26.5%; p = 0.007) and a decreased rate of acute renal failure (20.0% versus 32.4%; p = 0.003). Intraoperative mortality (0% versus 6.8%; p = 0.16), 30-day mortality (8.9% versus 10.3%; p = 1.00), and mortality during follow-up (9.8% versus 34.4%; p = 0.08) did not differ. However, overall mortality was significantly lower in the group after transatrial cannulation (17.7% versus 45.2%; p = 0.003). CONCLUSIONS In patients undergoing surgery for AAD, transatrial cannulation of the left ventricle proved to be a safe and easy cannulation method that significantly reduced postoperative complications.
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Affiliation(s)
- Azizolah Rahimi-Barfeh
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christina Grothusen
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan Schöttler
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Arne M Eide
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Maria Erdmann
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christine Friedrich
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Grischa Hoffmann
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Felix Schoeneich
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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