1
|
Biancari F, Onorati F, Peterss S, Buech J, Mariscalco G, Lega JR, Pinto AG, Fiore A, Perrotti A, Hérve A, Rukosujew A, Demal T, Conradi L, Wisniewski K, Pol M, Kacer P, Gatti G, Mazzaro E, Vendramin I, Piani D, Rinaldi M, Ferrante L, Pruna-Guillen R, Di Perna D, Gerelli S, El-Dean Z, Nappi F, Field M, Kuduvalli M, Pettinari M, Francica A, Jormalainen M, Dell'Aquila AM, Mäkikallio T, Juvonen T, Quintana E. Nature of Neurological Complications and Outcome After Surgery for Type A Aortic Dissection. Am J Cardiol 2024; 219:85-91. [PMID: 38458584 DOI: 10.1016/j.amjcard.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/18/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
Surgery for type A aortic dissection (TAAD) is frequently complicated by neurologic complications. The prognostic impact of neurologic complications of different nature has been investigated in this study. The subjects of this analysis were 3,902 patients who underwent surgery for acute TAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD). During the index hospitalization, 722 patients (18.5%) experienced stroke/global brain ischemia. Ischemic stroke was detected in 539 patients (13.8%), hemorrhagic stroke in 76 patients (1.9%) and global brain ischemia in 177 patients (4.5%), with a few patients having had findings of more than 1 of these conditions. In-hospital mortality was increased significantly in patients with postoperative ischemic stroke (25.6%, adjusted odds ratio [OR] 2.422, 95% confidence interval [CI] 1.825 to 3.216), hemorrhagic stroke (48.7%, adjusted OR 4.641, 95% CI 2.524 to 8.533), and global brain ischemia (74.0%, adjusted OR 22.275, 95% CI 14.537 to 35.524) compared with patients without neurologic complications (13.5%). Similarly, patients who experienced ischemic stroke (46.3%, adjusted hazard ratio [HR] 1.719, 95% CI 1.434 to 2.059), hemorrhagic stroke (62.8%, adjusted HR 3.236, 95% CI 2.314 to 4.525), and global brain ischemia (83.9%, adjusted HR 12.777, 95% CI 10.325 to 15.810) had significantly higher 5-year mortality than patients without postoperative neurologic complications (27.5%). The negative prognostic effect of neurologic complications on survival vanished about 1 year after surgery. In conclusion, postoperative ischemic stroke, hemorrhagic stroke, and global cerebral ischemia increased early and midterm mortality after surgery for acute TAAD. The magnitude of risk of mortality increased with the severity of the neurologic complications, with postoperative hemorrhagic stroke and global brain ischemia being highly lethal complications.
Collapse
Affiliation(s)
- Fausto Biancari
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland; Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Sven Peterss
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Joscha Buech
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom
| | - Javier Rodriguez Lega
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Angel G Pinto
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Amelié Hérve
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Andreas Rukosujew
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Marek Pol
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Igor Vendramin
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Luisa Ferrante
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Spain
| | - Dario Di Perna
- Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Sebastien Gerelli
- Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Zein El-Dean
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matteo Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Alessandra Francica
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Angelo M Dell'Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany; Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Spain
| |
Collapse
|
2
|
Juvonen T, Vendramin I, Mariscalco G, Jormalainen M, Perrotti A, Hervé A, Mazzaro E, Gatti G, Pettinari M, Peterss S, Buech J, Nappi F, Pinto AG, Rodriguez Lega J, Pol M, Rocek J, Kacer P, Rukosujew A, Wisniewski K, Piani D, Demal T, Conradi L, Ferrante L, Rinaldi M, Quintana E, Pruna-Guillen R, Gerelli S, Di Perna D, Fiore A, Folliguet T, Acharya M, El-Dean Z, Field M, Kuduvalli M, Onorati F, Francica A, Mäkikallio T, Dell'Aquila AM, Mustonen C, Raivio P, Rosato S, Biancari F. Femoral arterial cannulation for surgical repair of stanford type A aortic dissection. World J Surg 2024. [PMID: 38686961 DOI: 10.1002/wjs.12203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/21/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The benefits and harms associated with femoral artery cannulation over other sites of arterial cannulation for surgical repair of acute Stanford type A aortic dissection (TAAD) are not conclusively established. METHODS We evaluated the outcomes after surgery for TAAD using femoral artery cannulation, supra-aortic arterial cannulation (i.e., innominate/subclavian/axillary artery cannulation), and direct aortic cannulation. RESULTS 3751 (96.1%) patients were eligible for this analysis. In-hospital mortality using supra-aortic arterial cannulation was comparable to femoral artery cannulation (17.8% vs. 18.4%; adjusted OR 0.846, 95% CI 0.799-1.202). This finding was confirmed in 1028 propensity score-matched pairs of patients with supra-aortic arterial cannulation or femoral artery cannulation (17.5% vs. 17.0%, p = 0.770). In-hospital mortality after direct aortic cannulation was lower compared to femoral artery cannulation (14.0% vs. 18.4%, adjusted OR 0.703, 95% CI 0.529-0.934). Among 583 propensity score-matched pairs of patients, direct aortic cannulation was associated with lower rates of in-hospital mortality (13.4% vs. 19.6%, p = 0.004) compared to femoral artery cannulation. Switching of the primary site of arterial cannulation was associated with increased rate of in-hospital mortality (36.5% vs. 17.0%; adjusted OR 2.730, 95% CI 1.564-4.765). Ten-year mortality was similar in the study cohorts. CONCLUSIONS In this study, the outcomes of surgery for TAAD using femoral arterial cannulation were comparable to those using supra-aortic arterial cannulation. However, femoral arterial cannulation was associated with higher in-hospital mortality than direct aortic cannulation. TRIAL REGISTRATION ClinicalTrials.gov registration code: NCT04831073.
Collapse
Affiliation(s)
- Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Igor Vendramin
- Cardiothoracic Department, Udine University Hospital, Udine, Italy
| | | | - Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Amélie Hervé
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Matteo Pettinari
- Chirurgie Cardio-thoraco Vasculaire, Cliniques Universitaire Saint-Luc, Brussel, Belgium
| | - Sven Peterss
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Joscha Buech
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
- German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Angel G Pinto
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Javier Rodriguez Lega
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marek Pol
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan Rocek
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Andreas Rukosujew
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Daniela Piani
- Cardiothoracic Department, Udine University Hospital, Udine, Italy
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Luisa Ferrante
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Sebastien Gerelli
- Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Dario Di Perna
- Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Metesh Acharya
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
| | - Zein El-Dean
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
| | - Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Alessandra Francica
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Angelo M Dell'Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
- Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Caius Mustonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Stefano Rosato
- National Centre for Global Health, National Health Institute, Rome, Italy
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| |
Collapse
|
3
|
Biancari F, Dell'Aquila AM, Onorati F, Rossetti C, Demal T, Rukosujew A, Peterss S, Buech J, Fiore A, Folliguet T, Perrotti A, Hervé A, Nappi F, Conradi L, Pinto AG, Lega JR, Pol M, Kacer P, Wisniewski K, Mazzaro E, Gatti G, Vendramin I, Piani D, Ferrante L, Rinaldi M, Quintana E, Pruna-Guillen R, Gerelli S, Di Perna D, Acharya M, Mariscalco G, Field M, Kuduvalli M, Pettinari M, Rosato S, Mustonen C, Kiviniemi T, Roberts CS, Mäkikallio T, Juvonen T. Classification of the Urgency of the Procedure and Outcome of Acute Type A Aortic Dissection. Am J Cardiol 2024; 217:59-67. [PMID: 38401652 DOI: 10.1016/j.amjcard.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
Surgery for type A aortic dissection (TAAD) is associated with a high risk of early mortality. The prognostic impact of a new classification of the urgency of the procedure was evaluated in this multicenter cohort study. Data on consecutive patients who underwent surgery for acute TAAD were retrospectively collected in the multicenter, retrospective European Registry of TAAD (ERTAAD). The rates of in-hospital mortality of 3,902 consecutive patients increased along with the ERTAAD procedure urgency grades: urgent procedure 10.0%, emergency procedure grade 1 13.3%, emergency procedure grade 2 22.1%, salvage procedure grade 1 45.6%, and salvage procedure grade 2 57.1% (p <0.0001). Preoperative arterial lactate correlated with the urgency grades. Inclusion of the ERTAAD procedure urgency classification significantly improved the area under the receiver operating characteristics curves of the regression model and the integrated discrimination indexes and the net reclassification indexes. The risk of postoperative stroke/global brain ischemia, mesenteric ischemia, lower limb ischemia, dialysis, and acute heart failure increased along with the urgency grades. In conclusion, the urgency of surgical repair of acute TAAD, which seems to have a significant impact on the risk of in-hospital mortality, may be useful to improve the stratification of the operative risk of these critically ill patients. This study showed that salvage surgery for TAAD is justified because half of the patients may survive to discharge.
Collapse
Affiliation(s)
- Fausto Biancari
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland; Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - Angelo M Dell'Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Cecilia Rossetti
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Andreas Rukosujew
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Joscha Buech
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Amélie Hervé
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Angel G Pinto
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Javier Rodriguez Lega
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marek Pol
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital, Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, University Hospital, Udine, Italy
| | - Luisa Ferrante
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona Spain
| | - Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona Spain
| | - Sebastien Gerelli
- Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Dario Di Perna
- Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Metesh Acharya
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom
| | - Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matteo Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Stefano Rosato
- National Center for Global Health, Istituto Superiore di Sanitá, Rome, Italy
| | - Caius Mustonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
| |
Collapse
|
4
|
Biancari F, Demal T, Nappi F, Onorati F, Francica A, Peterss S, Buech J, Fiore A, Folliguet T, Perrotti A, Hervé A, Conradi L, Rukosujew A, Pinto AG, Lega JR, Pol M, Rocek J, Kacer P, Wisniewski K, Mazzaro E, Vendramin I, Piani D, Ferrante L, Rinaldi M, Quintana E, Pruna-Guillen R, Gerelli S, Di Perna D, Acharya M, Mariscalco G, Field M, Kuduvalli M, Pettinari M, Rosato S, D’Errigo P, Jormalainen M, Mustonen C, Mäkikallio T, Dell’Aquila AM, Juvonen T, Gatti G. Baseline risk factors of in-hospital mortality after surgery for acute type A aortic dissection: an ERTAAD study. Front Cardiovasc Med 2024; 10:1307935. [PMID: 38288052 PMCID: PMC10822912 DOI: 10.3389/fcvm.2023.1307935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/31/2023] [Indexed: 01/31/2024] Open
Abstract
Background Surgery for type A aortic dissection (TAAD) is associated with high risk of mortality. Current risk scoring methods have a limited predictive accuracy. Methods Subjects were patients who underwent surgery for acute TAAD at 18 European centers of cardiac surgery from the European Registry of Type A Aortic Dissection (ERTAAD). Results Out of 3,902 patients included in the ERTAAD, 2,477 fulfilled the inclusion criteria. In the validation dataset (2,229 patients), the rate of in-hospital mortality was 18.4%. The rate of composite outcome (in-hospital death, stroke/global ischemia, dialysis, and/or acute heart failure) was 41.2%, and 10-year mortality rate was 47.0%. Logistic regression identified the following patient-related variables associated with an increased risk of in-hospital mortality [area under the curve (AUC), 0.755, 95% confidence interval (CI), 0.729-0.780; Brier score 0.128]: age; estimated glomerular filtration rate; arterial lactate; iatrogenic dissection; left ventricular ejection fraction ≤50%; invasive mechanical ventilation; cardiopulmonary resuscitation immediately before surgery; and cerebral, mesenteric, and peripheral malperfusion. The estimated risk score was associated with an increased risk of composite outcome (AUC, 0.689, 95% CI, 0.667-0.711) and of late mortality [hazard ratio (HR), 1.035, 95% CI, 1.031-1.038; Harrell's C 0.702; Somer's D 0.403]. In the validation dataset (248 patients), the in-hospital mortality rate was 16.1%, the composite outcome rate was 41.5%, and the 10-year mortality rate was 49.1%. The estimated risk score was predictive of in-hospital mortality (AUC, 0.703, 95% CI, 0.613-0.793; Brier score 0.121; slope 0.905) and of composite outcome (AUC, 0.682, 95% CI, 0.614-0.749). The estimated risk score was predictive of late mortality (HR, 1.035, 95% CI, 1.031-1.038; Harrell's C 0.702; Somer's D 0.403), also when hospital deaths were excluded from the analysis (HR, 1.024, 95% CI, 1.018-1.031; Harrell's C 0.630; Somer's D 0.261). Conclusions The present analysis identified several baseline clinical risk factors, along with preoperative estimated glomerular filtration rate and arterial lactate, which are predictive of in-hospital mortality and major postoperative adverse events after surgical repair of acute TAAD. These risk factors may be valuable components for risk adjustment in the evaluation of surgical and anesthesiological strategies aiming to improve the results of surgery for TAAD. Clinical Trial Registration https://clinicaltrials.gov, identifier NCT04831073.
Collapse
Affiliation(s)
- Fausto Biancari
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Alessandra Francica
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Sven Peterss
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Joscha Buech
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
- German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Amélie Hervé
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Andreas Rukosujew
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Angel G. Pinto
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Javier Rodriguez Lega
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marek Pol
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan Rocek
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Konrad Wisniewski
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital, Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, University Hospital, Udine, Italy
| | - Luisa Ferrante
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Sebastien Gerelli
- Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Dario Di Perna
- Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Metesh Acharya
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom
| | - Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matteo Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Stefano Rosato
- National Center for Global Health, Istituto Superiore di Sanitá, Rome, Italy
| | - Paola D’Errigo
- National Center for Global Health, Istituto Superiore di Sanitá, Rome, Italy
| | - Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Caius Mustonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Angelo M. Dell’Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
- Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| |
Collapse
|
5
|
Juvonen T, Jormalainen M, Mustonen C, Demal T, Fiore A, Perrotti A, Hervé A, Mazzaro E, Gatti G, Pettinari M, Peterss S, Buech J, Nappi F, Conradi L, Pinto AG, Rodriguez Lega J, Pol M, Kacer P, Dell'Aquila AM, Rukosujew A, Wisniewski K, Vendramin I, Piani D, Ferrante L, Rinaldi M, Quintana E, Pruna-Guillen R, Gerelli S, Di Perna D, Folliguet T, Acharya M, Field M, Kuduvalli M, Onorati F, Rossetti C, Mäkikallio T, Raivio P, Mariscalco G, Biancari F. Direct Aortic Versus Supra-Aortic Arterial Cannulation During Surgery for Acute Type A Aortic Dissection. World J Surg 2023; 47:2899-2908. [PMID: 37432422 DOI: 10.1007/s00268-023-07116-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
AIMS In this study we evaluated the impact of direct aortic cannulation versus innominate/subclavian/axillary artery cannulation on the outcome after surgery for type A aortic dissection. METHODS The outcomes of patients included in a multicenter European registry (ERTAAD) who underwent surgery for acute type A aortic dissection with direct aortic cannulation versus those with innominate/subclavian/axillary artery cannulation, i.e. supra-aortic arterial cannulation, were compared using propensity score matched analysis. RESULTS Out of 3902 consecutive patients included in the registry, 2478 (63.5%) patients were eligible for this analysis. Direct aortic cannulation was performed in 627 (25.3%) patients, while supra-aortic arterial cannulation in 1851 (74.7%) patients. Propensity score matching yielded 614 pairs of patients. Among them, patients who underwent surgery for TAAD with direct aortic cannulation had significantly decreased in-hospital mortality (12.7% vs. 18.1%, p = 0.009) compared to those who had supra-aortic arterial cannulation. Furthermore, direct aortic cannulation was associated with decreased postoperative rates of paraparesis/paraplegia (2.0 vs. 6.0%, p < 0.0001), mesenteric ischemia (1.8 vs. 5.1%, p = 0.002), sepsis (7.0 vs. 14.2%, p < 0.0001), heart failure (11.2 vs. 15.2%, p = 0.043), and major lower limb amputation (0 vs. 1.0%, p = 0.031). Direct aortic cannulation showed a trend toward decreased risk of postoperative dialysis (10.1 vs. 13.7%, p = 0.051). CONCLUSIONS This multicenter cohort study showed that direct aortic cannulation compared to supra-aortic arterial cannulation is associated with a significant reduction of the risk of in-hospital mortality after surgery for acute type A aortic dissection. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04831073.
Collapse
Affiliation(s)
- Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland
- Anesthesia and Critical Care, Research Unit of Surgery, University of Oulu, Oulu, Finland
| | - Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland
| | - Caius Mustonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Amélie Hervé
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Matteo Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Sven Peterss
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Joscha Buech
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
- German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Angel G Pinto
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Javier Rodriguez Lega
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marek Pol
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Angelo M Dell'Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Andreas Rukosujew
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital, Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, University Hospital, Udine, Italy
| | - Luisa Ferrante
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Dario Di Perna
- Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Metesh Acharya
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
| | - Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Cecilia Rossetti
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland
| | | | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland.
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
| |
Collapse
|
6
|
Biancari F, Nappi F, Gatti G, Perrotti A, Hervé A, Rosato S, D'Errigo P, Pettinari M, Peterss S, Buech J, Juvonen T, Jormalainen M, Mustonen C, Demal T, Conradi L, Pol M, Kacer P, Dell’Aquila AM, Wisniewski K, Vendramin I, Piani D, Ferrante L, Mäkikallio T, Quintana E, Pruna-Guillen R, Fiore A, Folliguet T, Mariscalco G, Acharya M, Field M, Kuduvalli M, Onorati F, Rossetti C, Gerelli S, Di Perna D, Mazzaro E, Pinto AG, Lega JR, Rinaldi M. Preoperative arterial lactate and outcome after surgery for type A aortic dissection: The ERTAAD multicenter study. Heliyon 2023; 9:e20702. [PMID: 37829811 PMCID: PMC10565766 DOI: 10.1016/j.heliyon.2023.e20702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023] Open
Abstract
Background Acute type A aortic dissection (TAAD) is associated with significant mortality and morbidity. In this study we evaluated the prognostic significance of preoperative arterial lactate concentration on the outcome after surgery for TAAD. Methods The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) at 18 European centers of cardiac surgery. Results Data on arterial lactate concentration immediately before surgery were available in 2798 (71.7 %) patients. Preoperative concentration of arterial lactate was an independent predictor of in-hospital mortality (mean, 3.5 ± 3.2 vs 2.1 ± 1.8 mmol/L, adjusted OR 1.181, 95%CI 1.129-1.235). The best cutoff value preoperative arterial lactate concentration was 1.8 mmol/L (in-hospital mortality, 12.0 %, vs. 26.6 %, p < 0.0001). The rates of in-hospital mortality increased along increasing quintiles of arterial lactate and it was 12.1 % in the lowest quintile and 33.6 % in the highest quintile (p < 0.0001). The difference between multivariable models with and without preoperative arterial lactate was statistically significant (p = 0.0002). The NRI was 0.296 (95%CI 0.200-0.391) (p < 0.0001) with -17 % of events correctly reclassified (p = 0.0002) and 46 % of non-events correctly reclassified (p < 0.0001). The IDI was 0.025 (95%CI 0.016-0.034) (p < 0.0001). Six studies from a systematic review plus the present one provided data for a pooled analysis which showed that the mean difference of preoperative arterial lactate between 30-day/in-hospital deaths and survivors was 1.85 mmol/L (95%CI 1.22-2.47, p < 0.0001, I2 64 %). Conclusions Hyperlactatemia significantly increased the risk of mortality after surgery for acute TAAD and should be considered in the clinical assessment of these critically ill patients.
Collapse
Affiliation(s)
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Amélie Hervé
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Stefano Rosato
- Center for Global Health, National Health Institute, Rome, Italy
| | - Paola D'Errigo
- Center for Global Health, National Health Institute, Rome, Italy
| | - Matteo Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Sven Peterss
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Joscha Buech
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
- German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
| | - Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Caius Mustonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Marek Pol
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Angelo M. Dell’Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital, Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, University Hospital, Udine, Italy
| | - Luisa Ferrante
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Spain
| | - Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Spain
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom
| | - Metesh Acharya
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom
| | - Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Cecilia Rossetti
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | | | | | - Enzo Mazzaro
- Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Angel G. Pinto
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Javier Rodriguez Lega
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| |
Collapse
|
7
|
Biancari F, Dell'Aquila AM, Gatti G, Perrotti A, Hervé A, Touma J, Pettinari M, Peterss S, Buech J, Wisniewski K, Juvonen T, Jormalainen M, Mustonen C, Rukosujew A, Demal T, Conradi L, Pol M, Kacer P, Onorati F, Rossetti C, Vendramin I, Piani D, Rinaldi M, Ferrante L, Quintana E, Pruna-Guillen R, Lega JR, Pinto AG, Acharya M, El-Dean Z, Field M, Harky A, Kuduvalli M, Nappi F, Gerelli S, Di Perna D, Mazzaro E, Rosato S, Fiore A, Mariscalco G. Interinstitutional analysis of the outcome after surgery for type A aortic dissection. Eur J Trauma Emerg Surg 2023; 49:1791-1801. [PMID: 36826589 PMCID: PMC10449993 DOI: 10.1007/s00068-023-02248-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To evaluate the impact of individual institutions on the outcome after surgery for Stanford type A aortic dissection (TAAD). METHODS This is an observational, multicenter, retrospective cohort study including 3902 patients who underwent surgery for TAAD at 18 university and non-university hospitals. RESULTS Logistic regression showed that four hospitals had increased risk of in-hospital mortality, while two hospitals were associated with decreased risk of in-hospital mortality. Risk-adjusted in-hospital mortality rates were lower in four hospitals and higher in other four hospitals compared to the overall in-hospital mortality rate (17.7%). Participating hospitals were classified as overperforming or underperforming if their risk-adjusted in-hospital mortality rate was lower or higher than the in-hospital mortality rate of the overall series, respectively. Propensity score matching yielded 1729 pairs of patients operated at over- or underperforming hospitals. Overperforming hospitals had a significantly lower in-hospital mortality (12.8% vs. 22.2%, p < 0.0001) along with decreased rate of stroke and/or global brain ischemia (16.5% vs. 19.9%, p = 0.009) compared to underperforming hospitals. Aggregate data meta-regression of the results of participating hospitals showed that hospital volume was inversely associated with in-hospital mortality (p = 0.043). Hospitals with an annual volume of less than 15 cases had an increased risk of in-hospital mortality (adjusted OR, 1.345, 95% CI 1.126-1.607). CONCLUSION The present findings indicate that there are significant differences between hospitals in terms of early outcome after surgery for TAAD. Low hospital volume may be a determinant of poor outcome of TAAD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04831073.
Collapse
Affiliation(s)
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland.
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
| | - Angelo M Dell'Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Amélie Hervé
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Joseph Touma
- Department of Vascular Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Matteo Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Sven Peterss
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Joscha Buech
- LMU University Hospital, Ludwig Maximilian University, Munich, Germany
- German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland
- Anesthesia and Critical Care, Research Unit of Surgery, University of Oulu, Oulu, Finland
| | - Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland
| | - Caius Mustonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland
| | - Andreas Rukosujew
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Marek Pol
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Cecilia Rossetti
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital, Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, University Hospital, Udine, Italy
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Luisa Ferrante
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Javier Rodriguez Lega
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Angel G Pinto
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Metesh Acharya
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
| | - Zein El-Dean
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK
| | - Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amer Harky
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | | | - Dario Di Perna
- Centre Hospitalier Annecy Genevois, Épagny-Metz-Tessy, France
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Stefano Rosato
- Center for Global Health, National Health Institute, Rome, Italy
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | | |
Collapse
|
8
|
Fowler C, Kuduvalli M, Cooper G. Introduction to the three-part series on aortic dissection. Br J Cardiol 2023; 30:8. [PMID: 37705838 PMCID: PMC10495765 DOI: 10.5837/bjc.2023.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Catherine Fowler
- Trustee The Aortic Dissection Charitable Trust PO Box 812, Hope Valley, S40 9QY
| | - Manoj Kuduvalli
- Chair UK-Aortic Society and Consultant Cardiac Surgeon Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE
| | - Graham Cooper
- Trustee, The Aortic Dissection Charitable Trust, and Consultant Cardiac Surgeon Sheffield Teaching Hospitals, Herries Road, Sheffield, S5 7AU
| |
Collapse
|
9
|
Toff WD, Hildick-Smith D, Kovac J, Mullen MJ, Wendler O, Mansouri A, Rombach I, Abrams KR, Conroy SP, Flather MD, Gray AM, MacCarthy P, Monaghan MJ, Prendergast B, Ray S, Young CP, Crossman DC, Cleland JGF, de Belder MA, Ludman PF, Jones S, Densem CG, Tsui S, Kuduvalli M, Mills JD, Banning AP, Sayeed R, Hasan R, Fraser DGW, Trivedi U, Davies SW, Duncan A, Curzen N, Ohri SK, Malkin CJ, Kaul P, Muir DF, Owens WA, Uren NG, Pessotto R, Kennon S, Awad WI, Khogali SS, Matuszewski M, Edwards RJ, Ramesh BC, Dalby M, Raja SG, Mariscalco G, Lloyd C, Cox ID, Redwood SR, Gunning MG, Ridley PD. Effect of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement on All-Cause Mortality in Patients With Aortic Stenosis: A Randomized Clinical Trial. JAMA 2022; 327:1875-1887. [PMID: 35579641 PMCID: PMC9115619 DOI: 10.1001/jama.2022.5776] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear. OBJECTIVE To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial conducted at 34 UK centers, 913 patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk due to age or comorbidity were enrolled between April 2014 and April 2018 and followed up through April 2019. INTERVENTIONS TAVI using any valve with a CE mark (indicating conformity of the valve with all legal and safety requirements for sale throughout the European Economic Area) and any access route (n = 458) or surgical aortic valve replacement (surgery; n = 455). MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality at 1 year. The primary hypothesis was that TAVI was noninferior to surgery, with a noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI for the absolute between-group difference in mortality. There were 36 secondary outcomes (30 reported herein), including duration of hospital stay, major bleeding events, vascular complications, conduction disturbance requiring pacemaker implantation, and aortic regurgitation. RESULTS Among 913 patients randomized (median age, 81 years [IQR, 78 to 84 years]; 424 [46%] were female; median Society of Thoracic Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%) completed follow-up and were included in the noninferiority analysis. At 1 year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%) in the surgery group, with an adjusted absolute risk difference of -2.0% (1-sided 97.5% CI, -∞ to 1.2%; P < .001 for noninferiority). Of 30 prespecified secondary outcomes reported herein, 24 showed no significant difference at 1 year. TAVI was associated with significantly shorter postprocedural hospitalization (median of 3 days [IQR, 2 to 5 days] vs 8 days [IQR, 6 to 13 days] in the surgery group). At 1 year, there were significantly fewer major bleeding events after TAVI compared with surgery (7.2% vs 20.2%, respectively; adjusted hazard ratio [HR], 0.33 [95% CI, 0.24 to 0.45]) but significantly more vascular complications (10.3% vs 2.4%; adjusted HR, 4.42 [95% CI, 2.54 to 7.71]), conduction disturbances requiring pacemaker implantation (14.2% vs 7.3%; adjusted HR, 2.05 [95% CI, 1.43 to 2.94]), and mild (38.3% vs 11.7%) or moderate (2.3% vs 0.6%) aortic regurgitation (adjusted odds ratio for mild, moderate, or severe [no instance of severe reported] aortic regurgitation combined vs none, 4.89 [95% CI, 3.08 to 7.75]). CONCLUSIONS AND RELEVANCE Among patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk, TAVI was noninferior to surgery with respect to all-cause mortality at 1 year. TRIAL REGISTRATION isrctn.com Identifier: ISRCTN57819173.
Collapse
Affiliation(s)
| | - William D Toff
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, England
| | - Jan Kovac
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - Michael J Mullen
- Institute of Cardiovascular Science, University College London, London, England
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, England
| | - Anita Mansouri
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Ines Rombach
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Keith R Abrams
- Centre for Health Economics, University of York, York, England
- Department of Statistics, University of Warwick, Coventry, England
- Department of Health Sciences, University of Leicester, Leicester, England
| | - Simon P Conroy
- Department of Health Sciences, University of Leicester, Leicester, England
| | - Marcus D Flather
- Norwich Medical School, University of East Anglia, Norwich, England
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, England
| | - Mark J Monaghan
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, England
| | | | - Simon Ray
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, England
| | | | | | - John G F Cleland
- Robertson Centre for Biostatistics and Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Mark A de Belder
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, England
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, England
| | - Stephen Jones
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
| | - Cameron G Densem
- Department of Cardiology, Royal Papworth Hospital, Cambridge, England
| | - Steven Tsui
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, England
| | - Manoj Kuduvalli
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, England
| | - Joseph D Mills
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, England
| | - Adrian P Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Rana Sayeed
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Ragheb Hasan
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, England
| | - Douglas G W Fraser
- Department of Cardiovascular Medicine, University of Manchester, Manchester, England
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, England
| | - Simon W Davies
- Cardiac Department, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Alison Duncan
- Cardiac Department, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Nick Curzen
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, England
| | - Sunil K Ohri
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, England
| | | | - Pankaj Kaul
- Department of Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Douglas F Muir
- Department of Cardiology, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, England
| | - W Andrew Owens
- Department of Cardiothoracic Surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, England
| | - Neal G Uren
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Renzo Pessotto
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Simon Kennon
- Barts Heart Centre, Barts Health NHS Trust, London, England
| | - Wael I Awad
- Barts Heart Centre, Barts Health NHS Trust, London, England
| | - Saib S Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, England
| | | | - Richard J Edwards
- Cardiothoracic Department, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, England
| | | | - Miles Dalby
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Giovanni Mariscalco
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - Clinton Lloyd
- Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, England
| | - Ian D Cox
- Department of Cardiology, Derriford Hospital, Plymouth, England
| | - Simon R Redwood
- Cardiovascular Division, King's College London, British Heart Foundation Centre of Research Excellence, Rayne Institute, St Thomas' Hospital, London, England
| | - Mark G Gunning
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, England
| | - Paul D Ridley
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, England
| |
Collapse
|
10
|
Manoly I, Uzzaman M, Karangelis D, Kuduvalli M, Georgakarakos E, Quarto C, Ravishankar R, Mitropoulos F, Nasir A. Neuroprotective strategies with circulatory arrest in open aortic surgery - A meta-analysis. Asian Cardiovasc Thorac Ann 2022; 30:635-644. [PMID: 35014877 PMCID: PMC9260478 DOI: 10.1177/02184923211069186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Deep hypothermic circulatory arrest (DHCA) in aortic surgery is associated
with morbidity and mortality despite evolving strategies. With the advent of
antegrade cerebral perfusion (ACP), moderate hypothermic circulatory arrest
(MHCA) was reported to have better outcomes than DHCA. There is no
standardised guideline or consensus regarding the hypothermic strategies to
be employed in open aortic surgery. Meta-analysis was performed comparing
DHCA with MHCA + ACP in patients having aortic surgery. Methods A systematic review of the literature was undertaken. Any studies with DHCA
versus MHCA + ACP in aortic surgeries were selected according to specific
inclusion criteria and analysed to generate summative data. Statistical
analysis was performed using STATS Direct. The primary outcomes were
hospital mortality and post-operative stroke. Secondary outcomes were
cardiopulmonary bypass time (CPB), post-operative blood transfusion, length
of ICU stay, respiratory complications, renal failure and length of hospital
stay. Subgroup analysis of primary outcomes for Arch surgery alone was also
performed. Results Fifteen studies were included with a total of 5869 patients. There was
significantly reduced mortality (Pooled OR = +0.64, 95% CI = +0.49 to +0.83;
p = 0.0006) and stroke rate (Pooled OR = +0.62, 95%
CI = +0.49 to +0.79; p < 0.001) in the MHCA group. MHCA
was associated significantly with shorter CPB times, shorter duration in
ICU, less pulmonary complications, and reduced rates of sepsis. There was no
statistical difference between the two groups in terms of circulatory arrest
times, X-Clamp times, total operation duration, transfusion requirements,
renal failure and post-op hospital stay. Conclusion MHCA + ACP are associated with significantly better post-operative outcomes
compared with DHCA for both mortality and stroke and majority of the
secondary outcomes.
Collapse
Affiliation(s)
| | | | - Dimos Karangelis
- Department of Cardiac Surgery, Democritus University of Thrace, 69026University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - Efstratios Georgakarakos
- Department of Vascular Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | | | | - Abdul Nasir
- Peshawar Institute of Cardiology, Peshawar, Pakistan
| |
Collapse
|
11
|
Toolan C, Oo S, Shaw M, Field M, Kuduvalli M, Harrington D, Nawaytou O. Reinterventions and new aortic events after aortic surgery in Marfan syndrome. Eur J Cardiothorac Surg 2021; 61:ezab491. [PMID: 35325086 DOI: 10.1093/ejcts/ezab491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 10/10/2021] [Accepted: 10/17/2021] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Pre-emptive strategies to manage the aortic complications of Marfan syndrome have resulted in improved life expectancy yet, secondary to the variation of phenotypic expression, anticipating the risk and nature of future aortic events is challenging. We examine rates of new aortic events and reinterventions in a Marfan cohort following initial aortic presentation. METHODS Retrospective cohort study of Marfan patients with aortic pathology presenting to our institution 1998-2018. Patients were grouped according to index event: aortic dissection or root aneurysm. Patients with aortic dissection were classified according to Debakey criteria. Incidence of new aortic events and frequency of reintervention were analysed. RESULTS One hundred and twenty-six aortic procedures were performed in 74 Marfan patients with a median follow-up of 7 years. Forty-seven patients had an index event of root aneurysm and 27 had aortic dissection. Following operative intervention in the aneurysm group, 7 patients developed Debakey III dissections raising the overall number of patients who developed dissection within this cohort to 34. Reinterventions were more frequent in the dissection group with full replacement of the native aorta in 5 patients. CONCLUSIONS After operative intervention on the proximal aorta, a proportion will develop distal pathology. A greater focus on factors contributing to future events, such as mapping genotypes to clinical course, may lead the way for targeted operative techniques and surveillance.
Collapse
Affiliation(s)
- Caroline Toolan
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Shwe Oo
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Matthew Shaw
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark Field
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deborah Harrington
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Omar Nawaytou
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| |
Collapse
|
12
|
Jahangiri M, Bilkhu R, Embleton-Thirsk A, Dehbi HM, Mani K, Anderson J, Avlonitis V, Baghai M, Birdi I, Booth K, Bose A, Briffa N, Buchan K, Bhudia S, Cale A, Deglurkar I, Farid S, Hadjinikolaou L, Jarvis M, Javadpour SH, Jeganathan R, Kuduvalli M, Lall K, Mascaro J, Mehta D, Ohri S, Punjabi P, Venkateswaran R, Ridley P, Satur C, Stoica S, Trivedi U, Zaidi A, Yiu P, Moorjani N, Kendall S, Freemantle N. Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database. BMJ Open 2021; 11:e046491. [PMID: 34711589 PMCID: PMC8557283 DOI: 10.1136/bmjopen-2020-046491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 09/21/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore 'real-world' practice. DESIGN Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants' demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed. SETTING 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis. PARTICIPANTS 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG. RESULTS In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60-75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes. CONCLUSIONS Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.
Collapse
Affiliation(s)
| | - Rajdeep Bilkhu
- Department of Cardiac Surgery, St Thomas' Hospital, London, UK
| | | | - Hakim-Moulay Dehbi
- University College London Institute of Clinical Trials and Methodology, London, UK
| | - Krishna Mani
- Department of Cardiac Surgery, St George's Hospital, London, UK
| | - Jon Anderson
- Department of Cardiac Surgery, Hammersmith Hospital, London, UK
| | | | - Max Baghai
- Department of Cardiac Surgery, King's College Hospital, London, UK
| | - Inderpaul Birdi
- Department of Cardiac Surgery, Essex Cardiothoracic Centre, Basildon, UK
| | - Karen Booth
- Department of Cardiac Surgery, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Amal Bose
- Department of Cardiac Surgery, Lancashire Cardiac Centre, Blackpool, UK
| | - Norman Briffa
- Sheffield Teaching Hospitals NHS Foundation Trust Cardiothoracic Centre, Sheffield, UK
| | - Keith Buchan
- Department of Cardiac Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Alex Cale
- Department of Cardiac Surgery, Castle Hill Hospital, Cottingham, UK
| | - Indu Deglurkar
- Department of Cardiac Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Shakil Farid
- Department of Cardiac Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Leonidas Hadjinikolaou
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Martin Jarvis
- Department of Cardiac Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Kulvinder Lall
- Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Jorge Mascaro
- Department of Cardiac Surgery, Queen Elizabeth Medical Centre, Birmingham, UK
| | - Dheeraj Mehta
- Department of Cardiac Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Sunil Ohri
- Department of Cardiac Surgery, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Prakash Punjabi
- Department of Cardiac Surgery, Hammersmith Hospital, London, UK
| | | | - Paul Ridley
- Department of Cardiac Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Christopher Satur
- Department of Cardiac Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Serban Stoica
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Uday Trivedi
- Royal Sussex County Hospital Sussex Cardiac Centre, Brighton, UK
| | - Afzal Zaidi
- Department of Cardiac Surgery, Morriston Hospital, Swansea, UK
| | - Patrick Yiu
- Department of Cardiac Surgery, New Cross Hospital, Wolverhampton, UK
| | - Narain Moorjani
- Department of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Simon Kendall
- Department of Cardiac Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Nick Freemantle
- Comprehensive Clinical Trials Unit, University College London Institute of Clinical Trials and Methodology, London, UK
| |
Collapse
|
13
|
Harky A, Mason S, Othman A, Shaw M, Nawaytou O, Harrington D, Kuduvalli M, Field M. Outcomes of acute type A aortic dissection repair: Daytime versus nighttime. JTCVS Open 2021; 7:12-20. [PMID: 36003743 PMCID: PMC9390141 DOI: 10.1016/j.xjon.2021.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/22/2022]
Abstract
Objective We sought to report our experience of repairing acute type A aortic dissection (ATAAD) over 21 years during in-hours versus out-of-hours before and after the establishment of specialized aortic service and rota. Methods A retrospective analysis of all patients who had ATAAD repair between November 1998 and December 2019 in our center. In-hours were defined as 08:00 to 19:59 hours and out of hours were defined as 20:00 to 07:59 hours. Results A total of 286 patients underwent repair of ATAAD. Eighty operations took place during the prerota period (43 operations in hours, 37 out of hours) and 206 operations during the specialized rota period (110 in hours, 96 out of hours). There was no difference in 30-day mortality between the in-hours and out-of-hours groups in either the prerota (23.3% vs 32.4%; P = .36) or specialized rota periods (11.6% vs 11.5%; P = .94). Mean number of cases per year increased by 83% between the prerota and specialized rota periods. Thirty-day mortality reduced in both the in-hours (23.3% vs 11.6%) and out-of-hours (32.4% vs 11.5%) groups since introduction of the specialized aortic rota. Conclusions Outcomes in repair of ATAAD during in-hours and out-of-hours periods are similar when operated on in a specialized unit with a dedicated aortic team. This emphasizes the current global trend of service centralization without particular attention to time of day to operate on such critical cohort patients.
Collapse
Affiliation(s)
- Amer Harky
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Sabrina Mason
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Ahmed Othman
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Shaw
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Omar Nawaytou
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Deborah Harrington
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| |
Collapse
|
14
|
Affiliation(s)
- Mark Field
- Aortovascular Hub, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Aortovascular Hub, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Francesco Torella
- Aortovascular Hub, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Victoria McKay
- Aortovascular Hub, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Afshin Khalatbari
- Aortovascular Hub, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Gregory Y H Lip
- Aortovascular Hub, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| |
Collapse
|
15
|
Biancari F, Mariscalco G, Yusuff H, Tsang G, Luthra S, Onorati F, Francica A, Rossetti C, Perrotti A, Chocron S, Fiore A, Folliguet T, Pettinari M, Dell'Aquila AM, Demal T, Conradi L, Detter C, Pol M, Ivak P, Schlosser F, Forlani S, Chetty G, Harky A, Kuduvalli M, Field M, Vendramin I, Livi U, Rinaldi M, Ferrante L, Etz C, Noack T, Mastrobuoni S, De Kerchove L, Jormalainen M, Laga S, Meuris B, Schepens M, Dean ZE, Vento A, Raivio P, Borger M, Juvonen T. Correction to: European registry of type A aortic dissection (ERTAAD) - rationale, design and definition criteria. J Cardiothorac Surg 2021; 16:225. [PMID: 34365965 PMCID: PMC8351161 DOI: 10.1186/s13019-021-01606-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, and University of Helsinki, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, Finland. .,Anesthesia and Critical Care, Research Unit of Surgery, University of Oulu, Oulu, Finland.
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Hakeem Yusuff
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Geoffrey Tsang
- Southampton University Hospital, Southampton, UK.,UK Aortic Surgery Group, Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital, Southampton, UK
| | - Suvitesh Luthra
- Southampton University Hospital, Southampton, UK.,UK Aortic Surgery Group, Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital, Southampton, UK
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Alessandra Francica
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Cecilia Rossetti
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Andrea Perrotti
- Department of Cardio-Thoracic Surgery, Jean Minjoz University Hospital, Besançon, France
| | - Sidney Chocron
- Department of Cardio-Thoracic Surgery, Jean Minjoz University Hospital, Besançon, France
| | - Antonio Fiore
- Service de Chirurgie Thoracique et Cardio-vasculaire, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Thierry Folliguet
- Service de Chirurgie Thoracique et Cardio-vasculaire, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Matteo Pettinari
- Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Angelo M Dell'Aquila
- Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany
| | - Till Demal
- Department of Cardiovascular Surgery, German Aortic Centre Hamburg, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, German Aortic Centre Hamburg, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, German Aortic Centre Hamburg, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Marek Pol
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Peter Ivak
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Filip Schlosser
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Govind Chetty
- Northern General Hospital, Herries Road, Sheffield, UK
| | - Amer Harky
- Liverpool Cardiovascular Surgery, Liverpool Heart and Chest Hospital, Faculty of Health and Life Sciences, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Manoj Kuduvalli
- Liverpool Cardiovascular Surgery, Liverpool Heart and Chest Hospital, Faculty of Health and Life Sciences, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Mark Field
- Liverpool Cardiovascular Surgery, Liverpool Heart and Chest Hospital, Faculty of Health and Life Sciences, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Igor Vendramin
- Cardiac Surgery Department, University of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiac Surgery Department, University of Udine, Udine, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, University of Turin, Turin, Italy
| | - Luisa Ferrante
- Department of Cardiac Surgery, University of Turin, Turin, Italy
| | | | | | - Stefano Mastrobuoni
- Cardiovascular and Thoracic Surgery, Saint-Luc's Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Laurent De Kerchove
- Cardiovascular and Thoracic Surgery, Saint-Luc's Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, and University of Helsinki, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, Finland
| | - Steven Laga
- Department of Cardiac Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Bart Meuris
- Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marc Schepens
- Department of Cardiac Surgery, AZ St-Jan, Bruges, Belgium
| | - Zein El Dean
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Antti Vento
- Heart and Lung Center, Helsinki University Hospital, and University of Helsinki, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, and University of Helsinki, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, Finland
| | | | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, and University of Helsinki, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, Finland.,Anesthesia and Critical Care, Research Unit of Surgery, University of Oulu, Oulu, Finland
| |
Collapse
|
16
|
Biancari F, Mariscalco G, Yusuff H, Tsang G, Luthra S, Onorati F, Francica A, Rossetti C, Perrotti A, Chocron S, Fiore A, Folliguet T, Pettinari M, Dell'Aquila AM, Demal T, Conradi L, Detter C, Pol M, Ivak P, Schlosser F, Forlani S, Chetty G, Harky A, Kuduvalli M, Field M, Vendramin I, Livi U, Rinaldi M, Ferrante L, Etz C, Noack T, Mastrobuoni S, De Kerchove L, Jormalainen M, Laga S, Meuris B, Schepens M, El Dean Z, Vento A, Raivio P, Borger M, Juvonen T. European registry of type A aortic dissection (ERTAAD) - rationale, design and definition criteria. J Cardiothorac Surg 2021; 16:171. [PMID: 34112230 PMCID: PMC8194119 DOI: 10.1186/s13019-021-01536-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/11/2021] [Indexed: 01/10/2023] Open
Abstract
Background Acute Stanford type A aortic dissection (TAAD) is a life-threatening condition. Surgery is usually performed as a salvage procedure and is associated with significant postoperative early mortality and morbidity. Understanding the patient’s conditions and treatment strategies which are associated with these adverse events is essential for an appropriate management of acute TAAD. Methods Nineteen centers of cardiac surgery from seven European countries have collaborated to create a multicentre observational registry (ERTAAD), which will enroll consecutive patients who underwent surgery for acute TAAD from January 2005 to March 2021. Analysis of the impact of patient’s comorbidities, conditions at referral, surgical strategies and perioperative treatment on the early and late adverse events will be performed. The investigators have developed a classification of the urgency of the procedure based on the severity of preoperative hemodynamic conditions and malperfusion secondary to acute TAAD. The primary clinical outcomes will be in-hospital mortality, late mortality and reoperations on the aorta. Secondary outcomes will be stroke, acute kidney injury, surgical site infection, reoperation for bleeding, blood transfusion and length of stay in the intensive care unit. Discussion The analysis of this multicentre registry will allow conclusive results on the prognostic importance of critical preoperative conditions and the value of different treatment strategies to reduce the risk of early adverse events after surgery for acute TAAD. This registry is expected to provide insights into the long-term durability of different strategies of surgical repair for TAAD. Trial registration ClinicalTrials.gov Identifier: NCT04831073.
Collapse
Affiliation(s)
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland. .,Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland.
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Hakeem Yusuff
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Geoffrey Tsang
- Southampton University Hospital, Southampton, UK.,UK Aortic Surgery Group, Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital, Southampton, UK
| | - Suvitesh Luthra
- Southampton University Hospital, Southampton, UK.,UK Aortic Surgery Group, Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital, Southampton, UK
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Alessandra Francica
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Cecilia Rossetti
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Andrea Perrotti
- Department of Cardio-Thoracic Surgery, Jean Minjoz University Hospital, Besançon, France
| | - Sidney Chocron
- Department of Cardio-Thoracic Surgery, Jean Minjoz University Hospital, Besançon, France
| | - Antonio Fiore
- Service de Chirurgie Thoracique et Cardio-vasculaire, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Thierry Folliguet
- Service de Chirurgie Thoracique et Cardio-vasculaire, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Matteo Pettinari
- Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Angelo M Dell'Aquila
- Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany
| | - Till Demal
- Department of Cardiovascular Surgery, German Aortic Centre Hamburg, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, German Aortic Centre Hamburg, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, German Aortic Centre Hamburg, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Marek Pol
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Peter Ivak
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Filip Schlosser
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Govind Chetty
- Northern General Hospital, Herries Road, Sheffield, UK
| | - Amer Harky
- Liverpool Cardiovascular Surgery, Liverpool Heart and Chest Hospital, Faculty of Health and Life Sciences, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Manoj Kuduvalli
- Liverpool Cardiovascular Surgery, Liverpool Heart and Chest Hospital, Faculty of Health and Life Sciences, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Mark Field
- Liverpool Cardiovascular Surgery, Liverpool Heart and Chest Hospital, Faculty of Health and Life Sciences, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Igor Vendramin
- Cardiac Surgery Department, University of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiac Surgery Department, University of Udine, Udine, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, University of Turin, Turin, Italy
| | - Luisa Ferrante
- Department of Cardiac Surgery, University of Turin, Turin, Italy
| | | | | | - Stefano Mastrobuoni
- Cardiovascular and Thoracic Surgery, Saint-Luc's Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Laurent De Kerchove
- Cardiovascular and Thoracic Surgery, Saint-Luc's Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Steven Laga
- Department of Cardiac Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Bart Meuris
- Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marc Schepens
- Department of Cardiac Surgery, AZ St-Jan, Bruges, Belgium
| | - Zein El Dean
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Antti Vento
- Heart and Lung Center, Helsinki University Hospital, and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland
| | | | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland.,Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
| |
Collapse
|
17
|
Affiliation(s)
- Mark L Field
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L69 7TX, UK.,Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Manoj Kuduvalli
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L69 7TX, UK.,Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Francesco Torella
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L69 7TX, UK.,Liverpool Vascular & Endovascular Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L69 7TX, UK.,Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| |
Collapse
|
18
|
Torella F, Othman AA, Kuduvalli M. Dynamic visceral ischemia in type A dissection. J Card Surg 2021; 36:1136-1137. [PMID: 33491245 DOI: 10.1111/jocs.15374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Francesco Torella
- Liverpool Cardiovascular Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Ahmed A Othman
- Liverpool Cardiovascular Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Liverpool Cardiovascular Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| |
Collapse
|
19
|
Harky A, Othman A, Nistal De Paz C, Shaw M, Nawaytou O, Harrington D, Kuduvalli M, Field M. Systematic approach to diagnosis and management of infected prosthetic grafts in the proximal aorta. J Card Surg 2020; 36:145-152. [PMID: 33169445 PMCID: PMC7839687 DOI: 10.1111/jocs.15122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 01/01/2023]
Abstract
Objectives Management of infected prosthetic aortic grafts in the ascending and or root is complex and multifaceted. We report our diagnostic pathway, management and outcomes, identifying successful strategies. Methods This was a retrospective, single center, observational study. Consecutive patients who underwent management of infected aortic grafts in the ascending and/or root at our institution between October 1998 and December 2019 were included. The main outcome measures were: discharge from hospital alive with at least 1 year survival, operative mortality and success of primary treatment strategy. Results Twenty‐six patients presented with infection of proximal aortic grafts and were managed through a number of strategies with an overall hospital‐survival of 81% and 1 year survival of 69%. Twenty of them ultimately underwent redo surgery with 25% operative mortality (within 24 h of surgery). Five patients underwent washout and irrigation of which two were successfully treated and cured with adjunctive antibiotics and two went on to have staged explant and definitive surgery. Interval between surgery and infection was 42.5 ± 35.8 months. All patients had at least one major criterion and three minor criterions with no diagnostic uncertainty. The commonest primary strategy was 3a (definitive surgery), (13/26, 50%). Conclusions Adopting a systematic and flexible patient specific approach to the diagnosis and management of patients with proximal aortic graft infections results in reasonable overall 1 year survival. In the majority of patients surgery is ultimately required in an attempt to achieve a curative treatment; however this comes with high operative mortality risk.
Collapse
Affiliation(s)
- Amer Harky
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Center for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Ahmed Othman
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Carlos Nistal De Paz
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Matthew Shaw
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Omar Nawaytou
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deborah Harrington
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark Field
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Center for Cardiovascular Science, University of Liverpool, Liverpool, UK
| |
Collapse
|
20
|
Theologou T, Harky A, Shaw M, Eltyeb H, Elbakbak W, Snosi M, Harrington D, Kuduvalli M, Oo A, Field M. Management of Lower Limb Ischemia During Operative Repair of Acute Type A Aortic Dissection by Distal Crossover Grafts: a Case Series. Braz J Cardiovasc Surg 2020; 35:607-613. [PMID: 33118723 PMCID: PMC7598955 DOI: 10.21470/1678-9741-2019-0259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective To describe our experience of nine patients with extra-anatomical bypass for clinically ischemic distal limb during repair of acute Type A aortic dissection (ATAAD). Methods We retrospectively examined a series of nine patients who underwent surgery for ATAAD. We identified a subset of the patients who presented with concomitant radiographic and clinical signs of lower limb ischemia. All but one patient (axillobifemoral bypass) underwent femorofemoral crossover grafting by the cardiac surgeon during cooling. Results One hundred eighty-one cases of ATAAD underwent surgery during the study period with a mortality of 19.3%. Nine patients had persistent clinical evidence of lower limb ischemia (4.9%) and underwent extra-anatomical bypass during cooling. Two patients underwent additional fasciotomies. Mean delay from symptoms to surgery in these nine patients was 9.5 hours. Two patients had bilateral amputations despite revascularisation and, of note, had long delays in presentation for surgery (> 12 hours). There were no mortalities during these inpatient episodes. Outpatient radiographic follow-up at the first opportunity demonstrated 100% patency. Conclusion Our experience suggests that, during complicated aortic dissection, limb ischemia may have a devastating outcome including amputation when diagnosis and referral are delayed. Early diagnosis and surgery are crucial in preventing this potentially devastating complication.
Collapse
Affiliation(s)
- Thomas Theologou
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Amer Harky
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Shaw
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Hazim Eltyeb
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Walid Elbakbak
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mostafa Snosi
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Deborah Harrington
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Aung Oo
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| |
Collapse
|
21
|
Harky A, Harrington D, Nawaytou O, Othman A, Fowler C, Owens G, Torella F, Kuduvalli M, Field M. COVID-19 and cardiac surgery: A perspective from United Kingdom. J Card Surg 2020; 36:1649-1658. [PMID: 32981073 PMCID: PMC7537188 DOI: 10.1111/jocs.15039] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 09/05/2020] [Indexed: 12/11/2022]
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 in December 2019, presumed from the city of Wuhan, Hubei province in China, and the subsequent declaration of the disease as a pandemic by the World Health Organization as coronavirus disease 2019 (COVID‐19) in March 2020, had a significant impact on health care systems globally. Each country responded to this disease in different ways, however this was done broadly by fortifying and prioritizing health care provision as well as introducing social lockdown aiming to contain the infection and minimizing the risk of transmission. In the United Kingdom, a lockdown was introduced by the government on March 23, 2020 and all health care services were focussed to challenge the impact of COVID‐19. To do so, the United Kingdom National Health Service had to undergo widespread service reconfigurations and the so‐called “Nightingale Hospitals” were created de novo to bolster bed provision, and industries were asked to direct efforts to the production of ventilators. A government‐led public health campaign was publicized under the slogan of: “Stay home, Protect the NHS (National Health Service), Save lives.” The approach had a significant impact on the delivery of all surgical services but particularly cardiac surgery with its inherent critical care bed capacity. This paper describes the impact on provision for elective and emergency cardiac surgery in the United Kingdom, with a focus on aortovascular disease. We describe our aortovascular activity and outcomes during the period of UK lockdown and present a patient survey of attitudes to aortic surgery during COVID‐19 pandemic.
Collapse
Affiliation(s)
- Amer Harky
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deborah Harrington
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Omar Nawaytou
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Ahmed Othman
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Francesco Torella
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Prescot Street, Liverpool, UK.,School of Physical Sciences, University of Liverpool, Liverpool, UK
| | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark Field
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| |
Collapse
|
22
|
Abdulsalam A, Nawaytou O, Mehta V, Harrington D, Kuduvalli M, Field M. The Effect of Zone Implantation on Outcomes in Cases of Frozen Elephant Trunk. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Theologou T, Harky A, Shaw M, Harrington D, Kuduvalli M, Oo A, Field M. Mitroflow and Perimount Magna 10 years outcomes a direct propensity match analysis to assess reintervention rates and long follow‐up mortality. J Card Surg 2019; 34:1279-1287. [DOI: 10.1111/jocs.14250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Thomas Theologou
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Amer Harky
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Matthew Shaw
- Department of Clinical Audit and Clinical QualityThe Liverpool Heart and Chest HospitalLiverpool UK
| | - Deborah Harrington
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Manoj Kuduvalli
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Aung Oo
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Mark Field
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| |
Collapse
|
24
|
Mariscalco G, Bilal H, Catarino P, Hadjinikolaou L, Kuduvalli M, Field M, Mascaro J, Oo AY, Quarto C, Kuo J, Tsang G. Reflection From UK Aortic Group: Frozen Elephant Trunk Technique as Optimal Solution in Type A Acute Aortic Dissection. Semin Thorac Cardiovasc Surg 2019; 31:686-690. [PMID: 30980933 DOI: 10.1053/j.semtcvs.2019.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/18/2019] [Indexed: 12/29/2022]
Abstract
Diseases of the thoracic aorta are increasing in prevalence worldwide. Recent data indicated wide regional variation in the volume and complexity of aortic cases undertaken in United Kingdom cardiac centers, especially in case of acute type A aortic dissection (ATAAD) conditions. Patients treated in high-volume centers with a specific multidisciplinary aortic program had a significant reduction in ATAAD mortality when compared with low-volume centers. Following the initial phase of a national aortic center reorganization, the current study reflects the initial experience of a national collective of cardiothoracic surgeons with expertise in complex aortic surgery, using frozen elephant trunk as standard technique for the surgical treatment of patients affected by ATAAD. Between June 2013 and October 2017, 66 ATAAD patients (45% women) underwent hybrid aortic arch and frozen elephant trunk repair with the Thoraflex hybrid graft at 8 UK high-volume aortic centers. The in-hospital mortality accounted for 8 patients (12%). Postoperative temporary or permanent neurologic events and temporary renal replacement therapy occurred in 17% and 20% of patients, respectively. No spinal cord injury events were documented. Our data were similar to those reported in literature in the 2 largest experiences with the use of frozen elephant technique in ATAAD condition (in-hospital/30-day mortality: 11-12%). This initial experience demonstrated that frozen elephant technique can potentially be adopted as standard approach in life-threatening aortic diseases, with acceptable complication and mortality rates.
Collapse
Affiliation(s)
- Giovanni Mariscalco
- Cardiac Surgery Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
| | - Haris Bilal
- Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
| | | | - Leonidas Hadjinikolaou
- Cardiac Surgery Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Manoj Kuduvalli
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Jorge Mascaro
- University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Aung Y Oo
- Department of Cardiac Surgery, Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom
| | - Cesare Quarto
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, United Kingdom
| | - James Kuo
- Southwest Cardiothoracic Center, Derriford Hospital, Plymouth, United Kingdom
| | - Geoff Tsang
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | |
Collapse
|
25
|
Patris V, Giakoumidakis K, Argiriou M, Naka KK, Apostolakis E, Field M, Kuduvalli M, Oo A, Siminelakis S. Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach. Pragmat Obs Res 2018; 9:21-27. [PMID: 30022864 PMCID: PMC6044350 DOI: 10.2147/por.s157843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To estimate the incidence of postprocedural early cardiac complications among patients undergoing transcatheter aortic valve implantation, through transapical approach (TA-TAVI), and to identify factors independently associated with the occurrence of them. Patients and methods A retrospective cohort study of 90 patients, who had undergone TA-TAVI in a tertiary hospital of Liverpool, UK, during a 5-year period (September 2008–October 2013), was conducted. Data on patient demographics, periprocedural characteristics and cardiac complications presented within 30-day post TA-TAVI were collected, retrospectively, using the hospital’s electronic database. Results The overall 30-day incidence of cardiac complications was estimated at 18.9% (n=17/90). The rate of new onset of atrial fibrillation (AF), atrioventricular block requiring permanent pacemaker implantation, shockable cardiac arrest rhythm and cardiac tamponade was 11.1%, 3.3%, 2.2% and 2.2%, respectively. Bivariate analysis found that absence of preoperative AF (p=0.01), receiving of oral inotropes preprocedurally (p=0.01), intravenous inotropic support postprocedurally (p=0.01) and requirement for postprocedural tracheal intubation (p=0.001) were the main factors associated with increased probability for patient cardiac morbidity. Conclusion It seems that patients with absence of AF and oral inotropic support preprocedurally and those with post TA-TAVI mechanical ventilatory and intravenous inotropic support have greater probability to develop cardiac complications. This knowledge allows the early identification of high-risk patients and supports clinicians to apply both preventive and therapeutic interventions for the optimum patient management and care. In addition, administrators could allocate the health care system resources effectively.
Collapse
Affiliation(s)
- Vasileios Patris
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, Athens, Greece,
| | | | - Mihalis Argiriou
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, Athens, Greece,
| | - Katerina K Naka
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Mark Field
- Department of Cardiothoracic Surgery, Heart and Chest Hospital of Liverpool, Liverpool, UK
| | - Manoj Kuduvalli
- Department of Cardiothoracic Surgery, Heart and Chest Hospital of Liverpool, Liverpool, UK
| | - Aung Oo
- Department of Cardiothoracic Surgery, Heart and Chest Hospital of Liverpool, Liverpool, UK
| | - Stavros Siminelakis
- Department of Cardiothoracic Surgery, University of Ioannina, Ioannina, Greece
| |
Collapse
|
26
|
Patris V, Giakoumidakis K, Argiriou M, Naka KK, Apostolakis E, Field M, Kuduvalli M, Oo A, Siminelakis S. Predictors of length of stay and duration of tracheal intubation after transcatheter aortic valve implantation. J Thorac Dis 2017; 9:1012-1022. [PMID: 28523156 DOI: 10.21037/jtd.2017.03.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND While short-term outcomes for patients undergoing transcatheter aortic valve implantation (TAVI) have long been studied, there is very little data on their predictors. We aimed to identify the predictors of outcomes, such as intensive care unit (ICU) and in-hospital length of stay (LOS), duration of postoperative intubation and in-hospital mortality, after TAVI procedures. METHODS We conducted a retrospective cohort study of 162 consecutive patients with aortic valve disease, who were admitted to a tertiary hospital of Liverpool for TAVI, during a five-year period. The data was collected using of the hospital's structured database on November 2014. RESULTS By using a multivariate analysis we found that any postoperative bleeding [odds ratio (OR) 2.71; 95% confidence interval (CI): 1.41-5.24] was the independent predictor of prolonged ICU-LOS, while older age (OR 1.11; 95% CI: 1.05-1.17) and transapical TAVI (OR 4.11; 95% CI: 1.94-8.71) were the predictors of prolonged in-hospital LOS. Additionally, patients treated with oral inotropic agents, preoperatively (OR 5.77; 95% CI: 2.21-15.01), non-diabetics (OR 3.07; 95% CI: 1.12-8.42) and those with any postoperative bleeding (OR 3.53; 95% CI: 1.68-7.43) had a significantly greater probability in remaining intubated postoperatively. The multivariate analysis did not reveal any predictor of in-hospital mortality. CONCLUSIONS The above predictors permit the early identification of TAVI patients at high risk for longer hospitalization and increased mechanical ventilation. This piece of information is crucial for clinicians and administrators contributing to more efficient patient care planning and better allocation of healthcare resources.
Collapse
Affiliation(s)
- Vasileios Patris
- Department of Cardiothoracic Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | | | - Mihalis Argiriou
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Katerina K Naka
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Efstratios Apostolakis
- Department of Cardiothoracic Surgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Mark Field
- Department of Cardiothoracic Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Manoj Kuduvalli
- Department of Cardiothoracic Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Aung Oo
- Department of Cardiothoracic Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Stavros Siminelakis
- Department of Cardiothoracic Surgery, Medical School, University of Ioannina, Ioannina, Greece
| |
Collapse
|
27
|
Abstract
BACKGROUND Acute type A aortic dissection repair is a surgical emergency associated with high mortality. In 2007, Liverpool Heart & Chest Hospital was the first institution in the United Kingdom to implement a thoracic aortic on-call dissection rota. We set out to investigate whether the dissection rota improved hospital quality outcomes and long-term survival. METHODS Data from a prospectively collected database was analysed following case note validation. Two hundred patients underwent acute type A aortic dissection repair between October 1998 and November 2015. To assess the effect of the post-dissection rota on operative and postoperative outcomes, propensity matching of pre- and post-dissection rota patients was used. RESULTS Eighty patients were identified from the pre-dissection rota era and 120 from the post-dissection rota era. Sixty patients from each era were then propensity matched. Comparative analyses showed that patients who underwent acute type A dissection repair in the post-dissection rota period were less likely to suffer in-hospital mortality in both the matched and unmatched groups (30% vs. 13.3%; P=0.004 and 28.3% vs. 11.7%; P=0.055, respectively). A similar improvement was shown in acute renal failure (26.3% vs. 14.2%; P=0.033 and 31.7% vs. 15.0%; P=0.044, respectively). However, cardiopulmonary bypass times and aortic cross clamp times were still significantly longer in the matched post-dissection rota cohort. There was a significant improvement in 5-year survival for the pre- and post-dissection rota in both the matched and unmatched patients (P=0.004 and P=0.034). CONCLUSIONS Reorganization of surgical expertise, activity and implementation of a dissection rota within our hospital have resulted in lower in-hospital mortality and better survival outcomes in this group of patients.
Collapse
Affiliation(s)
- Mohamad Bashir
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Matthew Shaw
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Mark Field
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Manoj Kuduvalli
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Deborah Harrington
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Mathew Fok
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Aung Y Oo
- 1 Thoracic Aortic Aneurysm Service, 2 Department of Clinical Audit and Research, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| |
Collapse
|
28
|
Poon SS, Theologou T, Harrington D, Kuduvalli M, Oo A, Field M. Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis. Ann Cardiothorac Surg 2016; 5:156-73. [PMID: 27386403 DOI: 10.21037/acs.2016.05.06] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite recent advances in aortic surgery, acute type A aortic dissection remains a surgical emergency associated with high mortality and morbidity. Appropriate management is crucial to achieve satisfactory outcomes but the optimal surgical approach is controversial. The present systematic review and meta-analysis sought to access cumulative data from comparative studies between hemiarch and total aortic arch replacement in patients with acute type A aortic dissection. METHODS A systematic review of the literature using six databases. Eligible studies include comparative studies on hemiarch versus total arch replacement reporting short, medium and long term outcomes. A meta-analysis was performed on eligible studies reporting outcome of interest to quantify the effects of hemiarch replacement on mortality and morbidity risk compared to total arch replacement. RESULT Fourteen retrospective studies met the inclusion criteria and 2,221 patients were included in the final analysis. Pooled analysis showed that hemiarch replacement was associated with a lower risk of post-operative renal dialysis [risk ratio (RR) =0.72; 95% confidence interval (CI): 0.56-0.94; P=0.02; I(2)=0%]. There was no significant difference in terms of in-hospital mortality between the two groups (RR =0.84; 95% CI: 0.65-1.09; P=0.20; I(2)=0%). Cardiopulmonary bypass, aortic cross clamp and circulatory arrest times were significantly longer in total arch replacement. During follow up, no significant difference was reported from current studies between the two operative approaches in terms of aortic re-intervention and freedom from aortic reoperation. CONCLUSIONS Within the context of publication bias by high volume aortic centres and non-randomized data sets, there was no difference in mortality outcomes between the two groups. This analysis serves to demonstrate that for those centers doing sufficient total aortic arch activity to allow for publication, excellent and equivalent outcomes are achievable. Conclusions on differences in longer term outcome data are required. We do not, however, advocate total arch as a primary approach by all centers and surgeons irrespective of patient characteristics, but rather, a tailored approach based on surgeon and center experience and patient presentation.
Collapse
Affiliation(s)
- Shi Sum Poon
- Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Thomas Theologou
- Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deborah Harrington
- Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Aung Oo
- Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark Field
- Thoracic Aortic Aneurysm Service, Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| |
Collapse
|
29
|
Patris E, Giakoumidakis K, Patris V, Kuduvalli M, Argiriou M, Charitos C, Kalaitzis C, Touloupidis S. Perioperative prostate specific antigen levels among coronary artery bypass grafting patients: Does extracorporeal circulation and body temperature induce prostate specific antigen levels alterations? Urol Ann 2015; 7:58-62. [PMID: 25657546 PMCID: PMC4310119 DOI: 10.4103/0974-7796.148619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 02/10/2014] [Indexed: 11/16/2022] Open
Abstract
Purpose: The purpose of this study is to compare the perioperative total prostate specific antigen (tPSA) levels among coronary artery bypass grafting (CABG) patients with and without extracorporeal circulation (ECC), to investigate the changes overtime of tPSA in each group separately and to determine the effect of body core temperature on tPSA levels. Materials and Methods: A prospective study was conducted. Our sample was allocated to: (a) Seven patients who underwent off pump CABG (Group I) and (b) 16 CABG patients with ECC (Group II). The levels of tPSA were measured preoperatively (baseline), intra-operatively and at the 4th postoperative day. We compared the two groups on their tPSA levels and we investigated the changes of tPSA overtime in each group separately. Results: Intra-operative serum samples were obtained in significantly lower body temperature in patients of Group II than in those of Group I (31°C vs. 36.9°C, P < 0.001). In each group separately, postoperative tPSA levels were increased significantly compared to the baseline values (2.55 ng/ml vs. 0.39 ng/ml for Group I, P = 0.005 and 4.36 ng/ml vs. 0.77 for Group II, P < 0.001). CABG patients with ECC had significantly lower intra-operative tPSA levels than the baseline values (0.67 ng/ml vs. 0.77 ng/ml, P = 0.008). We did not observe significant differences of tPSA levels between the two groups. Conclusions: CABG surgery affects similarly the perioperative tPSA independently the involvement of ECC. Although all patients had significantly higher early postoperative tPSA levels, only those who underwent CABG with ECC had exceeded normal values and significantly decreased intra-operative tPSA. Hypothermia seems to be the causal factor of tPSA reduction.
Collapse
Affiliation(s)
- Emmanuel Patris
- Department of Urology, School of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece
| | | | - Vasileios Patris
- Department of Cardiac Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool L14 3 PE, United Kingdom
| | - Manoj Kuduvalli
- Department of Cardiac Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool L14 3 PE, United Kingdom
| | - Mihalis Argiriou
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, 10646 Athens, Greece
| | - Christos Charitos
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, 10646 Athens, Greece
| | - Christos Kalaitzis
- Department of Urology, School of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece
| | - Stavros Touloupidis
- Department of Urology, School of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece
| |
Collapse
|
30
|
Jafarzadeh F, Oo A, Kuduvalli M, Harrington D, Bashir M, Field M, Desmond M. 253 * INTRAOPERATIVE MOTOR EVOKED POTENTIAL CHANGES, PROCEDURE ALTERATIONS AND NEUROLOGICAL OUTCOME IN THORACIC AND THORACO-ABDOMINAL AORTIC ANEURYSM REPAIR. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
31
|
Fok M, Bashir M, Hammoud I, Harrington D, Kuduvalli M, Field M, Oo A. An apical left ventricular aneurysm rupture presenting as left breast mass 11 years after surgical repair. Ann R Coll Surg Engl 2014; 96:e6-7. [PMID: 25245713 DOI: 10.1308/003588414x13946184900561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Left ventricular (LV) pseudoaneurysm is a rare entity and, consequently, there is limited knowledge of the condition's natural history. The most frequent mode of presentation for LV pseudoaneurysm is heart failure with chest pain. However, the variable presentation of this condition requires a high index of suspicion for diagnosis. We report the case of a 75-year-old woman who had suffered an acute myocardial infarction 23 years previously, which resulted in a calcified LV apical aneurysm. Three weeks prior to being referred to our hospital, she was noted by her general practitioner to have a left-sided breast mass although mammography was negative. One week later, she attended the accident and emergency department; she was haemodynamically unstable but was resuscitated successfully. Contrast enhanced computed tomography showed a large haematoma located in the left chest wall communicating with the left ventricle. She underwent emergency cardiac surgical repair. On arrival at the intensive care unit following surgery, her haemodynamic status was unstable, and she deteriorated rapidly and died. With this report, we aim to raise the level of awareness for an apical LV pulsatile mass that could anatomically expand and present as a breast mass or tumour. An early diagnosis and timely surgical intervention is essential in order to achieve better outcomes and avoid detrimental complications.
Collapse
Affiliation(s)
- M Fok
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | | | | | | | | |
Collapse
|
32
|
Bashir M, Shaw M, Fok M, Harrington D, Field M, Kuduvalli M, Oo A. Long-term outcomes in thoracoabdominal aortic aneurysm repair for chronic type B dissection. Ann Cardiothorac Surg 2014; 3:385-92. [PMID: 25133101 DOI: 10.3978/j.issn.2225-319x.2014.05.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/22/2014] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Open repair for chronic aortic dissection remains a challenging surgical option. Different centers report diverse experiences and outcomes pertaining to thoracoabdominal aortic aneurysm repair (TAAAR) for chronic type B dissection. We highlight our center's experience and results on a background of published literature and current evidence. METHODS We reviewed 214 open TAAAR performed between October 1998 and February 2014. Of these, chronic type B dissection was present in 62 (29.0%) patients. We reviewed these patients in terms of demographics, operative characteristics and outcomes. Thirteen (21.0%) patients had surgery on the descending thoracic aorta [Category A =2 (3.2%), B =0 (0%), C =11 (17.7%)] and 49 (79.0%) in the thoracoabdominal thoracic aorta [Crawford extent I =5 (8.1%), extent II =39 (62.9%), extent III =4 (6.5%), extent IV =1 (1.6%)]. Left heart bypass was used in 12 (19.4%) patients. RESULTS The composite in-hospital endpoint, adverse outcome-defined as operative death, renal failure necessitating dialysis at discharge, stroke, or permanent paraplegia or paraparesis-occurred after 28 (45.2%) procedures. There were 14 (22.6%) operative deaths. In-hospital mortality was seven (16.3%) out of 43 elective patients, and increased to seven (36.8%) of the 19 non-elective ones. Permanent paraplegia or paraparesis occurred after two (3.2%) cases, stroke occurred after seven (11.3%) and renal failure requiring dialysis occurred after 16 (25.8%). Mean follow-up time was 3.2 years and actuarial 5-year mortality was 27.4% [nine (14.5%) elective and eight (12.9%) non-elective patients]. CONCLUSIONS TAAAR in chronic type B dissection carries a substantial risk of early adverse outcomes. The results could be well alleviated with cases directed towards specialized regional and supra-regional centers. Although the endovascular approaches offer relatively low mortality and morbidity, there is a lack of long-term data and guidelines on their use. There is a need for a multidisciplinary international registry on the management of thoracoabdominal aortic aneurysms and dissection. This would provide a degree of guidance on relevant clinical and surgical judgments and outcomes.
Collapse
Affiliation(s)
- Mohamad Bashir
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| | - Matthew Shaw
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| | - Matthew Fok
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| | - Deborah Harrington
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| | - Mark Field
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| | - Manoj Kuduvalli
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| | - Aung Oo
- 1 Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK ; 2 Department of Research and Clinical Audit, Liverpool Heart & Chest Hospital, Thomas Drive, L14 3PE, UK
| |
Collapse
|
33
|
Bashir M, Fok M, Shaw M, Field M, Kuduvalli M, Desmond M, Harrington D, Rashid A, Oo A. Liverpool Aortic Surgery Symposium V: New Frontiers in Aortic Disease and Surgery. Aorta (Stamford) 2014; 2:100-9. [PMID: 26798724 DOI: 10.12945/j.aorta.2014.13-051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 04/09/2014] [Indexed: 11/18/2022]
Abstract
Aortic aneurysm disease is a complex condition that requires a multidisciplinary approach in management. The innovation and collaboration among vascular surgery, cardiothoracic surgery, interventional radiology, and other related specialties is essential for progress in the management of aortic aneurysms. The Fifth Liverpool Aortic Surgery Symposium that was held in May 2013 aimed at bringing national and international experts from across the United Kingdom and the globe to deliver their thoughts, applications, and advances in aortic and vascular surgery. In this report, we present a selected short synopsis of the key topics presented at this symposium.
Collapse
Affiliation(s)
- Mohamad Bashir
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Fok
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Shaw
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Michael Desmond
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Abbas Rashid
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Aung Oo
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| |
Collapse
|
34
|
Bashir M, Field M, Shaw M, Fok M, Harrington D, Kuduvalli M, Oo A. Influences on Early and Medium-Term Survival Following Surgical Repair of the Aortic Arch. Aorta (Stamford) 2014; 2:56-73. [PMID: 26798716 DOI: 10.12945/j.aorta.2014.13-040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 03/12/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES It is now well established by many groups that surgery on the aortic arch may be achieved with consistently low morbidity and mortality along with relatively good survival compared to estimated natural history for a number of aortic arch pathologies. The objectives of this study were to: 1) report, compare, and analyze our morbidity and mortality outcomes for hemiarch and total aortic arch surgery; 2) examine the survival benefit of hemiarch and total aortic arch surgery compared to age- and sex-matched controls; and 3) define factors which influence survival in these two groups and, in particular, identify those that are modifiable and potentially actionable. METHODS Outcomes from patients undergoing surgical resection of both hemiarch and total aortic arch at the Liverpool Heart and Chest Hospital between June 1999 and December 2012 were examined in a retrospective analysis of data collected for The Society for Cardiothoracic Surgeons (UK). RESULTS Over the period studied, a total of 1240 patients underwent aortic surgery, from which 287 were identified as having undergone hemi to total aortic arch surgery under deep or moderate hypothermic circulatory arrest. Twenty three percent of patients' surgeries were nonelective. The median age at the time of patients undergoing elective hemiarch was 64.3 years and total arch was 65.3 years (P = 0.25), with 40.1% being female in the entire group. A total of 140 patients underwent elective hemiarch replacement, while 81 underwent elective total arch replacement. Etiology of the aortic pathology was degenerative in 51.2% of the two groups, with 87.1% requiring aortic valve repair in the elective hemiarch group and 64.2% in the elective total arch group (P < 0.001). Elective in-hospital mortality was 2.1% in the hemiarch group and 6.2% (P = 0.15) in the total arch group with corresponding rates of stroke (2.9% versus 4.9%, P = 0.47), renal failure (4.3% versus 6.2%, P = 0.54), reexploration for bleeding (4.3% versus 4.9%, P > 0.99), and prolonged ventilation (8.6% versus 16.1%, P = 0.09). Overall mortality was 20.9% at 5 years, while it was 15.7% in the elective hemiarch and 25.9% in the total arch group (P = 0.065). Process control charts demonstrated stability of annualized mortality outcomes over the study period. Survival curve was flat and parallel compared to age- and sex-matched controls beyond 2 years. Multivariate analysis demonstrated the following independent factors associated with survival: renal dysfunction [hazard ratio (HR) = 3.11; 95% confidence interval (CI) = 1.44-6.73], New York Heart Association (NYHA) class ≥ III (HR = 2.25; 95% CI = 1.38-3.67), circulatory arrest time > 100 minutes (HR = 2.92; 95% CI = 1.57-5.43), peripheral vascular disease (HR = 2.44; 95% CI = 1.25-4.74), and concomitant coronary artery bypass graft operation (HR = 2.14; 95% CI = 1.20-3.80). CONCLUSIONS Morbidity, mortality, and medium-term survival were not statistically different for patients undergoing elective hemi-aortic arch and total aortic arch surgery. The survival curve in this group of patients is flat and parallel to sex- and age-matched controls beyond 2 years. Multivariate analysis identified independent influences on survival as renal dysfunction, NYHA class ≥ III, circulatory arrest time (> 100 min), peripheral vascular disease, and concomitant coronary artery bypass grafting. Focus on preoperative optimization of some of these variables may positively influence long-term survival.
Collapse
Affiliation(s)
- Mohamad Bashir
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Shaw
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Fok
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Deborah Harrington
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Aung Oo
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| |
Collapse
|
35
|
Jafarzadeh F, Bashir M, Yan T, Harrington D, Field ML, Kuduvalli M, Oo A, Desmond M. Setting up and utilizing a service for measuring perioperative transcranial motor evoked potentials during thoracoabdominal aortic surgery and thoracic endovascular repair. Interact Cardiovasc Thorac Surg 2014; 18:748-56. [PMID: 24603163 DOI: 10.1093/icvts/ivu036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Paraplegia is a complication that may occur following surgery or endovascular stenting of thoracic and thoracoabdominal aortic pathology. Measuring transcranial motor evoked potentials (tcMEPs) has been shown to provide a reliable measure of spinal cord function during such procedures allowing interventions to protect cord function. In the spirit of sharing experience and eliminating the learning curve for others, this manuscript describes our experience of setting up a service for tcMEP monitoring as well as the documents and algorithms for measuring, recording and acting on the patient data, the so-called 'MEP Pathway'. METHODS Recording and interpretation of tcMEP during thoracoabdominal aortic intervention requires training of staff and close team working in the operating theatre and postoperative intensive care unit. Providing consistent, reliable, specific and sensitive information on spinal cord function and its safe and effective use to alter patient outcomes requires a protocol. The MEP pathway was developed by medical and paramedical staff at our institution based on clinical experience and literature reviews over a 1-year period (2012-2013). RESULTS The tcMEP pathway comprises six documents that guide staff in: (a) assessing suitability of patients, (b) setting up hardware, (c) preparing algorithms for management, (d) documenting intervention (left heart bypass, cardiopulmonary bypass or endovascular stenting) as well as (e) documenting postoperative intensive care processes. CONCLUSIONS The tcMEP pathway acts as a guide for safe introduction and use of tcMEPs in thoracoabdominal aortic interventions. tcMEP-led guidance of intraoperative and postoperative management in thoracic aortic surgery is an important adjunct in caring for this patient group.
Collapse
Affiliation(s)
- Fatemeh Jafarzadeh
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mohamad Bashir
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Tristan Yan
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deborah Harrington
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark L Field
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manoj Kuduvalli
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Aung Oo
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Michael Desmond
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| |
Collapse
|
36
|
Giakoumidakis K, Eltheni R, Patelarou A, Patris V, Kuduvalli M, Brokalaki H. Incidence and predictors of readmission to the cardiac surgery intensive care unit: A retrospective cohort study in Greece. Ann Thorac Med 2014; 9:8-13. [PMID: 24551011 PMCID: PMC3912693 DOI: 10.4103/1817-1737.124412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/21/2013] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION: Readmission in the intensive care unit (ICU) is a significant morbidity index, which has been related to poor patient outcomes AIM: To identify the preoperative and intraoperative risk factors for readmission in the cardiac surgery ICU. METHODS: We conducted a retrospective cohort study of 595 consecutive patients who were admitted to the cardiac surgery ICU of a tertiary hospital of Athens — Greece during the one-year period (September 2011-September 2012). Data collection was carried out, retrospectively, by the use of a short questionnaire and based on the review of medical and nursing patient records at December 2012. RESULTS: The incidence of ICU readmission was 3.7% (22/595). Respiratory disorders were the main reason for readmission (45.4%). Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (P < 0.001). Multivariate analysis revealed that female gender [for males odds ratio (OR) 0.37, 95% confidence interval (CI) 0.15-0.89], high logistic EuroSCORE (OR 1.02, 95% CI 1.00-1.04), prolonged cardiopulmonary (CPB) duration (OR 1.01, 95% CI 1.00-1.02) and preoperative renal failure (OR 1.02, 95% CI 1.00-1.05) were the independent risk factors for readmission to the cardiac surgery ICU. CONCLUSIONS: One intraoperative and three preoperative variables are associated strongly with higher probability for ICU readmission. Shorter CPB duration could contribute to lower ICU readmission incidence. In addition, the early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both the more efficient healthcare planning and resources allocation.
Collapse
Affiliation(s)
| | - Rokeia Eltheni
- Cardiac Surgery ICU, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Athina Patelarou
- Department of Anaesthesiology, University Hospital of Heraklion, Crete, Greece
| | - Vasileios Patris
- Cardiothoracic department, Liverpool Heart And Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Cardiothoracic department, Liverpool Heart And Chest Hospital, Liverpool, United Kingdom
| | - Hero Brokalaki
- Faculty of Nursing, National & Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
37
|
Jafarzadeh F, Field ML, Harrington DK, Kuduvalli M, Oo A, Kendall J, Desmond M, Mills K. Novel application of acetazolamide to reduce cerebrospinal fluid production in patients undergoing thoracoabdominal aortic surgery. Interact Cardiovasc Thorac Surg 2013; 18:21-6. [PMID: 24130087 DOI: 10.1093/icvts/ivt384] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Paraplegia is a rare but devastating complication, which may follow thoracoabdominal aortic surgery. Many adjuncts have been developed to reduce this risk including cerebrospinal fluid (CSF) drainage. Acetazolamide (carbonic anhydrase inhibitor) is a drug used to counteract mountain sickness and one of its effects is to reduce CSF production. Here, we report its first postoperative application in thoracoabdominal surgery with the aim of reducing cerebrospinal cord perfusion pressure and reducing risk of paraplegia. METHODS We retrospectively reviewed 6 patients who have been treated with this drug between 2011 and 2012 who were undergoing thoracoabdominal aortic surgery. Our indications were decided to include: (i) patients in whom a spinal drain could not be positioned; (ii) patients with blood-stained CSF; (iii) patients in whom the volume of CSF drained was outside guidelines; (iv) patients in whom CSF pressure was elevated; (v) patients with excessive vasopressor usage and (vi) patients with postoperative neurological dysfunction as measured by motor-evoked potentials or clinical examination. All were given 500 mg intravenous acetazolamide, not more than eight hourly, for a duration dependent on response. RESULTS In the 6 patients, 2 received a single dose of the drug and responded by an immediate drop in intracranial pressure (ICP) pressure. Of the 4 who received multiple doses of the drug, 1 had an immediate decline in ICP after each of the first six doses, while 3 had no discernable response. CONCLUSIONS This is the first report of the efficacy of acetazolamide in reducing CSF production and lowering ICP during thoracoabdominal aortic surgery. We believe that its use will be beneficial in the 6 patient groups described. Our experience suggests there are 'responders' and 'non-responders', the characteristics of whom are yet to be defined. Its efficacy in reducing not just CSF volume and ICP but also clinically relevant morbidity such as paraplegia, is the subject of a planned randomized controlled trial. This report serves to raise awareness of the possible efficacy of this drug when normal management strategies are limited or exhausted.
Collapse
Affiliation(s)
- Fatemeh Jafarzadeh
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Bashir M, Fok M, McWilliams RG, Desmond M, Field M, Fisher RK, Oo A, Kuduvalli M. A Single-Stage Repair of Arch and Descending Thoracic Aortic Aneurysms Using Jotec E-vita Open Plus Hybrid Stent Graft Combined With Antegrade Deployment of Thoracic Endograft. Aorta (Stamford) 2013; 1:227-30. [PMID: 26798698 DOI: 10.12945/j.aorta.2013.13-037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/20/2013] [Indexed: 11/18/2022]
Abstract
We report a unique case of a 63-year-old female with extensive peripheral vascular disease who underwent a single-stage surgical repair of the aortic arch and descending thoracic aortic aneurysm utilizing the Jotec E-vita Open Plus hybrid stent graft system combined with antegrade deployment of a thoracic endograft via a median sternotomy.
Collapse
Affiliation(s)
- Mohamad Bashir
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Fok
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Richard G McWilliams
- Radiology Department, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom; and
| | - Michael Desmond
- Department of Anaesthesia, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Robert K Fisher
- Department of Vascular Surgery, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom
| | - Aung Oo
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| |
Collapse
|
39
|
Bashir M, Shaw M, Desmond M, Kuduvalli M, Field M, Oo A. Cerebral protection in hemi-aortic arch surgery. Ann Cardiothorac Surg 2013; 2:239-44. [PMID: 23977590 DOI: 10.3978/j.issn.2225-319x.2013.02.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 02/20/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Mohamad Bashir
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | | | | | | |
Collapse
|
40
|
Bashir M, McWilliams RG, Desmond M, Kuduvalli M, Oo A, Field M. Blunt aortic injury secondary to fragmented tenth thoracic vertebral body. Ann Thorac Surg 2013; 95:2161-4. [PMID: 23706439 DOI: 10.1016/j.athoracsur.2012.09.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 09/17/2012] [Accepted: 09/25/2012] [Indexed: 11/17/2022]
Abstract
We present a case of blunt traumatic aortic laceration following a motor vehicle crash. The aortic laceration was 4.5 cm above the coeliac axis and occurred because of an unstable tenth thoracic vertebral body. Open surgery was considered high risk, whereas an endovascular approach with an endoprosthesis placed at the exact anatomic location of the laceration was advocated.
Collapse
Affiliation(s)
- Mohamad Bashir
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thoracic Aortic Aneurysm Service, Liverpool, United Kingdom.
| | | | | | | | | | | |
Collapse
|
41
|
Fok M, Bashir M, Rimmer L, Hammoud I, Oo A, Harrington D, Kuduvalli M, Field M. Imaging of Thoracic Intercostal Artery Rupture during the Propagation of a Type B Acute Aortic Syndrome. Aorta (Stamford) 2013; 1:202-205. [PMID: 26798695 PMCID: PMC4682744 DOI: 10.12945/j.aorta.2013.13-033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 08/30/2013] [Indexed: 06/05/2023]
Abstract
The natural history of an intramural hematoma (IMH) has not been completely defined. This is a case report of a 63-year-old woman, in whom imaging reveals intercostal artery rupture during the process of expansion of an IMH in a Type B acute aortic syndrome. This case demonstrates that intercostal artery rupture may act as a precursor for the transformation of IMH to a classical dissection. Interestingly, complete resolution of this condition is achieved through medical management.
Collapse
Affiliation(s)
- Matthew Fok
- Corresponding author: Matthew Fok, MBChB, Institute of Cardiovascular Medicine & Science, Thoracic Aneurysm Service, Liverpool Heart & Chest Hospital, Thomas Drive, Liverpool, L14 3PE, United Kingdom, Tel: +0044151 600 1616, Fax: +0044151 600 1862, E-Mail:
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Bashir M, Fok M, Hammoud I, Rimmer L, Shaw M, Field M, Harrington D, Kuduvalli M, Oo A. A Perspective on Natural History and Survival in Nonoperated Thoracic Aortic Aneurysm Patients. Aorta (Stamford) 2013; 1:182-9. [PMID: 26798691 DOI: 10.12945/j.aorta.2013.13-043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 08/22/2013] [Indexed: 01/15/2023]
Abstract
There are many questions that remain unanswered in the understanding of the natural history of thoracic aortic aneurysm (TAA). This review will critically appraise the current published evidence on the natural history of TAA in nonoperated patients and their present rates of survival.
Collapse
Affiliation(s)
- Mohamad Bashir
- The Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Fok
- The Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Ibrahim Hammoud
- The Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Lara Rimmer
- The Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Shaw
- Clinical Research and Development Unit, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- The Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Debbie Harrington
- The Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- The Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Aung Oo
- The Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| |
Collapse
|
43
|
Field ML, Vallabhaneni SR, Kuduvalli M, Brennan JA, Torella F, McWilliams RG, Oo A. Combined Cardiac Surgery and Endovascular Repair of Abdominal Aortic Aneurysms. J Endovasc Ther 2013; 20:345-9. [PMID: 23731307 DOI: 10.1583/12-3966r.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
44
|
Field ML, Harrington D, Bashir M, Kuduvalli M, Oo A. Intervention on thoracic and thoracoabdominal aortic aneurysms: can the UK offer a service? J R Soc Med 2012; 105:457-63. [PMID: 23257968 PMCID: PMC3526849 DOI: 10.1258/jrsm.2012.110354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Mark L Field
- Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool LS14 3PE, UK.
| | | | | | | | | |
Collapse
|
45
|
Theologou T, Ellison G, Vicinanza C, Torella M, Galuppo V, Leone A, Mendicino I, Sacco W, Bochicchio A, Field M, Oo A, Kuduvalli M, Indolfi C, Nadal-Ginard B, Torella D. European Society for Surgical Research: Biological Properties & Regenerative Potential, in Vitro & in Vivo, of Human Cardiac Stem Cells Isolated from the Adult Human Heart. J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
46
|
Attaran S, Safar M, Saleh HZ, Field M, Kuduvalli M, Oo A. Cannulating a Dissecting Aorta Using Ultrasound-Epiaortic and Transesophageal Guidance. Heart Surg Forum 2011; 14:E373-5. [DOI: 10.1532/hsf98.20101170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<p>Management of acute Stanford type A aortic dissection remains a major surgical challenge. Directly cannulating the ascending aorta provides a rapid establishment of cardiopulmonary bypass but consists of risks such as complete rupture of the aorta, false lumen cannulation, subsequent malperfusion and propagation of the dissection.</p><p>We describe a technique of cannulating the ascending aorta in patients with acute aortic dissection that can be performed rapidly in hemodynamically unstable patients under ultrasound-epiaortic and transesophageal (TEE) guidance.</p>
Collapse
|
47
|
Elsayed H, Govindraj R, El-Dean I, Kuduvalli M. Acute coronary syndrome due to coronary artery-pulmonary artery fistula. Asian Cardiovasc Thorac Ann 2011; 19:284. [PMID: 21885559 DOI: 10.1177/0218492311406550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hany Elsayed
- Cardiothoracic Department, Liverpool Heart and Chest Hospital, Liverpool, UK.
| | | | | | | |
Collapse
|
48
|
Field M, Doolan J, Safar M, Kuduvalli M, Oo A, Mills K, Kendall J, Desmond M. The safe use of spinal drains in thoracic aortic surgery. Interact Cardiovasc Thorac Surg 2011; 13:557-65. [DOI: 10.1510/icvts.2011.272211] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
49
|
Saleh HZ, Field M, Kuduvalli M, Oo AY. Synchronized epiaortic two-dimensional and color Doppler echocardiographic guidance enable routine ascending aortic cannulation in type A acute aortic dissection. J Thorac Cardiovasc Surg 2011; 142:479-80; author reply 480. [PMID: 21763885 DOI: 10.1016/j.jtcvs.2011.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 03/21/2011] [Indexed: 11/17/2022]
|
50
|
Attaran S, Field M, Desmond M, Priona G, Helliwell TR, Collis SA, Kuduvalli M, Oo A. Polypoid pseudomyxoma of ascending aorta after replacement with a Dacron graft. Ann Thorac Surg 2011; 92:338-9. [PMID: 21718870 DOI: 10.1016/j.athoracsur.2010.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 10/24/2010] [Accepted: 12/27/2010] [Indexed: 10/18/2022]
Abstract
We report a 58-year-old man who had a multi-lobulated pseudomyxomatous lesion in his ascending aorta 6 months after his root and ascending aorta was replaced by a Dacron graft.
Collapse
Affiliation(s)
- Saina Attaran
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|