The mortality of emergency surgical intervention for type A acute aortic dissection (AAD) has been variously reported as 15-30%. These findings are often derived from series spanning 10-20 years. Recent advances in surgical techniques, anesthesia, and perioperative medical management are likely to have lowered the mortality of emergency operations over the last few years. In fact, many factors, such as surgical techniques, use of sealed prosthesis, access of cardiopulmonary bypass, cerebral protection techniques, and postoperative surveillance have markedly changed during this long time interval, influencing the recently-improved surgical outcomes. For example, open distal anastomosis to avoid aortic cross clamping and antegrade systemic recirculation after distal anastomosis have dramatically improved the early and late outcomes of surgery for AAD. On the other hand, in recent aging society, the number of octogenarians undergoing emergency surgery for AAD has been steadily increasing and this may negate the impact of the beneficial advances. We reviewed clinical trend of the optimal treatment strategy for type A acute aortic dissection and presented our newly modified technique, namely, less invasive quick replacement (LIQR) with rapid re-warming for octogenarians undergoing emergency surgery for type A acute aortic dissection.
The ventricular assist device (VAD) is implanted as an effective treatment for end-stage heart failure and has been widely used as a bridge to cardiac transplantation or in destination therapy. In Japan, however, there are problems with the heart transplantation system, i.e., an extreme shortage of donors and limited availability of VAD. Until recently, only one paracorporeal ventricular assist device (NIPRO VAD) was approved for coverage by national health insurance. In this study, we investigated the results obtained using the NIPRO VAD at our institution. From 2006 to 2009, 8 patients underwent NIPRO VAD implantation (left VAD: LVAD) at Nihon University Itabashi Hospital. Three patients were be weaned from LVAD, and it was used as a bridge to heart transplantation in two patients who underwent transplantation in Germany. Four patients have since achieved long-term survival with LVAD without complications. All four patients with cardiogenic shock due to acute myocardial infarction died despite the use of LVAD. Although the outcome of LVAD therapy was poor for patients with cardiogenic shock due to acute myocardial infarction, it was effective in patients with fulminant myocarditis and as a bridge to transplantation.
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