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Itokawa R, Kowatari R, Imamura Y, Sasaki H, Kondo N, Daitoku K, Minakawa M. Delayed surgery for acute type A aortic dissection: a retrospective review of an alternative surgical strategy in the COVID-19 era. J Cardiothorac Surg 2024; 19:250. [PMID: 38643107 PMCID: PMC11031994 DOI: 10.1186/s13019-024-02682-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/24/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND During the coronavirus disease (COVID-19) pandemic, medical resources have often been limited to emergency surgeries. This study aimed to evaluate our experience with delayed surgery for acute type A aortic dissections (ATAADs). METHODS A retrospective study was conducted on 33 patients who underwent surgery for ATAADs between January 2020 and December 2021. The patients were divided into two groups: patients treated within 12 h of arrival (E group; N = 21) and those treated > 12 h after arrival (D group; N = 12) with strict antihypertensive therapy until surgery. RESULTS The plasma fibrinogen levels on arrival were lower in the D group than in the E group (174.3 ± 109.1 vs 293.4 ± 165.4, p = 0.038). The time to surgery from symptom onset was longer in the D group than in the E group (4 ± 1 h vs. 86 ± 108 h, p < 0.001). There was one case (3%) of mortality and seven cases (21%) of cerebral infarctions in the E group. There was no significant difference in the intraoperative data and quantity of blood transfused between the two groups. CONCLUSION Thus, delayed surgery for ATAAD with appropriate preoperative management may be an alternative surgical strategy in the COVID-19 era.
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Affiliation(s)
- Rin Itokawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ryosuke Kowatari
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Yuki Imamura
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hanae Sasaki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Norihiro Kondo
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
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Nishida H, Nakamura R, Tamaki R, Abe K. Inconsistent false lumen enhancement predicts late aortic events after hemiarch replacement in Acute type A aortic dissection. Am J Cardiol 2024:S0002-9149(24)00272-8. [PMID: 38636625 DOI: 10.1016/j.amjcard.2024.04.012] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/01/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
The impact of inconsistent enhancement within the patent false lumen on the occurrence of late aortic events remains uncertain. We enrolled a total of 55patients who exhibited a patent false lumen following hemiarch replacement. The Hounsfield unit(HU) measurements in the patent false lumen were obtained at two specific locations: the aortic arch(a) and the descending aorta(b). "The false lumen HU score" was calculated as the absolute value of 1-a/b, representing the discrepancy in Hounsfield units within the patent false lumen. We investigated the cutoff value of the false lumen HU score with the receiver operating characteristics curve to predict the incidence of late aortic events. We divided the patients based on the cutoff value and compared the cumulative incidence of the late aortic events. Analysis of the receiver operating characteristics curve showed the cutoff value of the false lumen HU score was 0.345. Based on this cutoff value, we divided them into two groups: GroupA(score<0.345,n=26) and Group B(score≧0.345,n=29). The baseline characteristics were similar between the two groups. Cumulative incidence of the late aortic events was significantly lower in Group A(7.8% at 5years) than in Group B(39.9% at 5years) (p=0.02). The false lumen HU score might be useful to predict the incidence of late aortic events following hemiarch replacement.
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Affiliation(s)
- Hidefumi Nishida
- Department of Cardiovascular Surgery, St.Luke's International Hospital, Tokyo, Japan.
| | - Ryota Nakamura
- Department of Cardiovascular Surgery, St.Luke's International Hospital, Tokyo, Japan
| | - Rihito Tamaki
- Department of Cardiovascular Surgery, St.Luke's International Hospital, Tokyo, Japan
| | - Kohei Abe
- Department of Cardiovascular Surgery, St.Luke's International Hospital, Tokyo, Japan
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Pan H, Shi Z, Wang S, Bai J, Zhang T. A predictive model of 30-day mortality in patients with acute type A aortic dissection. Eur J Radiol 2024; 175:111469. [PMID: 38636409 DOI: 10.1016/j.ejrad.2024.111469] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/14/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Acute type A aortic dissection (ATAAD) is a life-threatening cardiovascular disease that requires an effective predictive model to predict and assess a patient's risk of death. Our study aimed to construct a model for predicting the risk of 30-day death in patients with ATAAD and the prediction accuracy of the German Registry of Acute Aortic Dissection Type A (GERAADA) Score and the European System for Cardiac Operative Risk Evaluation (EuroSCORE II) was verified. MATERIALS AND METHODS Between June 2019 and June 2023, 109 patients with ATAAD underwent surgical treatment at our hospital (35 in the death group and 74 in the survival group). The differences in image parameters between the two groups were compared. Search for independent predictors and develop models that predict 30-day mortality in patients with ATAAD. GERAADA Score and EuroSCORE II were retrospectively calculated and indicated mortality was assessed using the receiver operating characteristic (ROC) curve. RESULTS Logistic regression analysis showed that ascending aortic length and pericardial effusion were independent predictors of death within 30 days in patients with ATAAD. We constructed four models, GERAADA Score (Model 1), EuroSCORE II (Model 2), Model 1, ascending aorta length, and pericardial effusion (Model 3), and Model 2, ascending aorta length, and pericardial effusion (Model 4). The area under the curve (AUC = 0.832) of Model 3 was significantly different from those of Models 1 (AUC = 0.683) and 2 (AUC = 0.599), respectively (p < 0.05, DeLong test). CONCLUSIONS Adding ascending aorta length and pericardial effusion to the GERAADA Score can improve the predictive power of 30-day mortality in patients with ATAAD.
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Affiliation(s)
- Hong Pan
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhenzhou Shi
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Shuting Wang
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jinquan Bai
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tong Zhang
- Department of Radiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
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Matniyaz Y, Luo YX, Jiang Y, Zhang KY, Wang WZ, Pan T, Wang DJ, Xue YX. Short- and Long-term survival prediction in patients with acute type A aortic dissection undergoing open surgery. J Cardiothorac Surg 2024; 19:171. [PMID: 38566106 PMCID: PMC10988835 DOI: 10.1186/s13019-024-02687-x] [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: 08/07/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Acute Type A aortic dissection (ATAAD) is a life-threatening cardiovascular disease associated with high mortality rates, where surgical intervention remains the primary life-saving treatment. However, the mortality rate for ATAAD operations continues to be alarmingly high. To address this critical issue, our study aimed to assess the correlation between preoperative laboratory examination, clinical imaging data, and postoperative mortality in ATAAD patients. Additionally, we sought to establish a reliable prediction model for evaluating the risk of postoperative death. METHODS In this study, a total of 384 patients with acute type A aortic dissection (ATAAD) who were admitted to the emergency department for surgical treatment were included. Based on preoperative laboratory examination and clinical imaging data of ATAAD patients, logistic analysis was used to obtain independent risk factors for postoperative in-hospital death. The survival prediction model was based on cox regression analysis and displayed as a nomogram. RESULTS Logistic analysis identified several independent risk factors for postoperative in-hospital death, including Marfan syndrome, previous cardiac surgery history, previous renal dialysis history, direct bilirubin, serum phosphorus, D-dimer, white blood cell, multiple aortic ruptures and age. A survival prediction model based on cox regression analysis was established and presented as a nomogram. The model exhibited good discrimination and significantly improved the prediction of death risk in ATAAD patients. CONCLUSIONS In this study, we developed a novel survival prediction model for acute type A aortic dissection based on preoperative clinical features. The model demonstrated good discriminatory power and improved accuracy in predicting the risk of death in ATAAD patients undergoing open surgery.
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Affiliation(s)
- Yusanjan Matniyaz
- Department of Cardiac Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Number 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Number 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Yuan-Xi Luo
- Department of Cardiac Surgery, Affiliated Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Yi Jiang
- Department of Cardiac Surgery, Affiliated Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Ke-Yin Zhang
- Department of Cardiac Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Number 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Wen-Zhe Wang
- Department of Cardiac Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Number 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Tuo Pan
- Department of Cardiac Surgery, Affiliated Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
| | - Dong-Jin Wang
- Department of Cardiac Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Number 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Number 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
- Department of Cardiac Surgery, Affiliated Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Number 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Number 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
| | - Yun-Xing Xue
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Number 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
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Xie LF, Han X, Xie YL, He J, Wu QS, Qiu ZH, Chen LW. A Predictive Model for Prolonged Mechanical Ventilation After Triple-Branched Stent Graft for Acute Type A Aortic Dissection. J Surg Res 2024; 296:66-77. [PMID: 38219508 DOI: 10.1016/j.jss.2023.12.007] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/13/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION The aim of this study is to develop a model for predicting the risk of prolonged mechanical ventilation (PMV) following surgical repair of acute type A aortic dissection (AAAD). METHODS We retrospectively collected clinical data from 381 patients with AAAD who underwent emergency surgery. Clinical features variables for predicting postoperative PMV were selected through univariate analysis, least absolute shrinkage and selection operator regression analysis, and multivariate logistic regression analysis. A risk prediction model was established using a nomogram. The model's accuracy and reliability were evaluated using the area under the curve of the receiver operating characteristic curve and the calibration curve. Internal validation of the model was performed using bootstrap resampling. The clinical applicability of the model was assessed using decision curve analysis and clinical impact curve. RESULTS Among the 381 patients, 199 patients (52.2%) experienced postoperative PMV. The predictive model exhibited good discriminative ability (area under the curve = 0.827, 95% confidence interval: 0.786-0.868, P < 0.05). The calibration curve confirmed that the predicted outcomes of the model closely approximated the ideal curve, indicating agreement between the predicted and actual results (with an average absolute error of 0.01 based on 1000 bootstrap resampling). The decision curve analysis curve demonstrated that the model has significant clinical value. CONCLUSIONS The nomogram model established in this study can be used to predict the risk of postoperative PMV in patients with AAAD. It serves as a practical tool to assist clinicians in adjusting treatment strategies promptly and implementing targeted therapeutic measures.
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Affiliation(s)
- Lin-Feng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, P. R. China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Xu Han
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
| | - Yu-Ling Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, P. R. China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Jian He
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, P. R. China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Qing-Song Wu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, P. R. China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Zhi-Huang Qiu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, P. R. China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, P. R. China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, P. R. China.
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Hu M, Wang J, Zhou Y, Wei X. Intermittent horizontal mattress suture technique in aortic root anastomosis for acute type A. Asian J Surg 2024:S1015-9584(24)00207-0. [PMID: 38378430 DOI: 10.1016/j.asjsur.2024.01.153] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Min Hu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Jing Wang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yongzhi Zhou
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Wei J, Hu Z, Wang W, Ding R, Chen Z, Yuan X, Xu F. Posterior False Lumen and Paraplegia Following FET Procedure in Acute Type A Aortic Dissection. Ann Thorac Surg 2024:S0003-4975(24)00099-7. [PMID: 38331207 DOI: 10.1016/j.athoracsur.2024.01.026] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Postoperative paraplegia is the major concern for frozen elephant trunk (FET) procedure in acute type A aortic dissection (ATAAD) patients. It is crucial to determine patients with high risk of paraplegia before implementing FET procedure. METHODS From January 2013 to December 2018, 544 ATAAD patients undergoing FET procedure were included in this study. The segment number of posterior false lumen (PFL) between T9-L2 levels was calculated. In-hospital outcomes and long-term survival were investigated based on the number of PFL. RESULTS The average age was 46.5±9.9 years old and the proportion of female was 19.5% in this cohort. The incidence of postoperative paraplegia was significantly increased when PFL was presented in 3 or more segments. Patients were divided into high-PFL (3-6 segments) (n=124) and low-PFL group (0-2 segments) (n=420). The demographic characteristics were similar between the two groups. The involvement of celiac trunk and superior mesenteric artery were significantly lower in the high-PFL group (all P<0.05). The other baseline characteristics and procedural information were statistically balanced. The incidence of postoperative paraplegia was significantly higher in the high-PHL groups (7.3% vs 1.9%, P=0.006). Multivariable logistic analysis revealed that the high-PFL was independently associated with postoperative paraplegia following FET procedure (OR=3.812, 95%CI: 1.378-10.550, P=0.010). Additionally, the moderate nasopharyngeal temperature of hypothermic circulatory arrest (≧23.0°C) was clarified as a protective factor for paraplegia (OR=0.112, 95%CI: 0.023-0.535, P=0.006). CONCLUSIONS ATAAD patients presenting with High-PFL between T9-L2 levels have significant high risk of postoperative paraplegia if undergoing FET procedure.
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Affiliation(s)
- Jinhua Wei
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Zhan Hu
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Wei Wang
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Runyu Ding
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Zujun Chen
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xin Yuan
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Fei Xu
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.
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Dumfarth J, Gasser S, Stastny L, Grimm M. Validation of GERAADA score-first step towards quality control in aortic surgery. Eur J Cardiothorac Surg 2024; 65:ezae023. [PMID: 38263594 DOI: 10.1093/ejcts/ezae023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/18/2024] [Indexed: 01/25/2024] Open
Affiliation(s)
- Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Simone Gasser
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Lukas Stastny
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
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Sun L, Li H, Feng X, Li X, Wang G, Sun J, Zhang X, Zhang W, Wang J, Niu Z, Liu G. Morphological risk of acute type A aortic dissection in the mildly to moderately dilated aorta. Eur J Cardiothorac Surg 2024; 65:ezae016. [PMID: 38218720 DOI: 10.1093/ejcts/ezae016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVES This study aimed to analyse and determine the role of aortic length and curvature in the pathogenesis of acute type A aortic dissection (ATAAD) with ascending aortic diameters (AADs) <5 cm. METHODS We reviewed the clinical and imaging data of patients with ATAAD (n = 201) and ascending aortic dilation (n = 83). Thoracic aortic bending index (TABI) was used to quantify aortic curvature and analyse its role in ATAAD below the diameter risk threshold. RESULTS The AAD was <5.0 and <4.0 cm in 78% and 37% of patients with ATAAD, respectively. The median ascending aortic length (AAL) was 104.6 mm (Q1-Q3, 96.5-113.6 mm), and in 62.7% of patients, it was <11 cm. The median TABI was 14.99 mm/cm (Q1-Q3, 14.18-15.86 mm/cm). Patients with ATAAD and those with aortic dilation were matched for AAD, age, sex, height and other clinical factors. After matched, the dissection group had higher AALs (median, 102.9 mm; Q1-Q3, 96.0-112.5 mm vs median, 88.2 mm; Q1-Q3, 83.7-95.9 mm; P < 0.001) and TABI (median, 14.84 mm/cm; Q1-Q3, 14.06-15.83 mm/cm vs median, 13.55 mm/cm; Q1-Q3, 13.03-14.28 mm/cm; P < 0.001). According to the regression analysis, the area under the curve required to distinguish patients with ATAAD from those with aortic dilation was 0.831 in AAL, 0.837 in TABI and 0.907 when AAL was combined with TABI. CONCLUSIONS The patients with ATAAD had higher AAL and TABI than those with aortic dilation. The combination of TABI and AAL might be a potential morphological marker for determining ATAAD risk below the current aortic diameter risk threshold.
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Affiliation(s)
- Lianjie Sun
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Haoyou Li
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Xiangzhen Feng
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao Li
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guoqing Wang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianchao Sun
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoming Zhang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenfeng Zhang
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Jianxun Wang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhaozhuo Niu
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Gaoli Liu
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Fakim D, Qin C, Chu MWA. Bio-Bentall and hybrid arch frozen elephant trunk repair for acute type A aortic dissection with malperfusion. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 38062928 DOI: 10.1510/mmcts.2023.092] [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] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The extent of repair in patients with acute type A aortic dissection is often determined by factors such as entry tear location, aortic anatomy, malperfusion and team expertise. The hybrid arch frozen elephant trunk, which has become an established technique to extend the distal acute type A aortic dissection repair, is particularly useful in malperfusion; however, it remains technically challenging and is associated with increased duration of circulatory arrest and risks of spinal cord ischaemia. Proximal dissection flap extension often determines repairability versus replacement of the aortic root. We present a case report highlighting the proximal and distal extent of repair in a patient with a known ascending aortic aneurysm presenting with an acute type A aortic dissection, with malperfusion, undergoing a successful bio-Bentall procedure and hybrid arch frozen elephant trunk repair.
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Affiliation(s)
- Djalal Fakim
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Chaoyi Qin
- 1Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada 2Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
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Minamidate N, Wakisaka H, Hachiro K, Miyashita F, Morimoto M, Kondo Y, Enomoto M, Takashima N, Suzuki T. Is central repair with coronary artery bypass grafting enough for multi-organ malperfusion in acute type A aortic dissection with coronary malperfusion? Asian J Surg 2023; 46:5449-5453. [PMID: 37311670 DOI: 10.1016/j.asjsur.2023.05.117] [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] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVES Acute type A aortic dissection with coronary malperfusion syndrome is rare but associated with high mortality. Multi-organ malperfusion is an independent predictor of acute type A aortic dissection. Coronary malperfusion requires treatment, but it is not feasible to treat all malperfusions. The adequacy of "central repair and coronary artery bypass grafting" for patients with coronary and other organ malperfusion is unknown. METHODS Of the 299 patients who underwent surgery between 2008 and 2018, 21 patients with coronary malperfusion, who received cental repair with coronary artery graft bypass, were analyzed retrospectively. They were divided; into Group M (n = 13, coronary and other organ malperfusion) and Group O (n = 8, coronary malperfusion only). The patient background, surgical content, details of malperfusion, surgical mortality and morbidity, and long-term outcome were compared. RESULTS There was no difference in operation time (205 ± 30 vs. 266 ± 88, p = 0.49), but the time from arrival to circulatory arrest tended to be shorter in Group M (81 vs. 134, p = 0.05). Among Group M, cerebral malperfusion was the most common at 92%. Two of the three cases with mesenteric malperfusion died. The mortality of Group M and Group O was 13% and 15% (P = 0.85), respectively. There was no difference in long-term mortality (p = 0.62). CONCLUSIONS Central repair and coronary artery bypass grafting is a sufficiently acceptable treatment for patients with acute type A aortic dissection and multi-organ malperfusion, including coronary malperfusion.
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Affiliation(s)
- Naoshi Minamidate
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan.
| | - Hodaka Wakisaka
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Kohei Hachiro
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Fumihiro Miyashita
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Masanori Morimoto
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yasuo Kondo
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Masahide Enomoto
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Noriyuki Takashima
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
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12
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Osada H, Minatoya K. Overview of acute type A dissection in Japan. Indian J Thorac Cardiovasc Surg 2023; 39:280-286. [PMID: 38093936 PMCID: PMC10713900 DOI: 10.1007/s12055-023-01548-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/04/2023] [Accepted: 05/24/2023] [Indexed: 12/17/2023] Open
Abstract
Acute type A aortic dissection is a relatively uncommon but devastating disease and usually requires emergency surgery. Based on the several database projects, a large amount of perioperative patient data has now been accumulated and is expected to be useful in clinical practice. Especially in Japan, the number of surgeries for acute type A aortic dissection has been gradually increasing recently, and the overall mortality rate has stabilized at less than 10%. One of the keys to further improvement in outcomes will be to improve the results of aortic root replacement. In addition, strategies need to be established for very elderly patients, comatose patients, and patients with malperfusion as preoperative conditions. The use of a relatively new device, the frozen elephant trunk, is also increasing and might be changing the surgical outcome. In this report, we describe the current status of acute type A aortic dissection in Japan, with reference to recent guidelines and literature.
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Affiliation(s)
- Hiroaki Osada
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507 Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507 Japan
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13
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Ishigaki T, Wakasa S, Shingu Y, Ohkawa Y, Yamada A. Impact of sarcopenia on early and mid-term outcomes of surgery for acute type A aortic dissection in octogenarians. Gen Thorac Cardiovasc Surg 2023; 71:674-680. [PMID: 36995640 DOI: 10.1007/s11748-023-01932-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To determine the association between sarcopenia and surgical outcomes in octogenarians with acute type A aortic dissection. METHODS We enrolled 72 octogenarians who had undergone type A aortic dissection surgery between April 2013 and March 2019. The psoas muscle index, an indexed area of the psoas muscle at the L3 level on preoperative computed tomography, was obtained as an indicator of sarcopenia. The study participants were divided into sarcopenia and non-sarcopenia groups based on the mean psoas muscle index. The postoperative outcomes were compared between the groups. RESULTS The median age was 84 years (interquartile range 82-87 years), and 13 patients were male. The mean psoas muscle index was 3.53 ± 0.97 cm2/m2. Except for sex, no significant differences were observed in patients' baseline characteristics and operative data between the two groups. The 30-day mortality rates in the sarcopenia and non-sarcopenia groups were 14% and 8%, respectively (P = 0.71), and postoperative morbidity was similar in both groups. Postoperative all-cause mortality was significantly higher in the sarcopenia group (log-rank P = 0.038), especially in patients aged 85 years or older (log-rank P < 0.01). The sarcopenia group had a lower home discharge rate than the non-sarcopenia group (21% vs. 54%, P < 0.01), and home discharge was associated with longer survival (log-rank P = 0.015). CONCLUSIONS All-cause mortality after emergency surgery for acute type A aortic dissection was significantly higher in octogenarians with sarcopenia than in those without, especially in patients aged 85 years or older.
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Affiliation(s)
- Takahiro Ishigaki
- Department of Cardiovascular Surgery, Kushiro City General Hospital, Kushiro, Japan
- Department of Cardiovascular Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoru Wakasa
- Department of Cardiovascular Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Yasushige Shingu
- Department of Cardiovascular Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yohei Ohkawa
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Akira Yamada
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan
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14
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Kawczynski MJ, van Kuijk SMJ, Olsthoorn JR, Maessen JG, Kats S, Bidar E, Heuts S. Type A aortic dissection: optimal annual case volume for surgery. Eur Heart J 2023; 44:4357-4372. [PMID: 37638786 DOI: 10.1093/eurheartj/ehad551] [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: 02/22/2023] [Revised: 07/06/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND AIMS The current study proposes a novel volume-outcome (V-O) meta-analytical approach to determine the optimal annual hospital case volume threshold for cardiovascular interventions in need of centralization. This novel method is applied to surgery for acute type A aortic dissection (ATAAD) as an illustrative example. METHODS A systematic search was applied to three electronic databases (1 January 2012 to 29 March 2023). The primary outcome was early mortality in relation to annual hospital case volume. Data were presented by volume quartiles (Qs). Restricted cubic splines were used to demonstrate the V-O relation, and the elbow method was applied to determine the optimal case volume. For clinical interpretation, numbers needed to treat (NNTs) were calculated. RESULTS One hundred and forty studies were included, comprising 38 276 patients. A significant non-linear V-O effect was observed (P < .001), with a notable between-quartile difference in early mortality rate [10.3% (Q4) vs. 16.2% (Q1)]. The optimal annual case volume was determined at 38 cases/year [95% confidence interval (CI) 37-40 cases/year, NNT to save a life in a centre with the optimal volume vs. 10 cases/year = 21]. More pronounced between-quartile survival differences were observed for long-term survival [10-year survival (Q4) 69% vs. (Q1) 51%, P < .01, adjusted hazard ratio 0.83, 95% CI 0.75-0.91 per quartile, NNT to save a life in a high-volume (Q4) vs. low-volume centre (Q1) = 6]. CONCLUSIONS Using this novel approach, the optimal hospital case volume threshold was statistically determined. Centralization of ATAAD care to high-volume centres may lead to improved outcomes. This method can be applied to various other cardiovascular procedures requiring centralization.
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Affiliation(s)
- Michal J Kawczynski
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, 6629HX Maastricht, Limburg, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, Maastricht, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, 6629HX Maastricht, Limburg, The Netherlands
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, 6629HX Maastricht, Limburg, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, Maastricht, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Suzanne Kats
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, 6629HX Maastricht, Limburg, The Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, 6629HX Maastricht, Limburg, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, Maastricht, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, 6629HX Maastricht, Limburg, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, Maastricht, PO Box 616, 6200 MD, Maastricht, The Netherlands
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15
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Dumfarth J, Stastny L, Gasser S, Grimm M. Malperfusion in elderly with acute type A dissection: accepting the natural course of the disease. Eur J Cardiothorac Surg 2023; 64:ezad329. [PMID: 37758253 DOI: 10.1093/ejcts/ezad329] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023] Open
Affiliation(s)
- Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Lukas Stastny
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Simone Gasser
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
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Pitts L, Kofler M, Montagner M, Heck R, Kurz SD, Buz S, Falk V, Kempfert J. The impact of malperfusion patterns in elderly patients undergoing surgery for acute type A aortic dissection. Eur J Cardiothorac Surg 2023; 64:ezad288. [PMID: 37589652 DOI: 10.1093/ejcts/ezad288] [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: 05/27/2023] [Revised: 07/28/2023] [Accepted: 08/16/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES The aim of this study is to investigate the outcome of elderly patients with surgically treated acute type A aortic dissection (ATAAD) complicated by malperfusion. METHODS Patients ≥70 years old who underwent surgical treatment for ATAAD between January 2000 and December 2020 were enrolled in this study and stratified by their specific Penn Classification into 4 different subgroups, where Penn Abc was defined as multilevel malperfusion. Short- and long-term outcomes were investigated. Multivariable binary logistic regression was performed to identify risk factors for 1-year mortality. RESULTS Four hundred elderly patients underwent surgical treatment for ATAAD. A total of 204 (51%) patients had no evidence of malperfusion (Penn Aa), 106 (26.5%) had localized organic malperfusion (Penn Ab), 44 (11%) patients had systemic malperfusion (Penn Ac) and 46 (11.5%) suffered from multilevel malperfusion (Penn Abc). For the latter, in-hospital mortality was 70% (P < 0.001). Age (P < 0.006) and multilevel malperfusion (P < 0.001) were independent risk factors for 1-year mortality. Patients with multilevel malperfusion showed the worst 1-year survival (P < 0.001). In the case of Penn Aa, in-hospital mortality was 13% (P < 0.001). CONCLUSIONS Surgery may lead to satisfactory results in the absence of malperfusion, even in octogenarians. Elderly patients with multilevel malperfusion show very poor surgical outcome. In these patients, the decision for surgery should be taken with caution. Operation, if performed, should be carried out by experienced teams only.
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Affiliation(s)
- Leonard Pitts
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Matteo Montagner
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Roland Heck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stephan D Kurz
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Semih Buz
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Health Sciences and Technology, Translational Cardiovascular Technologies, Institute of Translational Medicine, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
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Wang X, Deng C, Guo F, Cao X, Yan Y. Relationship between the postoperative lactate dynamic levels, the acute gastrointestinal injury and the prognosis among patients who undergo surgical treatment for acute type A aortic dissection. Heliyon 2023; 9:e17128. [PMID: 37484280 PMCID: PMC10361332 DOI: 10.1016/j.heliyon.2023.e17128] [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] [Received: 11/23/2022] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction This study aimed to determine the relationship between the postoperative lactate dynamic levels, the postoperative acute gastrointestinal injury (AGI), and the prognosis among the patients who underwent surgical treatment for an acute Stanford type-A aortic dissection (aTAAD). Methods A total of 271 aTAAD patients were recruited and monitored. Of the 271 aTAAD patients, 29.2% developed an AGI and were designated as the AGI group (n = 79); the other patients (n = 192) were designated as the non-AGI group. According to the 2-year follow up, the aTAAD patients were also divided into the alive and death subgroups for further analysis. Results Binary logistic regression analysis revealed that the postoperative 4-h lactate (P4L) level, time-to-return to the normal blood lactate level (TRNL), postoperative 16-h lactate (P16L) level, and neutrophil granulocyte (NEU) count had a good predictive value for an AGI after aTAAD. The 8-week and 2-year mortality rates were higher in the AGI group than the non-AGI group (P < 0.05). Basic data and clinical characteristics were significantly different between the alive and death groups (P < 0.05). A higher AGI rate and mortality occurred in the P4L level ≥10.15 mmol/L subgroup, TRNL ≥21-h subgroup, P16L level ≥2.95 mmol/L subgroup, NEU count ≥10.9 × 109/L subgroup, PaO2 < 77.7 mmHg subgroup, WBC count ≥9.58 × 109/L subgroup, and the operative time ≥427 min subgroup than the corresponding comparison subgroups (P < 0.05). The postoperative 0-h lactate (P0L) level, TRNL, postoperative 24-h lactate (P24L) level, D-dimer level, fibrinogen degradation products (FDP) level, duration of mechanical ventilation, and length of hospitalization were independent factors influencing the 30-day mortality rate in patients who underwent surgery for an aTAAD (P < 0.05). Cox regression multivariate analysis after univariate analysis of all-cause mortality showed the TRNL, postoperative 12-h lactate (P12L) level, P16L level, P24L level, D-dimer level, FDP level, and length of hospitalization were independently associated with the 2-year mortality rate in patients who underwent surgery for an aTAAD (P < 0.05). Conclusion The postoperative lactate changes and TRNL effectively predicted postoperative AGI and the mortality rate in patients with who underwent surgery for an aTAAD. The TRNL and P24L level were independent risk factors for the 30-day and 2-year mortality rates in patients who underwent surgery for an aTAAD.
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18
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Deng YZ, Luo MH, Luo JC, Li JK, Chen JQ, Zhang YJ, Hou JY, Su Y, Tu GW, Luo Z. Postoperative glucocorticoids in patients with acute type A aortic dissection (GLAD): study protocol for a prospective, single-center, randomized controlled trial. BMC Anesthesiol 2023; 23:164. [PMID: 37189085 DOI: 10.1186/s12871-023-02124-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Patients receiving surgical treatment of acute type A Aortic Dissection (aTAAD) are common to suffer organ dysfunction in the intensive care unit due to overwhelming inflammation. Previous studies have revealed that glucocorticoids may reduce complications in certain patient groups, but evidence between postoperative glucocorticoids administration and improvement in organ dysfunction after aTAAD surgery are lacking. METHODS This study will be an investigator-initiated, prospective, single-blind, randomized, single-center study. Subjects with confirmed diagnosis of aTAAD undergoing surgical treatment will be enrolled and 1:1 randomly assigned to receive either glucocorticoids or normal treatment. All patients in the glucocorticoids group will be given methylprednisolone intravenously for 3 days after enrollment. The primary endpoint will be the amplitude of variation of Sequential Organ Failure Assessment score on post-operative day 4 compared to baseline. DISCUSSION The trial will explore the rationale for postoperative application of glucocorticoids in patients after aTAAD surgery. TRIAL REGISTRATION This study has been registered on ClinicalTrials.gov (NCT04734418).
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Affiliation(s)
- Yi-Zhi Deng
- Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ming-Hao Luo
- Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jing-Chao Luo
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jia-Kun Li
- Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jia-Qi Chen
- Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yi-Jie Zhang
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jun-Yi Hou
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ying Su
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Guo-Wei Tu
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Zhe Luo
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Department of Critical Care Medicine, Xuhui Central Hospital, Shanghai, 200032, China.
- Shanghai Key Lab of Pulmonary Inflammation and Injury, Shanghai, China.
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Mvondo CM, Yon LCN, Kengni HNT, Ngowe MN. Composite aortic root replacement in African patients with type A aortic dissection: report of 12 cases. Pan Afr Med J 2023; 45:18. [PMID: 37426463 PMCID: PMC10323817 DOI: 10.11604/pamj.2023.45.18.37147] [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: 09/02/2022] [Accepted: 04/19/2023] [Indexed: 07/11/2023] Open
Abstract
Type A aortic dissection (TAAD) is associated with high mortality in the absence of appropriate surgical therapy. The involvement of the aortic root by the intimal tear and the presence of severe aortic insufficiency will require a more radical approach with composite root replacement (CRR) in most of the patients. We briefly report our surgical experience following CRR in 12 patients presenting with TAAD in our department. Between November 2009 and January 2022, a total of twelve (n=12) patients diagnosed with TAAD were operated in our institution. Clinical data and surgical outcomes were retrospectively reviewed. The mean age at admission was 51.1 ± 12.43 years (range: 34-72). One patient met the criteria for Marfan´s disease (1/12, 8.3%). The operative mortality was 16.66% (2/12). Composite root replacement with a mechanical valved conduit was performed in the majority (11/12, 91.66%;) whereas a separated supracoronary graft replacement and aortic valve replacement were performed in one patient. Concomitant aortic arch surgery (hemi or total) was done in 9/12 patients (75%). The commonest postoperative complications were: chest re-exploration for bleeding in 2/12 (16.66%), transitory cerebral ischemia in 1/12 (8.33%) and low cardiac output syndrome in 2/12 (16.66%). The mean length of stay in the Intensive Care Unit (ICU) was 4.8±3.8 days (range: 2-17). Delayed referral of patients with TAAD was observed in the majority of patients as they were operated in the subacute or chronic phase. Composite root replacement in these patients is associated with acceptable outcomes despite complex anatomic-pathological lesions.
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Affiliation(s)
- Charles Mve Mvondo
- Division of Cardiac Surgery, Cardiac Center of Shisong, St Elizabeth Catholic General Hospital, Kumbo, Cameroon
- Department of Surgery, Faculty of Medicine and Pharmaceutical Sciences, Douala, Cameroon
| | - Laurence Carole Ngo Yon
- Department of Surgery, Faculty of Medicine and Pharmaceutical Sciences, Douala, Cameroon
- Department of Cardiology, Jordan Medical Services, Yaoundé, Cameroon
| | - Hermann Nestor Tsague Kengni
- Department of Cardiology, National Social Insurance Fund Hospital, Yaoundé, Cameroun
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Marcelin Ngowe Ngowe
- Department of Surgery, Faculty of Medicine and Pharmaceutical Sciences, Douala, Cameroon
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20
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Luehr M. The clinical German Registry for Acute Aortic Dissection Type A (GERAADA) score: Go and see your patient! Eur J Cardiothorac Surg 2023; 63:7136647. [PMID: 37086433 DOI: 10.1093/ejcts/ezad169] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 04/23/2023] Open
Affiliation(s)
- Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital, University of Cologne, Cologne, Germany
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He X, Wang J, Xue Y, Wang S, Dong Y, Zhang H, Wang M. Mammalian sterile 20-like kinase 1 acts as a candidate biomarker of mortality of emergency surgical repair for acute type a aortic dissection. BMC Cardiovasc Disord 2023; 23:188. [PMID: 37038132 PMCID: PMC10088138 DOI: 10.1186/s12872-023-03144-8] [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: 10/27/2022] [Accepted: 02/23/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Acute type A aortic dissection (ATAAD) is a life-threatening pathological change of the aorta. Patients who have undergone aortic surgery are usually at high risk of mortality. AIM We investigated the predictive value of serum Mammalian sterile 20-like kinase 1 (MST1) as a biomarker for the risk of mortality of ATAAD patients. METHODS In this retrospective cohort study, we analyzed 160 consecutive ATAAD patients who had undergone emergency surgery from July 2016 to April 2017. Medical records and blood samples were collected and analyzed. ELISA assays were performed to detect the concentrations of several proteins including MST1. The relationship between these potential biomarkers and the primary endpoint of death was evaluated using Cox proportional hazard regression analysis. RESULTS Compared with a low level (< 1330.8 ng/L), high serum MST1 level (≥ 1330.8 ng/L) was positively associated with the 30-day mortality (OR = 5.233, 95%CI, 1.843-14.862, P < 0.01) and retained predictive after adjustment for sex, age, BMI, nasopharyngeal temperature and deep hypothermia circulatory arrest time (OR = 4.628 95% CI, 1.572-13.625, P < 0.01). A pre-existing basic clinical prediction model was improved with the inclusion of preoperative serum MST1. Specifically, the area under the ROC curve for base model (history of cerebrovascular disease, creatinine, time of operation) was 0.708 (95%CI, 0.546-0.836) and markedly increased to 0.823 when taking MST1 into consideration (95%CI, 0.700-0.912, P = 0.02). CONCLUSION Our study suggests that high preoperative circulating MST1, with a concentration greater than 1330.8 ng/L, was correlated with the 30-day mortality of ATAAD patients who underwent emergency surgery.
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Affiliation(s)
- Xiaohui He
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Jing Wang
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Yuan Xue
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shipan Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yanjun Dong
- College of Veterinary Medicine, China Agricultural University, Beijing, China.
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.
| | - Meili Wang
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China.
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Köse Y, Özyurt Köse S, Koçoğulları CU. Dilated sinuses of Valsalva subsequent to type A dissection surgery: Is reoperation inevitable? Turk Gogus Kalp Damar Cerrahisi Derg 2023; 31:171-175. [PMID: 37484642 PMCID: PMC10357858 DOI: 10.5606/tgkdc.dergisi.2023.24330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/05/2023] [Indexed: 07/25/2023]
Abstract
Background This study aims to investigate the dilation of sinus valsalva in patients who underwent aortic repair due to type A aortic dissection and to evaluate its progression. Methods Between January 2004 and December 2019, a total of 68 patients (50 males, 18 females; mean age: 54.2±10.1 years; range, 30 to 82 years) who underwent root-preserving surgery and followed for at least one year in the outpatient setting were retrospectively analyzed. The patients were divided into two groups according to dilatation during follow-up. Group 1 (n=32) included patients with dilatation and Group 2 (n=36) included patients without dilatation. The sinus of Valsalva diameters were measured using pre- and postoperative computed tomography angiography. Results The mean follow-up was 4.9±3.1 (range, 1 to 4) years. Sinus of Valsalva dilatation was observed in 47% of the patients during follow-up. Preoperative sinus of Valsalva diameter was a risk factor for aneurysmatic dilatation. A diameter of ≥4.05 cm was calculated as a cut-off value for developing dilatation requiring reoperation. Conclusion Follow-up using postoperative echocardiography or computed tomography angiography is of utmost importance for the assessment of development of sinus of Valsalva dilatation which requires reoperation in patients without intervention to the aortic root.
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Affiliation(s)
- Yiğit Köse
- Department of Cardiovascular Surgery, Health Sciences University, Dr. Siyami Ersek Chest Heart and Vascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Selen Özyurt Köse
- Department of Neurology, Marmara University Pendik Training and Research Hospital, Istanbul, Türkiye
| | - Cevdet Uğur Koçoğulları
- Department of Cardiovascular Surgery, Health Sciences University, Dr. Siyami Ersek Chest Heart and Vascular Surgery Training and Research Hospital, Istanbul, Türkiye
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Masada K, Shinzato K, Koizumi S, Yokawa K, Kasai M, Inoue Y, Seike Y, Sasaki H, Matsuda H. Role of initial medical treatment and effectiveness of thoracic endovascular aortic repair for acute type a aortic dissection with thrombosed false lumen. Eur J Cardiothorac Surg 2023; 63:7085601. [PMID: 36961338 DOI: 10.1093/ejcts/ezad102] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/08/2023] [Accepted: 03/24/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVES The optimal treatment for acute type A aortic dissection (AAAD) with thrombosed false lumen (T-FL) of the ascending aorta remains controversial. This study aimed to the evaluate clinical outcomes of initial medical treatment (IMT) and the effectiveness of thoracic endovascular aortic repair (TEVAR) for AAAD with T-FL. METHODS We retrospectively analysed 60 AAAD with T-FL patients. Emergent aortic repair was performed in 33 patients and IMT was selected in 27 uncomplicated patients with ascending aortic diameter < 50 mm and ascending T-FL thickness ≤ 10 mm. RESULTS Among the 27 patients who received IMT, 14 had intramural haematoma at admission; however, new ulcer-like projections appeared in 7 (50%) during hospitalization. Before discharge, 12 (44%) were treated with only medical treatment and 15 (56%) required delayed aortic repair including TEVAR in 8 and open repair in 7. The median interval from onset to delayed repair was 9 days and significantly more patients received TEVAR compared to those receiving emergent repair (53% vs 21%; P = 0.043). Between TEVAR (n = 15) and open repair (n = 33), one (7%) 30-day mortality occurred in TEVAR, whereas no in-hospital mortality occurred in open repair. During the median follow-up time of 24.8 months, no aorta-related death was observed and there were no statistically significant differences in the freedom rate from aortic events (TEVAR: 92.8%/3 years vs open repair: 88.4%/3 years; P = 0.871). CONCLUSIONS Our management with a combination of emergent aortic repair, IMT, and delayed aortic repair for AAAD with T-FL achieved favourable clinical outcomes. In the selected Japanese patients, IMT with repeated MDCT could detect a new intimal tear which could be closed by TEVAR in some cases and TEVAR for this pathology resulted in acceptable early and mid-term outcomes. Further investigations are required to validate the safety and efficacy of this management.
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Affiliation(s)
- Kenta Masada
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kento Shinzato
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shigeki Koizumi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Mio Kasai
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshimasa Seike
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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Luehr M, Gaisendrees C, Yilmaz AK, Winderl L, Schlachtenberger G, Van Linden A, Wahlers T, Walther T, Holubec T. Treatment of acute type A aortic dissection with the Ascyrus Medical Dissection Stent in a consecutive series of 57 cases. Eur J Cardiothorac Surg 2023; 63:6957090. [PMID: 36548434 DOI: 10.1093/ejcts/ezac581] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/01/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The Ascyrus Medical Dissection Stent (AMDS) has been recently introduced as an alternative for total arch replacement in acute aortic dissection type A (AADA). The aim of this study was to evaluate the postoperative outcomes after AMDS treatment in a large contemporary cohort of AADA patients. METHODS Data acquisition was performed retrospectively at 2 German aortic centres between 2020 and 2022 and comprised the perioperative parameters and postoperative results of all AADA patients. All patients treated with the AMDS for AADA were included in the study. The primary end point was in-hospital mortality. Secondary end points were defined as early postoperative and AMDS-related complications. RESULTS Fifty-seven AADA patients treated by AMDS were included in the study group. The mean age was 64.6 ± 10.8 years and 59.7% (n = 34) were males. The actual in-hospital mortality was considerably lower than the predicted mortality risk by the German registry for acute aortic dissection type A score (16% vs 22%). The median ICU and in-hospital stay were 5 (interquartile range: 3-13) and 12 (interquartile range: 10-22) days, respectively. Postoperative complications comprised acute renal insufficiency (37%) with need for temporary (16%) or permanent dialysis (5%), delirium (26%), re-exploration for bleeding (14%), tracheostomy (14%) and new stroke (4%). A new AMDS-related complication (central stent collapse) was observed in 9% (n = 5) by postoperative computed tomography and chest X-ray. The incidence of complete central AMDS collapse did not impact 30-day mortality. CONCLUSIONS The AMDS may be successfully used in AADA with acceptable 30-day mortality in accordance with the German registry for acute aortic dissection type A score. However, careful preoperative evaluation of the patient's individual aortic anatomy regarding potential contraindications and proper device implantation are strongly recommended to avoid complete central AMDS collapse.
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Affiliation(s)
- Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Centre, University of Cologne, Cologne, Germany
| | | | - Abdul Kadir Yilmaz
- Department of Cardiovascular Surgery, Goethe University and University Hospital Frankfurt, Frankfurt, Germany
| | - Leila Winderl
- Department of Cardiothoracic Surgery, Heart Centre, University of Cologne, Cologne, Germany
| | - Georg Schlachtenberger
- Department of Cardiothoracic Surgery, Heart Centre, University of Cologne, Cologne, Germany
| | - Arnaud Van Linden
- Department of Cardiovascular Surgery, Goethe University and University Hospital Frankfurt, Frankfurt, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Centre, University of Cologne, Cologne, Germany
| | - Thomas Walther
- Department of Cardiovascular Surgery, Goethe University and University Hospital Frankfurt, Frankfurt, Germany
| | - Tomas Holubec
- Department of Cardiovascular Surgery, Goethe University and University Hospital Frankfurt, Frankfurt, Germany
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Wang S, Wang T, Zhao C, Lin D. Systematic review and meta-analysis of the risk factors for postoperative delirium in patients with acute type A aortic dissection. J Thorac Dis 2023; 15:668-678. [PMID: 36910072 PMCID: PMC9992587 DOI: 10.21037/jtd-23-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/09/2022] [Accepted: 02/16/2023] [Indexed: 02/28/2023]
Abstract
Background Delirium is a common postoperative complication of acute type an aortic dissection, which is a serious threat to the patient's life after operation. However, there are many risk factors for delirium and there are different conclusions. The aim of this study was to systematically analyze the risk factors for postoperative delirium in patients with acute type a aortic dissection by means of meta-analysis. Methods Literature related to the risk factors of postoperative delirium in patients with acute type A aortic dissection was searched via the China National Knowledge Infrastructure (CNKI), cqvip.com (VIP), WanFang, PubMed, Willey Library, Embase, and Web of Science databases. Two persons independently conducted literature screening, data extraction and literature quality evaluation according to the inclusion and exclusion criteria. The quality of literature was evaluated with Newcastle-Ottawa Scale (NOS). R 4.2.1 was used to compare the risk factors for meta-analysis. Results After screening, 12 articles were included with a total of 2,511 cases, and 4 articles were at medium risk of bias and 8 articles were at low risk of bias. The meta-analysis results showed that patients in the delirium group had a higher probability of postoperative hypoxemia [odds ratio (OR) =1.65, 95% confidence interval (CI): 1.28-2.13, P<0.01], longer postoperative duration of ventilator assistance (OR =3.05, 95% CI: 2.47-3.77, P<0.01), higher incidence of renal insufficiency (OR =1.86, 95% CI: 1.33-2.58, P<0.01), lower hemoglobin levels (OR =0.33, 95% CI: 0.23-0.48, P<0.01), longer postoperative stay duration in the intensive care unit (ICU) (OR =2.25, 95% CI: 2.13-2.37, P<0.01), longer duration of hospitalization (OR =2.74, 95% CI: 2.37-3.16, P<0.01), and higher postoperative Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (OR =1.01, 95% CI: 0.90-1.12, P=0.92). Conclusions Post-op aortic dissection in patients with acute type A diabetes should be monitored for oxygen and blood levels. When patients had prolonged mechanical ventilation, renal insufficiency, decreased hemoglobin, and prolonged ICU stay, timely intervention is needed to prevent the high-risk factors of postoperative delirium.
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Affiliation(s)
- Shijian Wang
- Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Tianguang Wang
- Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Chaoyang Zhao
- Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Dewen Lin
- Department of Geriatrics, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
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Kaufeld T, Beckmann E, Rudolph L, Krüger H, Natanov R, Arar M, Korte W, Kaufeld J, Schilling T, Haverich A, Shrestha M, Martens A. Impact of preoperative malperfusion on postoperative outcomes in type A aortic dissection - importance of serum lactate estimation in ongoing malperfusion. Perfusion 2023:2676591231157545. [PMID: 36794541 DOI: 10.1177/02676591231157545] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Acute type A aortic dissection (ATAAD) is one of the most critical emergencies in cardiovascular surgery. Additional complications such as organ malperfusion can significantly decrease the chances of survival. Despite promptly performed surgical treatment, impaired organ perfusion may persist, thus close postoperative monitoring is recommended. But, is there a surgical consequence due to the existence of a preoperatively known malperfusion and is there a correlation between pre-, peri- and postoperative levels of serum lactate and proven malperfusion? METHODS Between 2011 and 2018, 200 patients (66% male; median age: 62.5 years; interquartile range: +/-12.4 years) that received surgical treatment at our institution for an acute dissection DeBakey type I were enrolled in this study. The cohort was divided into two groups according to the preoperative existence of malperfusion and non-malperfusion. At least one kind of malperfusion occurred in 74 patients (Group A: 37%), while 126 patients (Group B: 63%) showed no evidence of malperfusion. Furthermore, lactate levels of both cohorts were differentiated into four periods: preoperative, intraoperative, 24 hours after surgery, and 2-4 days after surgery. RESULTS The patients' status differed significantly prior to surgery. Group A (malperfusion) showed an elevated requirement for mechanical resuscitation (A: 10.8%; B: 5.6%; p: 0.173), were significantly more often admitted in an intubated state (A: 14.9%; B: 2.4%; p: 0.001) and showed higher incidences of stroke (A: 18.9% (n = 149); B: 3.2% (n = 4); p: 0.001). Levels of serum lactate from the preoperative period until days 2-4 were significantly increased in the malperfusion cohort at all times. CONCLUSIONS Preexisting malperfusion due to ATAAD may significantly increase the chance of early mortality in patients with ATAAD. Serum lactate levels were a reliable marker for inadequate perfusion from admission until day 4 after surgery. Despite this, early intervention survival in this cohort remains limited.
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Affiliation(s)
- Tim Kaufeld
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Erik Beckmann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Minneapolis Heart Institute, Abbott Northwestern Hospital, United States of America
| | - Linda Rudolph
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Heike Krüger
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ruslan Natanov
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Morsi Arar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wilhelm Korte
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jessica Kaufeld
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Tobias Schilling
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Malakh Shrestha
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andreas Martens
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Lin JL, Zheng GZ, Chen LW, Luo ZR. A nomogram model for assessing predictors and prognosis of postoperative delirium in patients receiving acute type A aortic dissection surgery. BMC Cardiovasc Disord 2023; 23:72. [PMID: 36750929 DOI: 10.1186/s12872-023-03111-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) complicates the postoperative course. There is limited information on POD-related risk factors (RFs) and prognosis in patients with acute type A aortic dissection (ATAAD) after modified triple-branched stent graft implantation (MTBSG) surgery. METHODS We retrospectively examined consecutive ATAAD patients who received MTBSG surgery in our hospital between January 2013 and December 2019. We employed univariate and multivariate analyses to identify stand-alone RFs for POD. A nomogram was next generated to estimate POD occurrence. The primary outcome was the development of POD, and the secondary outcomes were intensive care unit (ICU) and hospital stays, hospitalization costs, and in-hospital and follow-up mortality. RESULTS We selected 692 patients, of whom 220 experienced POD (31.8%). Based on our analysis, the following factors enhanced the likelihood of POD development: alcohol consumption (p < 0.001), acute physiology and chronic health evaluation II score (p = 0.023), serum total bilirubin (p = 0.007), stage 3 acute kidney injury (p < 0.001), serum interleukin-6 (p = 0.031), post-operative analgesics usage (p = 0.015), and ventilation duration (p = 0.008). POD patients had significantly longer ventilator times (p = 0.003), ICU stays (p < 0.001), and hospital stays (p = 0.038), together with increased hospitalization costs (p < 0.001) and in-hospital mortality (p = 0.019). However, POD was not a RF for mortality during follow-up (log-rank p = 0.611). CONCLUSIONS We demonstrated a strong link between POD and poor prognosis in ATAAD patients. We also constructed a prognosis estimator model which will benefit early management guidance to minimize the incidence of POD.
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Della Corte A, Lo Presti F, Saade W, Rubino AS, Palmieri L, Patanè F, Miraldi F, De Feo M. Acute type A aortic dissection in bicuspid versus tricuspid aortic valve patients: focus on geometrical features of the aorta. Eur J Cardiothorac Surg 2023; 63:6960927. [PMID: 36571506 DOI: 10.1093/ejcts/ezac576] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/29/2022] [Accepted: 12/24/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This retrospective observational study aimed to assess the geometrical features, including diameters, length and angulation, of the ascending aorta with bicuspid and tricuspid aortic valve and to identify imaging markers potentially predicting whether aortopathy is likely to evolve chronically or to complicate with acute type A dissection. METHODS Angio-computed-tomography scans of 354 patients (from 3 centres) with non-dilated (n = 97), aneurysmal (n = 100) or dissected aorta (n = 157) were reviewed. Diameters were measured at root, sinotubular junction, ascending, brachio-cephalic trunk origin; centreline lengths of the root and tubular tract and ascending-arch angle (between the ascending tubular tract axis and the proximal arch axis) were also measured. For 12 dissection patients, pre-dissection scans were available to investigate predisposing aortic geometry. Statistical analysis included: tricuspid versus bicuspid comparisons in each subgroup; univariate and multivariate analyses of the predictors of ascending-arch angle narrowing; and estimation of diagnostic accuracy of the angle parameter. RESULTS Diameters and lengths were similar between aneurysms and dissections, whereas dissections showed a significant ascending-arch angle narrowing (117 ± 13° in tricuspid, 115 ± 14° in bicuspid) compared to non-dilated and aneurysmal aortas (all P < 0.001). The best angle cut-off to discriminate dissection patients was 131° (96% sensitivity). In patients with a pre-dissection scan, Asc-Arch narrowing was already present before dissection. In non-dissected aortas over-angulation was predicted by root phenotype dilatation both in bicuspid and tricuspid patients. Bicuspid patients with non-dilated aorta showed elongated root (P = 0.027), a feature significantly correlated with Asc-Arch angle narrowing (P = 0.008). CONCLUSIONS The ascending-arch angle is promising as a risk marker for dissection to be used along with diameter. Its narrowing seems to be associated with elongation of the root, a feature that bicuspid patients can show even without significant dilatation. Root phenotype aortopathy may be at higher risk also with tricuspid aortic valve.
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Affiliation(s)
- Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Unit of Cardiac Surgery, V. Monaldi Hospital, Naples, Italy
| | - Federica Lo Presti
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Unit of Cardiac Surgery, V. Monaldi Hospital, Naples, Italy
| | - Wael Saade
- Department of Clinical Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Lucrezia Palmieri
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Unit of Cardiac Surgery, V. Monaldi Hospital, Naples, Italy
| | - Francesco Patanè
- Division of Cardiac Surgery, Cardio-Thoraco-Vascular Department, Papardo Hospital, Messina, Italy
| | - Fabio Miraldi
- Department of Clinical Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Marisa De Feo
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Unit of Cardiac Surgery, V. Monaldi Hospital, Naples, Italy
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Shiiya N. Management of noncerebral malperfusion complicating acute type A dissection. Asian Cardiovasc Thorac Ann 2023; 31:26-31. [PMID: 35167355 DOI: 10.1177/02184923211069812] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vital organ malperfusion in acute type A aortic dissection is associated with worse outcomes, especially when multiple organ systems are involved, and when coronary or mesenteric malperfusion is present. To achieve the two goals of central aortic repair and adequate and timely reperfusion, mechanism and organ-specific strategy in the methods and sequence of repair should be considered. For dynamic aortic malperfusion, reperfusion can be quickly achieved by femoral artery perfusion, and the fenestrated frozen elephant trunk operation, in which the proximal end of device is secured to zone 1 or 2 and distal 1 or 2 supra-aortic vessels are preserved by fenestration of the fabric, seems optimal as a method of central aortic repair. For coronary malperfusion, percutaneous coronary intervention before central aortic repair may have a role. However, it should be kept in mind that the door-to-unloading time is also important to reduce the area of myocardial infarction, and retrograde cardioplegia is not distributed to most of the right ventricle, which can be critical when right coronary malperfusion is present. Static mesenteric malperfusion should be addressed first, and second-look laparotomy should not be hesitated after central aortic repair. The use of a hybrid operating room may be an optimal solution to achieve both goals.
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Affiliation(s)
- Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Li J, Zhou Y, Qin W, Su C, Huang F, Chen X. Surgical outcomes of total arch replacement with modified elephant trunk technique in type A aortic dissection: insights from single-center experience. Asian Cardiovasc Thorac Ann 2023; 31:8-14. [PMID: 35014890 DOI: 10.1177/02184923211070115] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Total arch replacement with modified elephant trunk technique plays an important role in treating acute type A aortic dissection in China. We aim to summarize the therapeutic effects of this procedure in our center over a 17-year period. METHODS Consecutive patients treated at our hospital due to type A aortic dissection from January 2004 to January 2021 were studied. Relevant data of these patients undergoing total arch replacement with modified elephant trunk technique were collected and analyzed. RESULTS A total of 589 patients were included with a mean age of 53.1 ± 12.2 years. The mean of cardiopulmonary bypass, cross-clamping, and selected cerebral perfusion time were 199.6 ± 41.9, 119.0 ± 27.2, and 25.1 ± 5.0 min, respectively. In-hospital death occurred in 46 patients. Multivariate analysis identified four significant risk factors for in-hospital mortality: preexisting renal hypoperfusion (OR 5.43; 95% CI 1.31 - 22.44; P = 0.020), cerebral malperfusion (OR 11.87; 95% CI 4.13 - 34.12; P < 0.001), visceral malperfusion (OR 4.27; 95% CI 1.01 - 18.14; P = 0.049), and cross-clamp time ≥ 130 min (OR 3.26; 95% CI 1.72 - 6.19; P < 0.001). The 5, 10, and 15 years survival rates were 86.4%, 82.6%, and 70.2%, respectively. CONCLUSIONS Total arch replacement with modified elephant trunk technique is an effective treatment for acute type A aortic dissection with satisfactory perioperative results. Patients with preexisting renal hypoperfusion, cerebral malperfusion, visceral malperfusion, and long cross-clamp time are at a higher risk of in-hospital death.
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Affiliation(s)
- Jian Li
- Department of Thoracic and Cardiovascular Surgery, 385685Nanjing First Hospital, 385685Nanjing Medical University, P.R. China
| | - Yueyun Zhou
- Department of Thoracic and Cardiovascular Surgery, 385685Nanjing First Hospital, 385685Nanjing Medical University, P.R. China
| | - Wei Qin
- Department of Thoracic and Cardiovascular Surgery, 385685Nanjing First Hospital, 385685Nanjing Medical University, P.R. China
| | - Cunhua Su
- Department of Thoracic and Cardiovascular Surgery, 385685Nanjing First Hospital, 385685Nanjing Medical University, P.R. China
| | - Fuhua Huang
- Department of Thoracic and Cardiovascular Surgery, 385685Nanjing First Hospital, 385685Nanjing Medical University, P.R. China
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, 385685Nanjing First Hospital, 385685Nanjing Medical University, P.R. China
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31
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Huang PF, Liu YK, Zhao YB, Ma D. Carbon-dioxide-combining-power and postoperative short-term mortality in patients with Stanford type A acute aortic dissection. Asian J Surg 2022; 45:2925-2927. [PMID: 35760687 DOI: 10.1016/j.asjsur.2022.06.105] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Peng-Fei Huang
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, 063210, PR China
| | - Yu-Kun Liu
- Nursing Department, Huaxin College of Hebei GEO University, Shijiazhuang, Hebei, 050702, PR China.
| | - Yong-Bo Zhao
- Cardiac Surgery Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 051000, PR China.
| | - Dong Ma
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, 063210, PR China; Department of Biochemistry and Molecular Biology, Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Shijiazhuang, Hebei, 050017, PR China.
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32
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Thet MST, Balmforth D, Lopez-Marco A, Ye Oo A. Resternotomy aortic root and arch replacement following previous complex type A aortic dissection requiring endovascular repair for malperfusion. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36239233 DOI: 10.1510/mmcts.2022.042] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A redo sternotomy, aortic root, and arch replacement in a patient following previous complex surgical and endovascular type A aortic dissection repair is presented in this video case report. Shortly after having the initial type A aortic dissection repair with replacement of the ascending aorta, the patient developed severe visceral malperfusion due to a compressed distal true lumen and underwent emergency endovascular repair with ascending arch and descending thoracic aorta stents and chimney grafts for the aortic arch vessels as well as fenestration of the intimal flap of the abdominal aorta. Unfortunately, the patient developed permanent paraplegia and progressive symptomatic severe aortic regurgitation. The patient underwent a redo sternotomy, aortic root, and arch replacement with explantation of the ascending stent graft and chimney stent grafts. Antegrade cerebral perfusion was maintained throughout the procedure. The aortic arch was replaced using a Terumo Aortic Plexus multibranched graft distally anastomosed to the endovascular stent graft, and the innominate and left common carotid arteries were reimplanted onto the graft. The aortic root was replaced with a Bioconduit graft, using a modified Cabrol technique to reimplant the left coronary artery. A satisfactory postoperative course and computed tomography imaging highlight the feasibility of this highly complex aortic arch repair with careful preoperative planning.
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Affiliation(s)
- Myat Soe Thet Thet
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Damian Balmforth
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Ana Lopez-Marco
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Aung Ye Oo
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
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33
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Lee G, Elbatarny M, Shimamura J, Dagenais F, Peterson MD, Ouzounian M, Chu MWA. Hybrid arch frozen elephant trunk repair for acute type A aortic dissection: Extra-anatomic subclavian reconstruction. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36227647 DOI: 10.1510/mmcts.2022.080] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Acute type A aortic dissection is a life-threatening condition that confers significant early perioperative risk but is also associated with late aortic disease progression and the need for reintervention. Recent efforts to improve patient outcomes have focused on improving quality of care and extending treatment in the aortic root and arch to reduce late aortic events. The hybrid arch frozen elephant trunk technique facilitates a more aggressive distal aortic repair that may help mitigate the early and late deleterious effects of persistent false lumen perfusion. However, in the acute and emergency settings, management of the left subclavian artery remains a challenge. We present a step-by-step instructional guide on performing an emergency hybrid arch frozen elephant trunk procedure with emphasis on management of the difficult left subclavian artery. Our case report demonstrates a transthoracic aortoaxillary extra-anatomic bypass of the left axillary artery. We discuss the most important considerations when managing the left subclavian artery in an acute type A aortic dissection. Finally, we detail the benefits and limitations of the transthoracic aortoaxillary extra-anatomic technique and discuss other approaches to left subclavian artery reconstruction.
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Affiliation(s)
- Grace Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Junichi Shimamura
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Francois Dagenais
- Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Mark D. Peterson
- Division of Cardiac Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, University of Toronto, Toronto, Canada
| | - Michael W. A. Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
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34
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Lin CY, Wu MY, Tseng CN, Lee HF, Tsai FC. Delayed sternal closure for intractable bleeding after acute type A aortic dissection repair: outcomes and risk factors analyses. J Cardiothorac Surg 2022; 17:184. [PMID: 35982501 PMCID: PMC9389841 DOI: 10.1186/s13019-022-01946-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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perioperative coagulopathy and intractable bleeding are severe complications in acute type A aortic dissection (ATAAD) repair surgery. Mediastinal packing with delayed sternal closure (DSC) is a commonly adapted technique to stabilize the hemorrhagic tendency. This retrospective study aims to investigate the early and late outcomes and risk factors in patients who underwent DSC procedure during ATAAD repair surgery. METHODS This study investigated 704 consecutive patients who underwent ATAAD repair at this institution between January 2007 and September 2020. These patients were dichotomized into the DSC (n = 109; 15.5%) and primary sternal closure (PSC) groups (n = 595; 84.5%). The clinical features, surgical information, postoperative complications, 5-years cumulative survival, and freedom from reoperation rates were compared. A multivariate logistic regression analysis was used to identify the independent risk factors for patients who underwent DSC. RESULTS The DSC group showed a higher rate of hemopericardium and preoperative malperfusion, and was associated with longer cardiopulmonary bypass and aortic clamping times and a higher rate of intraoperative extracorporeal membrane oxygenation (ECMO) support. The DSC group showed higher blood transfusion volumes and rate of reexploration for bleeding after surgery. However, the in-hospital mortality rates (17.4% vs. 13.3%; P = 0.249), 5-year survival rates (66.9% vs. 68.2%; P = 0.635), and freedom from reoperation rates (89.1% vs. 82.5%; P = 0.344) were comparable between the DSC and PSC groups. Multivariate analysis revealed that hemopericardium, preoperative malperfusion, and intraoperative ECMO support were risk factors for implementing DSC. CONCLUSIONS DSC is an efficient life-saving technique to stabilize patients with intractable bleeding after undergoing ATAAD repair surgery, which leads to acceptable short- and long-term outcomes. Patients who were at risk for intractable bleeding should have early decision-making for implementing DSC.
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Affiliation(s)
- Chun-Yu Lin
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan. .,Department of Cardiothoracic and Vascular Surgery, New Taipei Municipal TuCheng Hospital, No.6, Sec.2, JinCheng Rd, TuCheng, New Taipei City, 236, Taiwan.
| | - Meng-Yu Wu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Cardiothoracic and Vascular Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chi-Nan Tseng
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Cardiothoracic and Vascular Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hsin-Fu Lee
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Cardiology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Feng-Chun Tsai
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Cardiothoracic and Vascular Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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35
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Hishikawa T, Ohashi T, Tadakoshi M, Kamikawa Y, Kageyama S, Kojima A, Hioki K, Yamauchi H. Effect of waiting time for COVID-19 screening on postoperative outcomes of type A aortic dissection: An institutional study. Asian Cardiovasc Thorac Ann 2022; 30:912-915. [PMID: 35971227 PMCID: PMC9382570 DOI: 10.1177/02184923221120413] [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: 11/15/2022]
Abstract
BACKGROUND Since November 2020, all patients undergoing emergency surgery at our hospital have been subjected to preoperative reverse transcription polymerase chain reaction (RT-PCR) screening to prevent nosocomial COVID-19 infection, with admission to the operating room requiring a negative result. Herein, we compared the pre- and postoperative outcomes of acute type A aortic dissection surgery before and after implementing the RT-PCR screening for all patients. METHODS We compared the postoperative results of 105 patients who underwent acute type A aortic dissection emergency surgery from January 2019 to October 2020 (Group I) and 109 patients who underwent the surgery following RT-PCR screening from November 2020 to March 2022 (Group II). RESULTS The average waiting time from arrival at the hospital to admission to the operating room was 36 and 81 min in Groups I and II, respectively. Ruptured cardiac tamponade was observed preoperatively in 26.6% and 21.1% of Groups I and II patients, respectively. The preoperative waiting time due to RT-PCR screening did not contribute to the cardiac tamponade. Surgical complications such as bleeding (reopened chest), respiratory failure, cerebral neuropathy, or mediastinitis did not increase significantly. The number of deaths 30 days after surgery (Group I = 13 and Group II = 3) showed no significant difference between the groups. There were no cases of nosocomial COVID-19 infections. CONCLUSIONS Preoperative COVID-19 screening is an important method to prevent nosocomial infections. The associated waiting time did not affect the number of preoperative ruptures or affect postoperative complications or mortality.
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Affiliation(s)
- Takanori Hishikawa
- Cardiovascular Surgery, 38111Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
| | - Takeki Ohashi
- Cardiovascular Surgery, 38111Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
| | - Masao Tadakoshi
- Cardiovascular Surgery, 38111Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
| | - Yuji Kamikawa
- Cardiovascular Surgery, 38111Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
| | - Soichiro Kageyama
- Cardiovascular Surgery, 38111Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
| | - Akinori Kojima
- Cardiovascular Surgery, 38111Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
| | - Kaoru Hioki
- Cardiovascular Surgery, 38111Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
| | - Hirotaka Yamauchi
- Cardiovascular Surgery, 38111Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
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36
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Minamidate N, Takashima N, Suzuki T. The impact of CK-MB elevation in patients with acute type A aortic dissection with coronary artery involvement. J Cardiothorac Surg 2022; 17:169. [PMID: 35794624 PMCID: PMC9260987 DOI: 10.1186/s13019-022-01924-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/21/2021] [Accepted: 05/28/2022] [Indexed: 11/11/2022] Open
Abstract
Background Acute type A aortic dissection (ATAAD) is a fatal disease and requires emergency surgery. In particular, it is known that mortality is high when a coronary artery is involved. However, the degree of myocardial damage of the coronary acute artery involvement (ACI) varies and may or may not increase creatine kinase muscle and brain isoenzyme (CK-MB). It is unknown how CK-MB elevation affects the surgical outcome. This study compared the surgical results between the two groups of ACI with or without CK-MB elevation. Methods Among 348 patients who underwent an emergency operation for acute type A aortic dissection, there were 28 (8.0%) patients complicated by ACI and underwent additional coronary artery bypass grafting. We divided 26 of those patients into two groups; the MI group ( with CK-MB elevation) and the NMI group (without CK-MB elevation), and compared both groups. Results Of the 26, sixteen were in the MI group, and ten were in the NMI group. The average CK-MB in the MI group was 225.5 IU/L, and that in the NMI group was 13.5 IU/L. The mean time from onset to surgery was 248 min in the MI group and 250 min in the NMI group. There was statistical significance in mortality ( 69% vs. 13%, p = 0.03). There was no significance in major complications (ICU days, reintubation, reoperation, pneumonia, sepsis). Conclusions Acute coronary artery involvement was associated with 8.0% of patients with ATAAD, and 62% had myocardial ischemia with CK-MB elevation. The MI group had significantly higher mortality than the NMI group. It is crucial for cases with suspected ACI to obtain coronary perfusion as soon as possible to prevent CK-MB from elevating.
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Affiliation(s)
- Naoshi Minamidate
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, 520-2192, Japan
| | - Noriyuki Takashima
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, 520-2192, Japan
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, 520-2192, Japan.
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37
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Huang F, Li X, Zhang Z, Li C, Ren F. Comparison of two surgical approaches for acute type A aortic dissection: hybrid debranching versus total arch replacement. J Cardiothorac Surg 2022; 17:166. [PMID: 35739545 PMCID: PMC9229500 DOI: 10.1186/s13019-022-01920-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/06/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background The goal of this study was to determine the clinical outcomes of total arch replacement with frozen elephant trunk surgery and hybrid debranching surgery for acute type A aortic dissection patients. Methods From January 2017 to December 2019, the clinical data of acute type A aortic dissection patients were retrospectively collected and analyzed. There were 142 patients underwent total arch replacement with frozen elephant trunk surgery and 35 patients underwent hybrid debranching surgery. Result The age, the body mass index and the renal insufficiency of patients in the hybrid group were higher than those in the total arch replacement (TAR) group (all P < 0.01). The operation time, the cardiopulmonary bypass time and the aortic occlusion time of patients in the TAR group were significantly longer than those in the hybrid group (all P < 0.01). Patients in the debranching group had shorter ventilator-assisted breathing time, shorter postoperative hospital stay time and shorter intensive care unit (ICU) stay time. The incidence of pulmonary infection and transient neurological dysfunction were lower, and the transfusions of red blood cells and plasma during the perioperative period were smaller. The survival rates at 2 years were 91.9% and 85.9% in the TAR and hybrid groups, respectively. Conclusion Hybrid debranching operation is a safe and effective method for acute type A aortic dissection. Compared with TAR surgery, hybrid debranching surgery has the characteristics of less trauma, rapid recovery and lower incidence of complication.
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Affiliation(s)
- Feng Huang
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China.,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.,Department of Cardiovascular Surgery, Fujian Provincial Geriatric Hospital, Fuzhou, 350000, China
| | - Xiaofeng Li
- Department of the Third Internal Medicine, Anqiu Municipal Hospital, Weifang, 262100, China
| | - Zili Zhang
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China.,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Chunping Li
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China.,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Fei Ren
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China. .,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
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Zhang Y, Lan Y, Chen T, Chen Q, Guo Z, Jiang N. Prediction of Acute Kidney Injury for Acute Type A Aortic Dissection Patients Who Underwent Sun's Procedure by a Perioperative Nomogram. Cardiorenal Med 2022; 12:117-130. [PMID: 35732144 DOI: 10.1159/000524907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/28/2021] [Accepted: 04/22/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Postoperative acute kidney injury (AKI) occurs in 20-40% of acute type A aortic dissection (ATAAD) patients undergoing cardiac surgery. A predictive model could be developed to assess the probability of AKI in patients with ATAAD before and after cardiac surgery in a timely manner. METHODS This retrospective study enrolled a total of 224 patients with ATAAD. Patients were subjected to total arch replacement using a tetrafurcate graft with stented elephant trunk implantation according to Sun's procedure. Statistical comparison for the collected data was done with Student's t test or Mann-Whitney U test (continuous variables) and χ2 test (categorical variables). The independent predictors were screened by multivariate logistic regression analysis and then incorporated into a nomogram. The reliability of cardiac surgery-associated AKI (CSA-AKI) models was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS This study enrolled 224 ATAAD patients, including 53 patients with AKI and 171 patients without AKI. The incidence of ATAAD-induced AKI in the cohort was 23.66%. The screened predictors for AKI include iliac artery involvement, creatinine, D-dimer, autotransfusion, platelet-rich plasma reinfusion, nasal temperature, red blood cells, fresh frozen plasma, drainage, and mechanical ventilation. The calculated AUC values for model 1, model 2, model 3, and model 4 were 0.710, 0.777, 0.827, and 0.848, respectively. Model 4 was optimum for AKI risk scoring compared with model 1, model 2, and model 3. CONCLUSIONS AKI prediction models were established for ATAAD patients using preoperative, intraoperative, and postoperative information. Particularly, model 4 shows superiority in risk prediction for CSA-AKI.
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Affiliation(s)
- Yuhui Zhang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.,Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Yongrong Lan
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Tongyun Chen
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Qingliang Chen
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Zhigang Guo
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Nan Jiang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
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Zhang L, Zhang L, Zhao Z, Liu Y, Wang J, Niu M, Sun X, Zhao X. Metabolic syndrome and its components are associated with hypoxemia after surgery for acute type A aortic dissection: an observational study. J Cardiothorac Surg 2022; 17:151. [PMID: 35698229 PMCID: PMC9195211 DOI: 10.1186/s13019-022-01901-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/12/2021] [Accepted: 05/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to explore whether or to what extent metabolic syndrome (METs) and its components were associated with hypoxemia in acute type A aortic dissection (ATAAD) patients after surgery. Methods This study involved 271 inpatients who underwent surgery. Demographic and clinical data were collected. Subgroup analysis, mixed model regression analysis, and receiver operating characteristic (ROC) curve analysis were performed, and a scoring system was evaluated. Results The 271 inpatients were assigned to the hypoxemia group (n = 48) or no hypoxemia group (n = 223) regardless of METs status. Compared to the no hypoxemia group, the hypoxemia group had a higher incidence of METs. Hypoxemia was present in 0%, 3.7%, 19.8%, 51.5%, 90.0% and 100% in the groups of individuals who met the diagnostic criteria of MetS 0, 1, 2, 3, 4 and 5 times, respectively. In the multivariable logistic regression analysis, BMI quartile was still a risk factor for hypoxemia after adjustment for other risk factors. After adjustment for potential confounding factors, METs was an independent risk factor for hypoxemia in several models. After assigning a score for each METs component present, the AUCs were 0.852 (95% CI 0.789–0.914) in all patients, 0.728 (95% CI 0.573–0.882) in patients with METs and 0.744 (95% CI 0.636–0.853) in patients without METs according to receiver operating characteristic analysis. Conclusions METs, especially body mass index, confers a greater risk of hypoxemia in ATAAD after surgery.
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Affiliation(s)
- Like Zhang
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Street, Yuhua District, Shijiazhuang, 500000, Hebei, China
| | - Lei Zhang
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Street, Yuhua District, Shijiazhuang, 500000, Hebei, China
| | - Zengren Zhao
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Street, Yuhua District, Shijiazhuang, 500000, Hebei, China.
| | - Yun Liu
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Street, Yuhua District, Shijiazhuang, 500000, Hebei, China
| | - Juzeng Wang
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Street, Yuhua District, Shijiazhuang, 500000, Hebei, China
| | - Mengye Niu
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Street, Yuhua District, Shijiazhuang, 500000, Hebei, China
| | - Xiansheng Sun
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Street, Yuhua District, Shijiazhuang, 500000, Hebei, China
| | - Xiansheng Zhao
- Department of Vascular Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Street, Yuhua District, Shijiazhuang, 500000, Hebei, China
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40
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Natour AK, Rteil A, Shepard A, Weaver M, Nypaver T, Nemeh H, Tanaka D, Kabbani L. Outcomes of patients with acute type A aortic dissection and concomitant lower extremity malperfusion. J Vasc Surg 2022:S0741-5214(22)01584-1. [PMID: 35598820 DOI: 10.1016/j.jvs.2022.03.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/29/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The occurrence of acute lower limb ischemia (ALLI) is a serious risk within the context of aortic dissection repair. The aim of the present study was to examine the outcomes of patients with acute type A aortic dissection (ATAD) and concomitant lower extremity malperfusion. METHODS We performed a retrospective medical record review at our tertiary referral center of patients who underwent ATAD repair from January 2002 to June 2018. We used univariate and multivariate analyses to compare the outcomes of patients with and without lower extremity malperfusion. The primary outcomes were 30-day and 1-year mortality. RESULTS A total of 378 patients underwent ATAD repair during the study period. Their mean age was 57 years, 68% were men, and 51% were White. A total of 62 patients (16%) presented with concomitant ALLI, including 35 (9%) who presented with isolated ALLI and 27 (7%) who presented with ALLI and concomitant malperfusion of at least one other organ. Of the 62 patients with ALLI, 46 underwent only proximal aortic repair. Of the 378 patients, 6 died within the first 24 hours, and their limb perfusion was not assessed. Among the 40 patients who underwent isolated proximal repair and survived >24 hours, 34 (85%) had resolution of their ALLI. Of the 16 patients who underwent concomitant lower extremity peripheral vascular procedures, 10 had bypass procedures and 1 died within 24 hours due to refractory coagulopathy and hypotension. All six patients with adequate follow-up imaging studies had asymptomatic occlusion of the bypass graft with recanalization of the occluded native arteries. Patients who presented with any organ malperfusion had increased 30-day (odds ratio, 1.8; P = .04) and 1-year (odds ratio, 1.8; P = .04) mortality and decreased overall survival (P < .01). For the patients with isolated ALLI, no significant differences were found in 30-day or 1-year mortality or overall survival (P = .57). CONCLUSIONS Proximal repair of ATAD resolves most cases of associated ALLI, and isolated ALLI does not affect short- or long-term survival. All patients with follow-up in our study who underwent extra-anatomic bypass developed asymptomatic graft occlusion, which could be attributed to competitive flow from the remodeled native arterial system. We believe that rapid and aggressive restoration of flow to the lower extremity is the best method to treat ALLI malperfusion syndrome. Close monitoring for the development of compartment syndrome is recommended.
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Jia H, Huang B, Kang L, Lai H, Li J, Wang C, Sun Y. Preoperative and intraoperative risk factors of postoperative stroke in total aortic arch replacement and stent elephant trunk implantation. EClinicalMedicine 2022; 47:101416. [PMID: 35518120 PMCID: PMC9062417 DOI: 10.1016/j.eclinm.2022.101416] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Acute type A aortic dissection (AAAD) is a disease with high mortality, for which total aortic arch replacement (TAAR) combined with stent elephant implantation (SETI) is a reliable surgical treatment; however, it is associated with a high incidence of postoperative stroke. This retrospective study aimed to find preoperative and postoperative risk factors for postoperative stroke in patients with TAAR combined with SETI, and to provide predictive models and single-factor threshold suggestions. METHODS From October 2019 to March 2021, 229 AAAD patients who underwent TAAR and SETI were selected. Patients were divided into stroke group (n = 23) and non-stroke group (n = 206), and preoperative/intraoperative factors were evaluated by independent-samples T-test/ Mann-Whitney U test/Chi-Square test and odds ratio (OR) analysis. The Logistic regression equation and decision tree were used to construct the prediction model of the probability of postoperative stroke. Bayesian-learning model and 2-order derivation were used to calculate the inflection points of the continuous variables. FINDINGS Platelet count (PLT), International normalised ratio (INR) value, presence of diabetic history, and cardiopulmonary bypass (CPB) time were independent predictors of postoperative stroke (P-value < 0.05), and the above four factors were used to construct the Logistic regression equation. As for the decision-tree model, a radical model with higher accuracy in stroke predicting was chosen. Three inflection points for the effect of continuous variables (PLT count = 60 × 10^9/L; INR value = 1.82; CPB time = 300 min) on postoperative stroke were found by 2-order derivation. INTERPRETATION PLT count, INR value, presence of diabetic history, and CPB time were significant preoperative and intraoperative risk factors for postoperative stroke, and the identification and modeling of these factors can help us to take more active brain protection measures in high-risk patients. FUNDING YS was funded by the National Natural Science Foundation of China (Grant ID 81671942).
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Key Words
- AAAD, acute type A aortic dissection
- Acute type A aortic dissection
- CABG, coronary artery bypass grafting
- CPB, cardiopulmonary bypass
- CT, computed tomography
- CTA, Computed tomographic angiography
- CTP, computed tomographic perfusion imaging
- DHCA, deep hypothermic circulatory arrest
- OR, odds ratio
- PLT, platelet count
- Postoperative stroke
- Predictive model
- SETI, stent elephant trunk implantation
- TAAR, Total aortic arch replacement
- δrso2min, the lowest relative regional cerebral oxygen saturation to base‐line
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Chen W, Song X, Hong L, Xu H, Qian Y, Zhang W, Sun J, Shen X, Liu Y, Wang X, Shi Q, Liu H, Mu X, Zhang C. The association between lymphocyte-monocyte ratio and postoperative acute kidney injury in patients with acute type A aortic dissection. J Cardiothorac Surg 2022; 17:60. [PMID: 35365164 PMCID: PMC8974121 DOI: 10.1186/s13019-022-01813-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/13/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the relationship between baseline lymphocyte-monocyte ratio (LMR) and postoperative acute kidney injury (AKI) in patients with acute type A aortic dissection (ATAAD). METHODS ATAAD patients undergoing surgery in Nanjing First Hospital were enrolled from January 2019 to April 2021. Lymphocyte and monocyte were measured on admission. Multivariable logistic regression analyses were performed to explore the relationship between LMR and postoperative AKI. We also used receiver operating characteristic (ROC), net reclassification index (NRI) and integrated discrimination improvement (IDI) analyses to assess the predictive ability of LMR. RESULTS Among the 159 recruited patients, 47 (29.6%) were diagnosed with AKI. Univariate logistic regression analysis indicated that ATAAD patients with higher levels of LMR were prone to have lower risk to develop AKI (odds ratio [OR], 0.493; 95% confidence interval [CI] 0.284-0.650, P = 0.001). After adjustment for the potential confounders, LMR remained an independent related factor with postoperative AKI (OR 0.527; 95% CI 0.327-0.815, P = 0.006). The cutoff value for LMR to predict AKI was determined to be 2.67 in the ROC curve analysis (area under curve: 0.719). NRI and IDI further confirmed the predictive capability of LMR in postoperative AKI. CONCLUSION Elevated baseline LMR levels were independently associated with lower risk of postoperative AKI in ATAAD patients.
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Affiliation(s)
- Wenxiu Chen
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Xiaochun Song
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Liang Hong
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Huan Xu
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Yan Qian
- Department of Intensive Care Unit, Wuhu Hospital Affiliated to East China Normal University, Wuhu, 241000, Anhui, People's Republic of China
| | - Wenhao Zhang
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Jiakui Sun
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Xiao Shen
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Ying Liu
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Xiang Wang
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Qiankun Shi
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Han Liu
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Xinwei Mu
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China.
| | - Cui Zhang
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China.
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Takahashi B, Kamohara K, Amamoto S, Kawaguchi A. Impact of after-hours surgery on outcomes of acute type A aortic dissection repair. Surg Today 2022; 52:1453-1462. [PMID: 35338427 DOI: 10.1007/s00595-022-02487-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/27/2021] [Accepted: 01/16/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To establish whether emergency surgery performed outside working hours (after hours) contributed to adverse outcomes for patients with acute type A aortic dissection (ATAAD). METHODS We reviewed the operation records of ATAAD repair in our institution from 2004 to 2019 (n = 187). Emergency surgery was performed by one of a few teams of experienced surgeons, regardless of the time of day. Patients were divided into two groups based on the surgery start time: during working hours (n = 65) and after hours (n = 122). A propensity score-matched analysis was performed for 58 pairs of patients. RESULTS The overall in-hospital mortality was 6.9% for the working-hours group and 13.8% for the after-hours group. There were no significant differences between the groups in the relatively limited study population (n = 187). Surgeon experience and aortic interventions did not differ remarkably between the groups. After-hours repair was not associated with postoperative complications. There were no significant differences in the long-term survival or aortic event-free rates between the groups. CONCLUSIONS After-hours surgery did not affect the short- or long-term outcomes of ATAAD repair under our backup system, which supports the recommendation of immediate surgical repair. Efforts to minimize the discrepancies between working hours and after hours could help to improve the surgical outcomes of patients undergoing ATAAD repair.
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Affiliation(s)
- Baku Takahashi
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-0937, Japan.
| | - Keiji Kamohara
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-0937, Japan
| | - Sojiro Amamoto
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-0937, Japan
| | - Atsushi Kawaguchi
- Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
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Qiu Z, Xiao J, Wu Q, Chai T, Zhang L, Li Y, Chen L. Partial upper sternotomy for extensive arch repair in older acute type A aortic dissection patients. BMC Cardiovasc Disord 2022; 22:117. [PMID: 35313815 PMCID: PMC8939131 DOI: 10.1186/s12872-022-02511-1] [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] [Received: 09/06/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The partial upper sternotomy (PUS) approach is acceptable for aortic valve replacement, and even aortic root operation. However, the efficiency of PUS for extensive arch repair of acute type A aortic dissection (AAAD) in older adult patients has not been well investigated. METHODS Between January 2014 and December 2019, 222 older adult patients (≥ 65 years) diagnosed with AAAD went through extensive arch repair, among which 127 received PUS, and 95 underwent full sternotomy (FS). Logistic regression analysis was used to identify risk factors for early death, and negative binomial regression analysis was applied to explore risk factors related to post-operative ventilator-supporting time and intensive care unit stay time. RESULTS Total early mortality was 8.1% (18/222 patients). The PUS group had shorter Cardiopulmonary bypass time (133.0 vs.155.0 min, P < 0.001), cross-clamp time (44.0 vs. 61.0 min, P < 0.001) and shorter selective cerebral perfusion time (11.0 vs. 21.0 min, P < 0.001) than the FS group. Left ventricle ejection fraction < 50% (odds ratio [OR] 17.05; 95% confidence interval [CI] 1.87-155.63; P = 0.012) and malperfusion syndromes (OR 65.83; 95% CI 11.53-375.86; P < 0.001) were related to early death. In the multivariate model, the PUS approach contributed to shorter ventilator-supporting time (incidence rate ratio [IRR] 0.76; 95% CI 0.64-0.91; P = 0.003), when compared with the FS group. CONCLUSIONS The early results of emergency extensive arch repair of AAAD via PUS in older adult patients were satisfactory. However, the long-term results remain to be investigated.
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Affiliation(s)
- Zhihuang Qiu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, 350001, Fujian, China
| | - Jun Xiao
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, 350001, Fujian, China
| | - Qingsong Wu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, 350001, Fujian, China
| | - Tianci Chai
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, 350001, Fujian, China
| | - Li Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Yumei Li
- Department of Toxicology, Fujian Center for Evaluation of New Drug, Fujian Medical University, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China. .,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, Fujian, China. .,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, 350001, Fujian, China.
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Wang D, Wang S, Song Y, Wang H, Zhang A, Wu L, Huang X, Ye P, Du X. Predictors and outcomes of postoperative tracheostomy in patients undergoing acute type A aortic dissection surgery. BMC Cardiovasc Disord 2022; 22:94. [PMID: 35264113 DOI: 10.1186/s12872-022-02538-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background Despite surgical advances, acute type A aortic dissection remains a life-threatening disease with high mortality and morbidity. Tracheostomy is usually used for patients who need prolonged mechanical ventilation in the intensive care unit (ICU). However, data on the risk factors for requiring tracheostomy and the impact of tracheostomy on outcomes in patients after Stanford type A acute aortic dissection surgery (AADS) are limited. Methods A retrospective single-institutional study including consecutive patients who underwent AADS between January 2016 and December 2019 was conducted. Patients who died intraoperatively were excluded. Univariate analysis and multivariate logistic regression analysis were used to identify independent risk factors for postoperative tracheostomy (POT). A nomogram to predict the probability of POT was constructed based on independent predictors and their beta-coefficients. The area under the receiver operating characteristic curve (AUC) was performed to assess the discrimination of the model. Calibration plots and the Hosmer–Lemeshow test were used to evaluate calibration. Clinical usefulness of the nomogram was assessed by decision curve analysis. Propensity score matching analysis was used to analyze the correlation between requiring tracheostomy and clinical prognosis. Results There were 492 patients included in this study for analysis, including 55 patients (11.2%) requiring tracheostomy after AADS. Compared with patients without POT, patients with POT experienced longer ICU and hospital stay and higher mortality. Age, cerebrovascular disease history, preoperative white blood cell (WBC) count and renal insufficiency, intraoperative amount of red blood cell (RBC) transfusion and platelet transfusion were identified as independent risk factors for POT. Our constructed nomogram had good discrimination with an AUC = 0.793 (0.729–0.856). Good calibration and clinical utility were observed through the calibration and decision curves, respectively. For better clinical application, we defined four intervals that stratified patients from very low to high risk for occurrence of POT. Conclusions Our study identified preoperative and intraoperative risk factors for POT and found that requiring tracheostomy was related to the poor outcomes in patients undergoing AADS. The established prediction model was validated with well predictive performance and clinical utility, and it may be useful for individual risk assessment and early clinical decision-making to reduce the incidence of tracheostomy.
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Inoue Y, Inoue M, Koga M, Koizumi S, Yokawa K, Masada K, Seike Y, Sasaki H, Yoshitani K, Minatoya K, Matsuda H. Novel brain computed tomography perfusion for cerebral malperfusion secondary to acute type A aortic dissection. Interact Cardiovasc Thorac Surg 2022; 35:6537619. [PMID: 35218663 PMCID: PMC9336564 DOI: 10.1093/icvts/ivac046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/13/2022] [Revised: 02/05/2022] [Accepted: 02/06/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The management of acute type A aortic dissection with malperfusion syndrome remains challenging. To evaluate preoperative condition, symptoms might be subjective and objective evaluation of cerebral artery has not yet been established. For quantitative evaluation, this study focused on brain computed tomography perfusion (CTP), which has been recommended by several guidelines of acute ischaemic stroke. METHODS In the last 2 years, 147 patients hospitalized due to acute type A aortic dissection were retrospectively reviewed. Among the 23 (16%) patients with cerebral malperfusion, 14 who underwent brain CTP (6 preoperative and 8 postoperative) were enrolled. CTP parameters, including regional blood flow and time to maximum, were automatically computed using RApid processing of Perfusion and Diffusion software. The median duration from the onset to hospital arrival was 129 (31-659) min. RESULTS Among the 6 patients who underwent preoperative CTP, 4 with salvageable ischaemic lesion (penumbra: 8-735 ml) without massive irreversible ischaemic lesion (ischaemic core: 0-31 ml) achieved acceptable neurological outcomes after emergency aortic replacement regardless of preoperative neurological severity. In contrast, 2 patients with an ischaemic core of >50 ml (73, 51 ml) fell into a vegetative state or neurological death due to intracranial haemorrhage. CTP parameters guided postoperative blood pressure augmentation without additional supra-aortic vessel intervention in the 8 patients who underwent postoperative CTP, among whom 6 achieved normal neurological function regardless of common carotid true lumen stenosis severity. CONCLUSIONS CTP was able to detect irreversible ischaemic core, guide critical decisions in preoperative patients and aid in determining the blood pressure augmentation for postoperative management focusing on residual brain ischaemia.
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Affiliation(s)
- Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shigeki Koizumi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenta Masada
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshimasa Seike
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenji Yoshitani
- Department of Transfusion, Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan,Corresponding author. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shimmachi, Suita, Osaka 564-8565, Japan. Tel: +81-6-6170-1070; fax: +81-6-6170-1782; e-mail: (H. Matsuda)
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Takekawa H, Tsukui D, Kobayasi S, Suzuki K, Hamaguchi H. Point-of-care ultrasound for stroke patients in the emergency room. J Med Ultrason (2001) 2022. [PMID: 35112168 DOI: 10.1007/s10396-021-01185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
Stroke requires rapid determination of the cause to provide timely and appropriate initial management. Various ultrasonographic techniques have been evaluated as ways to determine the cause of stroke; among them, carotid artery ultrasonography is particularly useful since it provides considerable information within a short time period when used to evaluate a specific site. In the emergency room, carotid artery ultrasonography can be used to diagnose internal carotid artery stenosis, predict an occluded vessel, and infer the cause of ischemic stroke. Additionally, carotid artery ultrasonography can diagnose different conditions including subclavian artery steal syndrome, bow hunter's stroke, Takayasu's arteritis, moyamoya disease, and dural arteriovenous fistula. Furthermore, patients with ischemic stroke with a pulse deficit or hypotension must be differentiated from acute type A aortic dissection, which requires emergency surgery; carotid artery ultrasonography can immediately differentiate between the two conditions by identifying the intimal flap of the common carotid artery. The following article provides an overview of carotid artery ultrasonography performed as point-of-care ultrasound in the emergency room in patients with suspected stroke.
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Arima D, Suematsu Y, Yamada R, Matsumoto R, Kurahashi K, Nishi S, Yoshimoto A. Relationship of acute type A aortic dissection and disseminated intravascular coagulation. J Vasc Surg 2022; 75:1553-1560.e1. [PMID: 34998941 DOI: 10.1016/j.jvs.2021.12.064] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Acute type A aortic dissection (ATAAD) is a critical disease presenting with disseminated intravascular coagulation (DIC). However, the relationship between the degree of DIC and false lumen conditions remains unclear. In the present study, we evaluated the degree of preoperative DIC and the outcomes of ATAAD treatment. METHODS A total of 124 patients with ATAAD (70 men and 54 women) treated from January 2012 to January 2020 were included in the present study. The correlation between the preoperative Japanese Association for Acute Medicine (JAAM) DIC score and the false lumen diameter and length, measured using preoperative computed tomography, was examined retrospectively. The correlations were calculated using liner regression analysis. The level of statistical significance was set at P < .05. RESULTS The patients were divided into two groups: a low JAAM DIC score group and a high JAAM DIC score group. The preoperative JAAM DIC scores in the high- and low-score groups were 4.8 ± 1.2 and 1.7 ± 2.3, respectively (P < .001). The 5-year survival rates and aortic event-free rates in the low-score group were favorable compared with the high-score group; however, the differences were not statistically significant (80.8% vs 54.5%, P = .065; 63.9% vs 59.8%, P = .15, respectively). The false lumen diameter in the ascending aorta was greater in the high-score group than that in the low-score group (P < .05). The JAAM DIC score correlated significantly with the ascending false lumen diameter and the dissection length (r = 0.32 and P < .001; r = 0.29 and P = .001, respectively). A high JAAM DIC score was associated with communicating-type ATAAD (P < .05). CONCLUSIONS Our results suggest that high preoperative JAAM DIC scores are associated with a large false lumen and communicating-type ATAAD.
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Affiliation(s)
- Daisuke Arima
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Yoshihiro Suematsu
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan.
| | - Ryotaro Yamada
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Ryumon Matsumoto
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Kanan Kurahashi
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Satoshi Nishi
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Akihiro Yoshimoto
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan
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Czerny M. Adaption of EuroSCORE II to predict mortality in acute type A aortic dissection: an effort to make fit what does not. Eur J Cardiothorac Surg 2021; 61:1076. [PMID: 34910125 DOI: 10.1093/ejcts/ezab511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/17/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Martin Czerny
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Henzi D, Platzmann A, Brtek J, Holubec T, Emmert MY, Vogt P, Mestres CA, Reser D. Increasing atmospheric temperature implicates increasing risk for acute type A dissection in hypertensive patients. J Thorac Dis 2021; 13:5799-5806. [PMID: 34795928 PMCID: PMC8575824 DOI: 10.21037/jtd-21-824] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/19/2021] [Indexed: 11/06/2022]
Abstract
Background Acute type A aortic dissection (AAAD) is a life-threatening condition with high mortality within 24 hours. We hypothesized if there is a correlation between seasonal weather changes and the occurrence of AAAD. The aim of the present study was to identify seasonal specific weather and patient characteristics predicting the occurrence of AAAD. Methods This is a retrospective analysis of all consecutive patients of our department with AAAD between January 1st 2006 and December 31st 2016. The national meteorological department provided the data of temperature, humidity and air pressure during the study period. The occurrence of AAAD, preoperative neurological impairment and mortality were analyzed in correlation with the obtained daily weather data within the entire cohort and in patients with and without hypertension separately. Results A total of 517 patients were included. Mean age was 63.4±13 years, 69.4% were male and 68.8% had documented hypertension. In-hospital mortality was 17.7%. In the whole cohort, the occurrence of AAAD was significantly increased in March, October, December (P=0.016). In hypertensive patients, the occurrence was increased 34% with rising temperature (0.1-9.6 °C, OR1.34, 95% CI: 1.06-1.69, P=0.015). There was no correlation between weather variables and preoperative neurological impairment or mortality. Conclusions Our data suggests a relation between an increasing number of events of AAAD and certain months within our catchment area and a significantly increased occurrence with rising temperatures (independent from absolute temperature at time of the event) in hypertensive patients.
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Affiliation(s)
- Deborah Henzi
- University Children's Hospital Zurich, Zürich, Switzerland
| | - Anna Platzmann
- Department for Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Jan Brtek
- Department for Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maximilian Y Emmert
- Department for Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Vogt
- Department for Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Carlos A Mestres
- Department for Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Diana Reser
- Department for Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland.,Department for Cardiovascular Surgery, HerzKlinik Hirslanden, Switzerland
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