Mortality and reoperations in survivors operated on for acute type A aortic dissection and implications for catheter-based or hybrid interventions

Abstract

Despite close follow-up, aortic-related death after a successful operation for acute type A aortic dissection is prevalent, and overall mortality remains substantial. Reoperations are not uncommon, may be indicated very late as well as repeatedly in the same patient, and are associated with a significant mortality. Increased use of applicable but seemingly under-used catheter-based or hybrid treatment approaches could benefit this growing patient population by offering repeat intervention to more patients and as substitute for reoperative open surgery in selected cases.

Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection

“…Patients who present without pain present a diagnostic challenge and are more likely to have a missed or delayed diagnosis (13)(14)(15)(16). Surgical treatment is indicated for all type A AADs, and medical management is used for uncomplicated type B AAD; however, long-term outcomes indicate significant late mortality from late complications in both groups (18). Surgical treatment is indicated for all type A AADs, and medical management is used for uncomplicated type B AAD; however, long-term outcomes indicate significant late mortality from late complications in both groups (18).…”

Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection

“…Zero percent to 14% hospital mortality and 8% to 21% long-term mortality have been reported in other series [22][23][24][25], but these series had very small patient cohorts (n ¼ 24, 21, 19, and 17) and even smaller numbers of patients who underwent procedures involving replacement of the entire arch. Of interest, in our series, full arch replacement versus hemiarch replacement was not significantly associated with either operative or long-term mortality (p ¼ 0.54 and 0.28, respectively).…”

Factors of Prolonged Intensive Care Unit Stay After Surgery in Patients with Type A Acute Aortic Dissection

“…Many Citation: Khan MF, Fa X, Yu HB (2016) Factors of Prolonged Intensive Care Unit Stay After Surgery in Patients with Type A Acute Aortic studies have pointed out that the elderly, renal failure, preoperative hemodynamic instability, cardiopulmonary resuscitation, cardiac tamponade, prolonged deep hypothermic cardio-circulatory arrest (DHCA), damaged nervous system(CVA), respiratory insufficiency are important factors of postoperative death [16][17][18][19]. Postoperative ICU stay time affects on recovery of Stanford acute type A aortic dissection.…”