The outcome of surgical management of type A aortic dissection

Skripochnik, Edvard; Friedman, Patricia; Michler, Robert E.; Neragi-Miandoab, Siyamek

doi:10.1177/0218492313506921

Cited by 7 publications

(6 citation statements)

References 19 publications

(40 reference statements)

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“…No significant differences in the 5-year survival between the groups were observed. Similar results were obtained by Skripochnik et al [ 22 ]; in assessing 1- and 4-year survival, they noted no significant differences between patients in the mini-invasive and those in full access groups. However, Merk et al reported higher 5- and 8-year survival rates in patients who underwent minimal access operation than in those who underwent traditional interventions [ 20 ].…”

Section: Discussionsupporting

confidence: 88%

Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)

et al. 2018

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Background: new minimally invasive sternotomy (mini-sternotomy) procedures have improved the treatment outcome and reduced the incidence of perioperative complications leading to improved patient satisfaction and a reduced cost of aortic valve replacement in comparison to the conventional median sternotomy (full sternotomy). The aim of this study is to compare and gain new insights into operative and early postoperative outcomes, long-term postoperative results, and 5-year survival rates after aortic valve replacement through a ministernotomy and full sternotomy. Methods: This is a retrospective study of patients who underwent an isolated replacement of the aortic valve via a full sternotomy or ministernotomy from 2011 to 2016. From 2011 to 2016, 426 cardiac interventions were performed, 70 of which (16.4%) were of the ministernotomy and 356 (83.6%) of the full sternotomy. Through propensity score matching, 70 patients who underwent the ministernotomy (ministernotomy group) were compared with 70 patients who underwent the full sternotomy (control group). Results: in the propensity matching cohort, no statistical difference in operative time was noted (p = 0.856). The ministernotomy had longer cross clamp (88.7 ± 20.7 vs. 80.3 ± 24.6 min, p = 0.007) and bypass (144.0 ± 29.9 vs. 132.9 ± 44.9 min, p = 0.049) times, less ventilation time (9.7 ± 1.7 vs. 11.7 ± 1.4 h, p < 0.001), shorter hospital stay (18.3 ± 1.9 vs. 21.9 ± 1.9 days, p = 0.012), less 24-h chest tube drainage (256.2 ± 28.6 vs. 407.3 ± 40.37 mL, p < 0.001), fewer corrections of coagulopathy (p < 0.001), fewer patients receiving catecholamine (5.71 vs. 30.0%, p < 0.001) and better cosmetic results (p < 0.001). Moreover, the number of patients without complaints at 1 year after the operation was significantly greater in the ministernotomy group (p = 0.002), and no significant differences in the 5-year survival between the groups were observed. In the overall cohort, the ministernotomy had longer cross clamp times (88.7 ± 20.7 vs. 79.9 ± 24.8 min, p < 0.001), longer operative times (263.5 ± 62.0 vs. 246.7 ± 74.2 min, p = 0.037) and bypass times (144.0 ± 29.9 vs. 132.7 ± 44.5 min, p = 0.026), lower incidence of 30-day mortality (1(1.4) vs. 13(3.7), p = 0.022), shorter hospital stays post-surgery p = 0.025, less 24-h chest tube drainage, p < 0.001, and fewer corrections of coagulopathy (p < 0.001). Conclusions: the ministernotomy has a number of advantages compared with the full sternotomy and thus could be a better approach for aortic valve replacement.

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Section: Discussionsupporting

confidence: 88%

Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)

et al. 2018

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“…Contemporary reports showed 10% to 25% perioperative mortality in spite of advances in techniques and perioperative management (3)(4)(5)12). These numbers increase dramatically when there is hemodynamic compromise at presentation (1,2,(5)(6)11,13,14). Hence, early recognition and surgical correction is recommended to prevent aortic rupture, repair the aortic regurgitation, and restore flow to end-organs (2,14).…”

Section: Discussionmentioning

confidence: 99%

“…Axillary artery cannulation has the advantage of delivering cerebral perfusion through the initial cannulation site. There is less risk for visceral malperfusion, but it can be technically demanding in large patients, requires a separate incision, has been associated with brachial plexus injury and arm ischemia, and can cause insufficient systemic CPB flow if the vessel is small, has a serpentine course, atherosclerotic, or is itself dissected (9,13,23,24). Innominate artery cannulation, first described by Banbury and Cosgrove in 2000, is less commonly used (23).…”

Section: Cannulation Techniquementioning

confidence: 99%

Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Cabasa¹,

Pochettino²

2016

Ann. Cardiothorac. Surg.

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Background: Type A aortic dissection (TAAD) is a complex cardiovascular disease that is associated with high perioperative morbidity and mortality. The most effective approach is still being debated-such as the best cannulation technique, and conservative versus extensive initial surgery. We reviewed our experience over the last 20 years and examined for variables that correlated with observed outcomes.Methods: All patients who underwent TAAD repair were reviewed. Chi-Square tests, Fisher Exact tests and Wilcoxon tests were performed where appropriate. Survival and freedom from reoperations were analyzed with the Kaplan-Meier actuarial method.Results: Acute TAAD was associated with a higher incidence of permanent stroke (P=0.010), renal failure (P=0.025), prolonged mechanical ventilator support (P=0.004), higher operative mortality (P=0.039) and higher 30-day mortality (P=0.003) compared to chronic TAAD. There was a trend towards higher risk for transient neurologic events among patients who were reoperated on (P=0.057). Extensive proximal repair led to longer perfusion and cross clamp times (P<0.001) and the need for temporary mechanical support postoperatively (P=0.011). More patients that had extensive distal repair underwent circulatory arrest (P=0.009) with no significant differences in the incidence of peri-operative complications, early, middle and long-term survival compared to the conservative management group. Overall survival in our series was 66.73% and 46.30% at 5 and 10 years respectively (median survival time: 9.38 years). There was a significant improvement in operative mortality (P=0.002) and 30-day mortality (P=0.033) in the second decade of our study.Conclusion: TAAD is a complex disease with several options for its surgical management. Each technique has its own advantages and complications and surgical management should be individualized depending on the clinical presentation. We propose our present approach to maximize benefits in both the short and long term.

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“…Most series addressing surgery for acute type A aortic dissection focus on perioperative outcome and often lack reporting of survival greater than 4 years. 3,[6][7][8][9][10] The few contemporary trials with longer follow-up show comparable outcomes. 11 However, patient number reported is substantially smaller in most studies.…”

Section: Discussionmentioning

confidence: 99%

Survival, Neurologic Injury, and Kidney Function after Surgery for Acute Type A Aortic Dissection

Schoenrath

Labèr

Maralushaj

et al. 2015

Thorac cardiovasc Surg

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Background To analyze survival, neurologic injury, and kidney function after acute type A aortic dissection. Methods A total of 445 patients undergoing surgery for acute type A aortic dissection were analyzed. Evaluation according to risk factors for mortality, neurologic injury, and kidney function was performed. Results Overall 1-, 5-, and 10-year survival rates were 82.8 AE 1.8%, 73.6 AE 2.4%, and 59.3 AE 3.9, respectively. Independent preoperative risk factors for mortality were preexisting renal impairment (p ¼ 0.001), reduced left ventricular ejection fraction (p < 0.001), and age (p < 0.001). Perioperative risk factors were prolonged crossclamp (p < 0.001) and cerebral perfusion time (p ¼ 0.001). Risk factors for renal failure were preexisting renal impairment (p < 0.001), prolonged cross-clamp time (p < 0.001), cerebral perfusion time (p < 0.001), and age (p ¼ 0.022). Risk factors for neurologic injury were cross-clamp time (p ¼ 0.038), cerebral perfusion time (p ¼ 0.007), and age (p ¼ 0.045). Conclusion In addition to classic risk factors, survival after type A aortic dissection is affected by preexisting renal impairment. Preexisting renal impairment is predictive of postoperative renal failure. Therefore treatment and prevention strategies for renal failure during the acute and long-term course after acute type A aortic dissection are warranted.

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The outcome of surgical management of type A aortic dissection

Abstract: Our results identify the major risk factors for perioperative and long-term mortality. Age is an independent risk factor for mortality.

Cited by 7 publications

References 19 publications

Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)

Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)

Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Survival, Neurologic Injury, and Kidney Function after Surgery for Acute Type A Aortic Dissection

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