Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians Without Patient Selection

Suzuki, Tomoaki; Asai, Tomohiro; Kinoshita, Takeshi

doi:10.1016/j.athoracsur.2018.10.010

Cited by 16 publications

(21 citation statements)

References 26 publications

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“…Type A aortic dissection (TAAD) is a critical illness that requires emergency surgery and cardiopulmonary bypass (CPB) to reduce mortality related to various complications, such as the rupture of aortic dissection, acute myocardial ischemia, shock, and the insufficient perfusion of vital organs (1). Timely CPB surgery can result in good prognoses, even among elderly and/or pregnant TAAD patients (2,3). The use of CPB with hypothermic and/ or moderate hypothermic circulatory arrest is still the gold standard in clinical practice (4).…”

Section: Introductionmentioning

confidence: 99%

Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics

et al. 2021

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Background:The aim of the present study was to use a numerical simulation based on computational fluid dynamics (CFD) to analyze the difference of different cannulation methods on hemodynamics characteristic in a type A aortic dissection (TAAD) model. Methods:A finite-element analysis based on the CFD model of a TAAD patient was used, and axillary artery cannulation (AAC), innominate artery cannulation (IAC), and femoral artery cannulation (FAC) were analyzed under different situations, including a cardiac output (CO) of 2.5 L/min and cardiopulmonary bypass (CPB) of 2.5 L/min (partial CPB before cross-clamping aorta, defined as condition A), and a CO of 0 L/min and CPB of 5 L/min (aortic cross-clamping phase, defined as condition B). The insertion of an 8-mm cannula into the different models was simulated. Hemodynamic characteristics, including wall shear stress, wall stress, blood flow, and velocity were analyzed.Results: In condition A, the total flow of branches of the aortic arch was 2,009.5 mL/min (AAC), 1,855.47 mL/min (IAC), and 1,648.03 mL/min (FAC). All cannulation methods improved left renal blood perfusion. However, in relation to blood flow in the right renal artery, FAC showed the highest blood flow (105 mL/min). The results in condition B were similar to those of condition A. The velocity, shear stress, and stress of entry tear via AAC and IAC decreased in condition B compared with condition A. The velocity, shear stress, stress of tear via AAC was lower than that of IAC.Conclusions: Different cannulation modes have an effect on the hemodynamic characteristic of the tear, but this effect is related to different states of CPB. AAC was found to superior to IAC, especially in reducing velocity, stress, and shear stress of site of tear. However, IAC and AAC are more conductive to blood supply than FAC in branch vessels of the aortic arch without being affected by the CPB state.

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Section: Introductionmentioning

confidence: 99%

Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics

et al. 2021

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“…12 Other groups have reported acceptable rates of surgical mortality between 0% and 15.6% in octogenarians. [13][14][15] A number of studies have investigated outcomes of patients presenting with neurological deficit as a complication of TAAAD. Several analyses have shown that patients who present with CVA in the presence of TAAAD are at risk of significantly increased rates of postoperative mortality between 25.7% -40.2%.…”

Section: Discussionmentioning

confidence: 99%

Type A Acute Aortic Dissection Presenting With Cerebrovascular Accident at Advanced Age

Angleitner

Brinster

Gleason

et al. 2022

Seminars in Thoracic and Cardiovascular Surgery

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Acute type A aortic dissection remains a fatal disease despite recent improvements in surgical outcomes, and the patients experience various post-surgical complications. Based on several reports on surgical outcomes in older patients with acute type A aortic dissection, the surgical mortality rate is 3.7%-35% [2][3][4]9,10,[15][16][17][18]. TAR has higher mortality and morbidity rates than ascending or hemiarch replacement [19].…”

Section: Discussionmentioning

confidence: 99%

“…Another study reported that despite longer CPB, aortic clamp, and circulatory arrest times, there was no difference in mortality and morbidity between hemiarch replacement and TAR [20]. Some studies reported that the surgical procedure in all older patients with acute type A aortic dissection was either ascending or hemiarch replacement [2,9], whereas others reported ascending or hemiarch replacement in 90% of patients [3,10,17,19]. These reports indicate that older patients with acute type A aortic dissection avoid TAR as a surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Limited Repair And Conservative Approaches In Older Patients With Acute Type A Aortic Dissection

Maze

Tokui

Murakami

et al. 2021

Preprint

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Background: Surgical indication and the selection of surgical procedures for acute type A aortic dissection in older patients are controversial; therefore, we examined the surgical outcomes in older patients.Methods: From January 2012 through December 2019, 174 patients surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the older (≥80 years old) and below-80 (≤79 years old) age groups. Additionally, we compared the surgical and conservative treatment groups.Results: The primary entry was found in the ascending aorta in 51.6% and 32.8% of the older and below-80 groups, respectively (p = 0.049). Ascending or hemiarch replacement was performed in all older group cases and 57.3% of the below-80 group cases (total arch replacement was performed in the remaining 42.7%; p < 0.001). Hospital mortality rates were similar in both groups. The significant risk factors for hospital mortality were age, preoperative intubation, cardiopulmonary bypass time, and postoperative stroke. The 5-year survival rates were 48.4% ± 10.3% (older group) and 86.7% ± 2.9% (below-80 group; p < 0.001). The rates of freedom from aortic events at 5 years were 86.9% ± 8.7% (older group) and 86.5% ± 3.9% (below-80 group; p = 0.771). The 5-year survival rate of the conservative treatment group was 19.2% ± 8.0% in the older group. There was no significant difference between the surgical treatment groups (p = 0.103).Conclusion: The surgical approach did not achieve a significant survival advantage over conservative treatment and may not always be the reasonable treatment of choice for older patients.

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Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians Without Patient Selection

Cited by 16 publications

References 26 publications

Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics

Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics

Type A Acute Aortic Dissection Presenting With Cerebrovascular Accident at Advanced Age

Clinical Outcomes of Limited Repair And Conservative Approaches In Older Patients With Acute Type A Aortic Dissection

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