No abstract

No abstract

Background. Pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is technically demanding. We tried to identify the predictors for short-and long-term outcomes after PEA for CTEPH with aggressive use of pulmonary vasodilators, including epoprostenol sodium.Methods. From 2005 to 2013, 122 CTEPH patients, whose preoperative mean pulmonary artery pressure (mPAP) was 47 ± 10 mm Hg and pulmonary vascular resistance was 847 ± 373 dynes/s/cm 5 , underwent PEA with hypothermic circulatory arrest. Before PEA, all patients underwent pulmonary vasodilator therapy, including epoprostenol sodium of 2 to 6 ng/kg/min. We collected the perioperative and follow-up data retrospectively to identify the predictors for early and late outcomes after PEA.Results. In-hospital mortality was 7.4% (n [ 9). Predictors for in-hospital death were age older than 65 years Patients and MethodsThis retrospective study complied with the Declaration of Helsinki. The Fujita Health University Institutional Review Board approved the study (approval number

The frozen elephant trunk (FET) technique allows single-stage extended surgical repair of Stanford type A aortic dissection and has shown promotion of aortic remodeling by maintaining the true lumen flow and facilitating its expansion and by promoting false lumen thrombosis. However, few studies have compared the effectiveness of FET technique, in terms of the downstream aortic remodeling. Between 2005 and 2017, 50 patients underwent total arch replacement for Stanford type A aortic dissection, including that with (n = 22) and without FET technique (n = 28). We compared distal aortic remodeling in patients who underwent total arch replacement with (using a J-Graft open stent graft) or without the technique. The false lumen complete thrombosis rate and the ratio of true lumen area at three levels of the descending aorta were evaluated post operation. In FET group, the diameter and length of the stent graft were 29.0 ± 3.9 mm and 70.9 ± 17.4 mm, respectively. The in-hospital death with and without the FET technique was 0 and 3, respectively, with no late death in both groups. Eight patients (28.6%) only in the non-FET group required additional surgical treatment for downstream aorta. In the FET group, the ratio of true lumen area at the level of bronchial carina and false lumen complete thrombosis rate at the levels of bronchial carina and aortic valve were significantly higher than non-FET group. A more favorable remodeling in the descending aorta was observed in patients who underwent FET associated with a total arch replacement compared to those who underwent total arch replacement alone.

2468TOCHII M et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp therapy. 9 Thus, the effect of age alone on emergency surgery for AAD is not entirely understood. Furthermore, the longterm outcome of surgery for AAD in octogenarians remains uncertain. Therefore, we reviewed the surgical outcomes to investigate and compare the validity of surgery for AAD in octogenarians and younger patients. Methods Study PatientsWe reviewed our surgical outcomes for patients who underwent surgical treatment for AAD via a median sternotomy at the Department of Cardiovascular Surgery, Fujita Health University, Toyoake, Japan, from 2005 to 2015. According to the Japanese guidelines for aortic dissection, 16 surgery performed within 14 days after the onset of dissection was defined as the acute phase, whereas surgery performed within 48 h was defined as the very acute phase. We retrospectively reviewed clinical records and data on patient demographics, results of imaging studies, details of medical and surgical treatments, and patients' outcomes. We he increasing life expectancy of the population will be accompanied by a rise in the incidence of cardiovascular diseases, including aortic dissection and aneurysm. 1 Because the Stanford type A aortic dissection (AAD) extending to the ascending aorta is a condition that has an extremely poor prognosis, 2 immediate surgical intervention is indicated once it has been diagnosed. The current AAD hospital mortality rates remain between 15% and 30%, 3-8 despite gradual improvement over time. Increased age is a strong independent predictor of hospital death following cardiovascular interventions, including the surgical repair of AAD. 7,9,10 Surgery for octogenarians with AAD may be avoided or denied because of the high surgical morbidity and mortality reported in elderly patients. A recent meta-analysis of 10 publications from 2001 to 2011 showed an overall mortality rate of 36.7% (111/308) in octogenarians, a 2.6-fold higher mortality risk than that in younger patients. 11 In contrast, some reports have demonstrated satisfactory surgical outcomes of AAD in octogenarians. 12-15 A recent report also demonstrated that although the number of surgical deaths significantly increased with increased age, it was still better than that with non-surgical Background: Because increased age is a strong independent predictor of mortality and morbidity, surgery for octogenarians with Stanford type A aortic dissection (AAD) may be avoided.