Early and midterm outcomes of quick proximal arch replacement with mild hypothermia and rapid rewarming for type A acute aortic dissection

Hata, Mitsumasa; Akiyama, Kenji; Hata, Hiroyuki; Sezai, Akira; Yoshitake, Isamu; Wakui, Shinji; Shiono, Motomi

doi:10.1016/j.jtcvs.2012.06.047

Cited by 13 publications

(9 citation statements)

References 24 publications

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“…Despite continuous improvements in diagnosis, surgical treatment, and perioperative management, the latest report from the International Registry of Acute Aortic Dissection (IRAD) revealed an in‐hospital surgical mortality of 23.9% . This is similar to that found in a more recent study from another large registry, while several single‐center series report mortality well below 10% . Patients who survive to discharge have reasonable intermediate and long‐term survival rates …”

Section: Introductionsupporting

confidence: 62%

Extent of Preoperative False Lumen Thrombosis Does Not Influence Long‐Term Survival in Patients With Acute Type A Aortic Dissection

Larsen

Bartnes

Tsai

et al. 2013

JAHA

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BackgroundPartial thrombosis of the false lumen has been related to aortic growth, reoperations, and death in the chronic phase of type B and repaired type A aortic dissections. The impact of preoperative false lumen thrombosis has not been studied previously. We used data from a contemporary, multinational database on aortic dissections to evaluate whether different degrees of preoperative false lumen thrombosis influenced long‐term prognosis.Methods and ResultsWe examined the records of 522 patients with surgically treated acute type A aortic dissections who survived to discharge between 1996 and 2011. At the preoperative imaging, 414 (79.3%) patients had patent false lumens, 84 (16.1%) had partial thrombosis of the false lumen, and 24 (4.6%) had complete thrombosis of the false lumen. The annual median (interquartile range) aortic growth rates were 0.5 (−0.3 to 2.0) mm in the aortic arch, 2.0 (0.2 to 4.0) mm in the descending thoracic aorta, and similar regardless of the degree of false lumen thrombosis. The overall 5‐year survival rate was 84.7%, and it was not influenced by false lumen thrombosis (P=0.86 by the log‐rank test). Independent predictors of long‐term mortality were age >70 years (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.20 to 4.56, P=0.012) and postoperative cerebrovascular accident, coma, and/or renal failure (HR, 2.62; 95% CI, 1.40 to 4.92, P=0.003).ConclusionsPatients with acute type A aortic dissection who survive to discharge have a favorable prognosis. Preoperative false lumen thrombosis does not influence long‐term mortality, reintervention rates, or aortic growth.

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Section: Introductionsupporting

confidence: 62%

Extent of Preoperative False Lumen Thrombosis Does Not Influence Long‐Term Survival in Patients With Acute Type A Aortic Dissection

Larsen

Bartnes

Tsai

et al. 2013

JAHA

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“…With a short circulatory arrest time (19 AE 5 min) and cardiopulmonary bypass time (86.2 AE 17.8 min), they reported a stroke rate of 4.4%, and hospital mortality of 3.3%. 14 In a series of 119 patients, Matsuyama and colleagues 15 reported a low mortality rate of 3.4% (1.6% for elective cases) and a favorable 4-year survival of 86.5%; incidences of permanent neurologic deficit (5%) and paraplegia (1.7%) were acceptable. Wiedemann and colleagues 6 reported high overall mortality (19%) and neurologic adverse events (26%) in a series of 329 patients; the lowest mortality (13%) and lowest neurologic adverse event rate (12%) were observed with antegrade cerebral perfusion.…”

Section: Discussionmentioning

confidence: 97%

The outcome of surgical management of type A aortic dissection

Skripochnik

Friedman

Michler

et al. 2013

Asian Cardiovasc Thorac Ann

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“…Lansman et al and Griepp et al popularized profound hypothermia for organ protection during aortic arch surgery . There is emerging evidence to suggest that mild to moderate hypothermia is comparable to deep hypothermia in terms of operative risk, and the optimal temperature during circulatory arrest remains unclear. One has to weigh the risks of potentially increased coagulopathy, increased length of operation, and increased systemic inflammatory response with deeper degrees of hypothermia versus the potential benefits of better organ protection.…”

Section: Discussionmentioning

confidence: 99%

Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database

et al. 2018

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Purpose: Management of acute type A aortic dissection (AAAD) is challenging and operative strategies are varied. We used the STS Adult Cardiac Surgery Database (STS ACSD) to describe contemporary surgical strategies and outcomes for AAAD. Results: In this cohort, median age was 60 years old, 66% were male, and 80% had hypertension. The most common arterial cannulation strategies included femoral (36%), axillary (27%), and direct aortic (19%). The median perfusion and cross-clamp times were 181 and 102 min, respectively. The lowest temperature on bypass showed significant variation. Hypothermic circulatory arrest (HCA) was used in 78% of cases.Among those undergoing HCA, brain protection strategies included antegrade cerebral perfusion (31%), retrograde cerebral perfusion (25%), both (4%), and none (40%). Median HCA plus cerebral perfusion time was 40 min. Major complications included prolonged ventilation (53%), reoperation (19%), renal failure (18%), permanent stroke (11%), and paralysis (3%). Operative mortality was 17%. The median intensive care unit and hospital length of stays were 4.7 and 9.0 days, respectively. Among 640 centers, the median number of cases performed during the study period was three. Resuscitation, unresponsive state, cardiogenic shock, inotrope use, age >70, diabetes, and female sex were found to be independent predictors of mortality. Conclusions:These data describe contemporary patient characteristics, operative strategies, and outcomes for AAAD in North America. Mortality and morbidity for AAAD remain high.

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Early and midterm outcomes of quick proximal arch replacement with mild hypothermia and rapid rewarming for type A acute aortic dissection

Abstract: Our original technique is a safe and less-invasive procedure that enables a quicker surgery. The midterm outcome also was favorable.

Cited by 13 publications

References 24 publications

Extent of Preoperative False Lumen Thrombosis Does Not Influence Long‐Term Survival in Patients With Acute Type A Aortic Dissection

Extent of Preoperative False Lumen Thrombosis Does Not Influence Long‐Term Survival in Patients With Acute Type A Aortic Dissection

The outcome of surgical management of type A aortic dissection

Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database

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