No abstract

Prophylactic levosimendan did not result in a rate of the short-term composite end point of death, renal-replacement therapy, perioperative myocardial infarction, or use of a mechanical cardiac assist device that was lower than the rate with placebo among patients with a reduced left ventricular ejection fraction who were undergoing cardiac surgery with the use of cardiopulmonary bypass. (Funded by Tenax Therapeutics; LEVO-CTS ClinicalTrials.gov number, NCT02025621 .).

No abstract

No abstract

No abstract

No abstract

Outcomes and survival in surgical treatment of the descending thoracic aorta with acute dissection Bozinovski J, Coselli JS. Ann Thorac Surg 2008;85:965-71. Conclusion: Open replacement of the descending thoracic aorta or thoracoabdominal aorta for acute type B dissection carries substantial morbidity and mortality rates.Summary: In a large majority of cases, acute type B aortic dissection is managed medically with a favorable outcome. Certainly, aortic rupture in the setting of acute type B dissection is an indication for emergency intervention. Some centers also used continued pain or a large diameter aortic dissection as an indication for urgent repair. In this article the authors describe the results of open urgent or emergency repair of the descending thoracic aorta or the thoracoabdominal aorta for acute dissection in 76 consecutive patients (72% male). The patients were acquired during a 16-year period from 1989 to 2004 and therefore represent a relatively small component of patients treated for thoracic dissection at this center during that time. The average age of the patients who underwent surgery for acute type B aortic dissection was 64.1 Ϯ 12.2 years (range, 36-86 years), and 22% presented with rupture. A variety of surgical adjuncts were used without a specific protocol, including hypothermic circulatory arrest in eight patients and left carotid bypass in 15. Spinal fluid drainage was used in only five patients. Aortic clamp time was 38.4 Ϯ 17.3 minutes.One patient died intraoperatively. The overall 30-day operative mortality was 22.4%. Paraplegia occurred in 6.6%, and hemodialysis was required in 19.7%, with about half of these patients requiring permanent hemodialysis. Cardiac complications occurred in 43.4%, and 10 patients had prolonged respirator dependence necessitating tracheostomy. The hospital stay was 26.0 Ϯ 29.7 days. Rupture was not associated with an increased risk of operative mortality or perioperative complication.Comment: The article highlights why it is best to avoid an operation in acute type B dissections. Even in a center with acknowledged expertise in thoracic aortic surgery, mortality is high and morbidity is also very high. Because mortality and morbidity rates were the same for patients with and without rupture, it is important to reassess indications for emergency or urgent open thoracic aortic repair in patients with acute type B dissection. We need better natural history data to know whether continued pain predicts rupture or if a larger initial diameter of the dissection predicts actual rupture. One can also see this article as providing justification for endovascular repair of ruptured or severely symptomatic acute type B dissections. Given the results here, most centers are likely to do better with endovascular repair rather than open repair of an acute type B dissection. Telmisartan, ramipril, or both in patients at high risk for vascular events ONTARGET Investigators. N Engl J Med 2008;358:1547-59.

Background: Contemporary outcomes after surgical management of thoracic aortic disease have improved; however, the impact of sex-related differences is poorly understood. Methods: A total of 1653 patients (498 [30.1%] female) underwent thoracic aortic surgery with hypothermic circulatory arrest between 2002 and 2017 in 10 institutions of the Canadian Thoracic Aortic Collaborative. Outcomes of interest were in-hospital death, stroke, and a modified Society of Thoracic Surgeons–defined composite for mortality or major morbidity (stroke, renal failure, deep sternal wound infection, reoperation, prolonged ventilation). Multivariable logistic regression was used to determine independent predictors of these outcomes. Results: Women were older (mean±SD, 66±13 years versus 61±13 years; P <0.001), with more hypertension and renal failure, but had less coronary disease, less previous cardiac surgery, and higher ejection fraction than men. Rates of aortic dissection were similar between women and men. Rates of hemiarch, and total arch repair were similar between the sexes; however, women underwent less aortic root reconstruction including aortic root replacement, Ross, or valve-sparing root operations (29% versus 45%; P <0.001). Men experienced longer cross-clamp and cardiopulmonary bypass times, but similar durations of circulatory arrest, methods of cerebral perfusion, and nadir temperatures. Women experienced a higher rate of mortality (11% versus 7.4%; P =0.02), stroke (8.8% versus 5.5%; P =0.01), and Society of Thoracic Surgeons–defined composite end point for mortality or major morbidity (31% versus 27%; P =0.04). On multivariable analyses, female sex was an independent predictor of mortality (odds ratio, 1.81; P <0.001), stroke (odds ratio, 1.90; P <0.001), and Society of Thoracic Surgeons–defined composite end point for mortality or major morbidity (odds ratio, 1.40; P <0.001). Conclusions: Women experience worse outcomes after thoracic aortic surgery with hypothermic circulatory arrest. Further investigation is required to better delineate which measures may reduce sex-related outcome differences after complex aortic surgery.