Deutsches Register für akute Aortendissektion Typ A (GERAADA)

Conzelmann, Lars O.; Krüger, Tobias; Hoffmann, Isabell; Rylski, Bartosz; Easo, Jerry; Oezkur, Mehmet; Kallenbach, Klaus; Dapunt, O; Kretzler, Matthias; Weigang, Ernst; GERAADA-Zentren, für die teilnehmenden

doi:10.1007/s00059-011-3512-x

Cited by 49 publications

(24 citation statements)

References 55 publications

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“…In previous studies, complicated preoperative conditions, such as the presence of hemodynamic instability, requirement for cardiopulmonary resuscitation (CPR), end-organ malperfusion, and haemopericardium with cardiac tamponade, were recognized as adverse factors for surgical outcomes of ATAAD patients 1 – 4 . Among these high-risk patients, the in-hospital mortality rates were reported to be 36–54%, which was approximately twice that of the majority of ATAAD population 5 , 6 . Those with uncomplicated ATAAD comprise a relatively stable subgroup; however, their characteristics and surgical results seem underreported.…”

Section: Introductionmentioning

confidence: 96%

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

Lin

See

Tseng

et al. 2020

Sci Rep

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This retrospective study aimed to clarify the short-term and mid-term outcomes of and prognostic factors for patients who underwent surgical repair for uncomplicated acute type A aortic dissection (ATAAD). Between January 2007 and June 2019, 603 consecutive patients underwent ATAAD repair at our institution. According to patients’ preoperative presentations and imaging studies, uncomplicated ATAAD was found in 276 (45.8%) patients by excluding preoperative complicated factors. Patients with uncomplicated ATAAD were classified into the survivor (n = 243) and non-survivor (n = 33) groups. Clinical features, surgical information, and postoperative complications were compared. Three-year survival and freedom from reoperation rates for survivors were analyzed using the Kaplan–Meier actuarial method. The in-hospital surgical mortality rate of uncomplicated ATAAD patients was 11.9%. The non-survivor group had a higher rate of postoperative malperfusion-related complications, and a multivariate analysis revealed that repeat surgery, retrograde cerebral perfusion, and intraoperative extracorporeal membrane oxygenation support were predictors of in-hospital mortality. In the survivor group, 3-year cumulative survival and freedom from aortic reoperation rates were 89.6% (95% confidence interval [CI] 84.8–92.9%) and 83.1% (95% CI 76.8–87.7%), respectively. In conclusion, uncomplicated and complicated ATAAD rates were similar; the short-term and mid-term surgical outcomes in patients with uncomplicated ATAAD were generally acceptable.

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Section: Introductionmentioning

confidence: 96%

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

Lin

See

Tseng

et al. 2020

Sci Rep

View full text Add to dashboard Cite

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“…Previous studies reported that the incidence of preoperative CPR ranges from 3.8% to 6.3% [ 1 – 3 ]. Among these patients, the in-hospital mortality rates ranged from 50% to 95% [ 1 , 4 , 5 ], which was approximately five-times to six-times higher than that of the general ATAAD population [ 6 , 7 ]. However, even though they comprise an extremely high-risk subgroup, the clinical characteristics and surgical results of patients with ATAAD undergoing preoperative CPR may be under-reported.…”

Section: Introductionmentioning

confidence: 99%

Surgical results in acute type A aortic dissection with preoperative cardiopulmonary resuscitation: Survival and neurological outcome

Lin

Tseng

et al. 2020

PLoS ONE

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Background Acute type A aortic dissection (ATAAD) is a life-threatening disease that requires emergent surgical intervention. This retrospective study aimed to clarify the individual characteristics, short-term and mid-term outcomes, and prognostic factors of patients who underwent surgical repair of ATAAD with preoperative cardiopulmonary resuscitation (CPR). Methods Between January 2007 and January 2020, 656 consecutive patients underwent ATAAD repair at our institution; 22 (3.4%) of these patients underwent CPR prior to surgery. Patients who underwent preoperative CPR were classified as the survivor group (n = 9) and non-survivor group (n = 13), according to whether they survived to hospital discharge. Clinical features, surgical information, and postoperative complications were analyzed and compared. Three-year cumulative survival rates and cerebral performance categories (CPC) scores are presented. Results In patients undergoing CPR prior to ATAAD surgery, the in-hospital mortality rate was 59.1%. A total of 72.7% of patients underwent concomitant surgical resuscitation procedures during CPR such as emergent subxiphoid pericardiotomy and/or emergent cardiopulmonary bypass. The survivor group had a higher rate of return of spontaneous heartbeat (ROSB) compared to the non-survivor group (100% versus 53.8%; P = 0.017). The 3-year cumulative survival rates were 35.1% (95% confidence interval [CI], 27.6%–42.6%) and 85.7% (95% CI, 81.9%–88.8%) for overall patients and for survivors, respectively. As for the neurological outcome, 77.8% (7/9) of patients had full cerebral performance (CPC-1) at the 3-month follow-up examination after discharge. Conclusions Patients with ATAAD undergoing preoperative CPR, especially those without ROSB after CPR, are at high risk for in-hospital mortality. However, the short-term and mid-term outcomes, including the cerebral performance after discharge and 3-year survival rate, are promising for patients who survived to discharge.

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“…Despite advancements in diagnostic tools, management algorithms, and surgical techniques in the past decades, ATAAD remains challenging for cardiothoracic surgeons. The in-hospital mortality rates ranged from 18% to 25% according to the international registry of acute aortic dissection, and have been reported as 17% by the German registry for acute aortic dissection type A [1, 2]. It is vital to use fast and safe arterial inflow to establish effective cardiopulmonary bypass (CPB) and avoid malperfusion in patients undergoing surgery for ATAAD.…”

Section: Introductionmentioning

confidence: 99%

Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience

et al. 2019

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BackgroundRepair of acute type A aortic dissection (ATAAD) is a complex and emergent cardiovascular surgery that is associated with high perioperative morbidity and mortality. Each cannulation strategy has different benefits and drawbacks during cardiopulmonary bypass. Using a retrospective study design, we aimed to clarify the safety and efficacy of right axillary artery cannulation in combination with femoral artery cannulation compared to single arterial cannulation for ATAAD repair.MethodsFrom January 2007 to July 2017, 476 adult patients underwent ATAAD repair at a single institution. Patients were classified into groups according to their cannulation strategy: the double arterial cannulation (DAC) group (n = 377; 79.2%) or single arterial cannulation (SAC) group (n = 99; 20.8%). Preoperative demographics, surgical information, and postoperative recovery were compared between both groups. Survival and freedom from reoperation rates were analyzed using the Kaplan-Meier actuarial method.ResultsDemographics, comorbidities, and surgical procedures were generally homogenous between the two groups, except for sex, age, and rate of extensive aortic repair. Patients who underwent DAC had lower in-hospital mortality (13.5% vs. 25.3%; P = 0.005) and lower incidence of malperfusion-related complications (18.8% vs. 30.3%; P = 0.011) than those who underwent SAC. During multivariate analysis, SAC was identified as an in-hospital mortality predictor (odds ratio, 2.81; 95% confidence interval, 1.52–5.17; P = 0.001), as were preoperative ventilator support, intraoperative extracorporeal membrane oxygenation installation, and postoperative malperfusion-related complications. Three-year cumulative survival and freedom from reoperation rates were 74.8% and 85.3% for the DAC group and 62.6% and 81.1% for the SAC group, respectively (P = 0.010 and 0.430, respectively).ConclusionsWith acceptable short- and mid-term outcomes, DAC is effective and safe for establishing cardiopulmonary bypass during ATAAD repair.

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Deutsches Register für akute Aortendissektion Typ A (GERAADA)

Cited by 49 publications

References 55 publications

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

Surgical results in acute type A aortic dissection with preoperative cardiopulmonary resuscitation: Survival and neurological outcome

Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience

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