Background: The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute type A aortic dissection by the method of cerebral perfusion used.Methods: A total of 324 patients from five academic medical centers underwent repair of acute type A aortic dissection between January 2000 and December 2010. Of those, antegrade cerebral perfusion (ACP) was used for 84 patients, retrograde cerebral perfusion (RCP) was used for 55 patients, and deep hypothermic circulatory arrest (DHCA) was used for 184 patients during repair. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality and Cox Regression hazard ratios were calculated to determine the predictors of long term mortality.Results: Operative mortality was not influenced by the type of cerebral protection (19% for ACP, 14.5% for RCP and 19.1% for DHCA, P=0.729). In multivariable logistic regression analysis, hemodynamic instability [odds ratio (OR) =19.6, 95% confidence intervals (CI), 0.102-0.414, P<0.001] and CPB time >200 min (OR =4.7, 95% CI, 1.962-1.072, P=0.029) emerged as independent predictors of operative mortality.Actuarial 5-year survival was unchanged by cerebral protection modality (48.8% for ACP, 61.8% for RCP and 66.8% for no cerebral protection, log-rank P=0.844).Conclusions: During surgical repair of type A aortic dissection, ACP, RCP or DHCA are safe strategies for cerebral protection in selected patients with type A aortic dissection.
Purpose of ReviewThis review describes the Organ Procurement and Transplantation Network (OPTN) recently implemented policy to remove donation service area (DSA) and region from combined kidney and pancreas (KP) and pancreas (PA) allocation. It also highlights the OPTN 6-month post-implementation monitoring report data analysis findings and discusses the next steps in terms of continuous distribution. Recent Findings Post-implementation data demonstrates an increase in transplantation rates and volumes for KP and PA post-policy implementation. Distance from donor hospital to transplant center increased for KP but decreased for PA, with minor increases in cold ischemia time for KP. Kidney transplant rates and volumes also increased. Summary As predicted, the elimination of DSA has resulted in improvement in access and utilization of pancreata for transplant with increases in both KP and PA volumes without detriment to kidney alone volumes. Minimal increases in CIT and increased utilization are encouraging for pancreas transplantation overall and are seemingly positive indicators for a continuous distribution.
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