Mortality and Neurologic Injury After Surgical Repair With Hypothermic Circulatory Arrest in Acute and Chronic Proximal Thoracic Aortic Pathology

Czerny, Martin; Krähenbühl, Eva; Reineke, David; Sodeck, Gottfried; Englberger, Lars; Weber, Alberto; Schmidli, Jürg; Kadner, Alexander; Erdoes, Gabor; Schoenhoff, Florian; Jenni, Hansjörg; Stalder, Mario; Carrel, Thierry

doi:10.1161/circulationaha.110.010124

Cited by 50 publications

(42 citation statements)

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“…A further screening of abstracts and full texts was conducted and a final sample of 18 studies considered relevant to our review (1,2,5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Of these, seven were excluded from the quantitative meta-analysis for different reasons.…”

Section: Prisma Preferred Reporting Items For Systematic Reviews Andmentioning

confidence: 99%

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Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis

Bruno¹,

Chivasso²,

Guida³

et al. 2016

Ann. Cardiothorac. Surg.

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Background:The results of surgical treatment of type A aortic dissection (AAD) in the elderly are controversial and aggravated by a higher operative mortality rate. The studies published in this subset of patients are mainly retrospective analyses or small samples from international registries. We sought to investigate this topic by conducting a contemporary meta-analysis of the most recent observational studies.Methods: A systematic literature search was conducted for any study published in the last five years on aortic dissection treated surgically in patients 70 years and older. A pooled risk-ratio meta-analysis has been conducted three main post-operative outcomes: short-term mortality, stroke and acute kidney injury.Results: A total of 11 retrospective observational studies have been included in the quantitative metaanalysis. Pooled meta-analysis showed an increased risk of short term mortality for the elderly population 2 =14%, P=0.31) after surgery were comparable to the younger cohort of patients. Conclusions:Although affected by an increased risk of short-term mortality in the elderly, surgical repair remains the treatment of choice for AAD. The main post-operative outcomes are comparable to younger patients and the mid-term survival rates are acceptable.

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Section: Prisma Preferred Reporting Items For Systematic Reviews Andmentioning

confidence: 99%

“…Only seven studies (1,6,7,(11)(12)(13)(14) reported post-operative stroke rates with an incidence in the elderly group ranging from 4.76% to 28.3 %, with a pooled rate of 19.2%. A total of 348 elderly patients over an overall population of 1,204 patients were included into this meta-analysis.…”

Section: Post-operative Strokementioning

confidence: 99%

Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis

Bruno¹,

Chivasso²,

Guida³

et al. 2016

Ann. Cardiothorac. Surg.

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“…The majority of entry tears in patients undergoing surgery for acute type A aortic dissection are located in the proximal thoracic aorta and can therefore be addressed by surgical resection during repair [7]. Nevertheless, a certain percentage, being potentially underreported in the literature, do have their primary entry at a more distal site, such as the descending aorta with retrograde propagation of the dissecting membrane into the proximal thoracic aorta [8].This mechanism has also been confirmed in experimental studies [9].…”

Section: Commentmentioning

confidence: 89%

“…Furthermore, patients with acute aortic syndromes such as symptomatic penetrating aortic ulcer, intramural haematoma, as well as traumatic aortic injury were also excluded. Our surgical and perfusional strategy in patients with acute type A aortic dissection has been described in detail previously [7]. From a surgical standpoint, hemiarch replacement was the minimum requirement.…”

Section: Patientsmentioning

confidence: 99%

“…These findings support the major importance of adequate imaging-if haemodynamics are favourable-in each and every patient with the diagnosis of an acute type A aortic dissection. Adequate imaging-in our opinion-contains a CTA of the entire aorta in order to perceive the extent of dissection, judge the involvement of branches and anticipate the repair strategy needed [7]. By determining exactly the site of the primary entry tear, a tear-oriented approach can be performed by conventional surgical means or by extending the armamentarium with a vascular and endovascular approach in order to be able to cover the primary entry tear as well as large communications between both lumina, which may have the same pathophysiological consequence as a patent primary entry tear, at least in the proximal and mid thoracic aorta [18].…”

Section: Commentmentioning

confidence: 99%

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What makes the difference between the natural course of a remaining type B dissection after type A repair and a primary type B aortic dissection?

Czerny¹,

Roost-Krähenbühl²,

Sodeck³

et al. 2012

Thorac cardiovasc Surg

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OBJECTIVES: To analyse the outcome and need for intervention [surgery or thoracic endovascular aortic repair (TEVAR)] in patients after surgery for remaining type B dissection after type A repair and primary type B aortic dissection. METHODS:Within a 10-year period, 247 patients with remaining type B after type A, and 112 patients with primary type B aortic dissection were analysed. We assessed the clinical outcome as well as the need for intervention (surgery or TEVAR) within the aortic arch and the thoracoabdominal aorta as well as risk factors. RESULTS:The median follow-up was 23 months (interquartile range 5-52). There was a significant difference with regard to the status of the primary entry tear between patients after surgical repair of an acute type A aortic dissection and primary acute type B aortic dissection ( patent vs. non-patent entry 35 vs. 83%, P < 0.001). The overall need for any kind of intervention (surgery or TEVAR) was 19%. Multivariate Cox regression analysis revealed a patent primary entry tear in patients after surgery for acute type A aortic dissection as an independent predictor for intervention (surgery or TEVAR) during follow-up [odds ratio (OR) 6.4; confidence interval (CI) 1.39-29.81, P = 0.017]. Multivariate Cox regression analysis did not reveal a patent primary entry tear in patients after acute type B aortic dissection as an independent predictor for intervention (surgery or TEVAR) during follow-up (OR 0.67; CI 0.27-1.69, P = 0.671). Finally, the thrombosis status of the false lumen was not an independent predictor for intervention (surgery or TEVAR) either in patients after surgery for acute type A aortic dissection (OR 3.46; CI 0.79-15.16, P = 0.100) or in patients after acute type B aortic dissection (OR 0.77; CI 0.31-1.93, P = 0.580).CONCLUSIONS: A remaining type B dissection after type A repair and a primary type B aortic dissection represent two distinct pathophysiological entities with regard to late outcome. The need for any kind of intervention in the thoracoabdominal aorta is significantly higher in primary type B aortic dissections. A remaining patent primary entry tear independently predicts the need for intervention (surgery or TEVAR) in patients after surgery for acute type A aortic dissection and, thereby, remains the main target of initial therapy. The thrombosis status of the false lumen seems to be of secondary importance.

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Intramural Hematoma of the Ascending Aorta; Diagnosis, Management and Outcome

Czerny

Schmidli

2014

Controversies in Aortic Dissection and Aneurysmal Disease

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Mortality and Neurologic Injury After Surgical Repair With Hypothermic Circulatory Arrest in Acute and Chronic Proximal Thoracic Aortic Pathology

Cited by 50 publications

References 24 publications

Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis

Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis

What makes the difference between the natural course of a remaining type B dissection after type A repair and a primary type B aortic dissection?

Intramural Hematoma of the Ascending Aorta; Diagnosis, Management and Outcome

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