Thoracic aortic surgery: An overview of 40 years clinical practice

Bekkers, Jos A.; Riele, R J L M Te; Takkenberg, Johanna J.M.; Raap, Goris Bol; Hofland, Jan; Roos‐Hesselink, Jolien W.; Bogers, Ad J.J.C.

doi:10.1016/j.jtcvs.2012.11.036

Cited by 15 publications

(18 citation statements)

References 24 publications

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“…The estimated 1-year survival of only 74% in our analysis is compatible with previously reported findings, keeping in mind that we did not exclude hospital mortality from our analysis. 15,19,[23][24][25][26][27][28] These results support the need for timely diagnosis and elective surgery in patients with an elevated risk of aortic rupture or dissection. Given that elective operative mortality is relatively low and aortic dissection is strongly associated with poor outcomes, we tend to intervene electively at smaller sizes in patients at risk.…”

Section: Discussionsupporting

confidence: 53%

“…These findings are within the previously published ranges of survival estimates for aortic (arch) surgery of 63% to 82% at 5 years and 53% to 78% at 10 years. [14][15][16][17][18][19] These results demonstrate that aortic arch surgery using straight DHCA is safe and can match other techniques in terms of early and late outcomes.…”

Section: Discussionmentioning

confidence: 64%

“…Our study cohort had significantly worse survival compared with the reference population, in agreement with previous reports. 2,19,20 However, after exclusion of high-risk patients who underwent emergency surgery, surgery for aortic dissection, or redo surgery, a negative effect on late survival was no longer apparent. These data show that in low-risk patients, aortic arch surgery can indeed achieve normal life expectancy.…”

Section: Discussionmentioning

confidence: 99%

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Favorable late survival after aortic surgery under straight deep hypothermic circulatory arrest

Damberg

Carino

Charilaou

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Aortic surgery with DHCA can be performed with favorable late survival, with the duration of DHCA period having only a limited impact. However, these results cannot be generalized for very long durations of DHCA (>50 minutes), when perfusion methods may be preferable. In elective, nondissection first-time surgeries, a late survival comparable to that in a reference population can be achieved. Early survival is adversely affected by aortic dissection, redo status, and disease extent.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Favorable late survival after aortic surgery under straight deep hypothermic circulatory arrest

Damberg

Carino

Charilaou

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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“…Thoracic aorta replacement surgery is one of the most complex surgical procedures requiring meticulous perioperative care with a reported 30-day mortality rate ranging from 5 to 10% [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, serious postoperative complications including paraplegia or stroke are not uncommon, and thus, there is still room for improvement in patient outcomes despite recent improvement [10,11].…”

Section: Introductionmentioning

confidence: 99%

Association between institutional case volume and mortality following thoracic aorta replacement: A nationwide Korean cohort study

Nam

Jang

et al. 2020

Preprint

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Abstract Background The inverse relationship between case volume and postoperative mortality following high-risk surgical procedures have been reported. Thoracic aorta surgery is associated with one of the highest postoperative mortality. The relationship between institutional case volume and postoperative mortality in patients undergoing thoracic aorta replacement surgery was evaluated. Methods All thoracic aorta replacement surgeries performed in Korea between 2009 and 2016 in adult patients were analyzed using an administrative database. Hospitals were divided into low (<30 cases/year), medium (30–60 cases/year), or high (>60 cases/year) volume centers depending on the annual average number of thoracic aorta replacement surgeries performed. The impact of case volume on in-hospital mortality was assessed using the logistic regression. Results Across 83 hospitals, 4867 cases of thoracic aorta replacement were performed. In-hospital mortality was 8.6% (191/2222), 10.7% (77/717), and 21.9% (422/1928) in high, medium, and low volume centers, respectively. The adjusted risk of in-hospital mortality was significantly higher in medium (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.16–2.11, P = 0.004) and low volume centers (OR, 3.12; 95% CI, 2.54–3.85, P <0.001) compared to high volume centers. Conclusions Patients who had underwent thoracic aorta replacement surgery in lower volume centers had increased risk of in-hospital mortality after surgery compared to those in higher volume centers. Our results may provide the basis for minimum case volume requirement or regionalization in thoracic aorta replacement surgery for optimal patient outcome.

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Evaluation of spinal cord protective threshold of serum memantine, an NMDA receptor antagonist, in a rabbit model of paraplegia

Panthee

Ōno

Yamamoto

et al. 2020

Indian J Thorac Cardiovasc Surg

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Purpose To evaluate the threshold of serum memantine for prevention of spinal cord injury (SCI) in a rabbit paraplegic model. Methods Forty-two New Zealand white rabbits were divided into 7 groups. Preoperatively, oral memantine was given starting from 60 mg OD for 7 days in the initial group, then reducing the dose and/or duration to 60 mg OD for 5 days, 30 mg OD for 5 days, 30 mg OD for 3 days, 15 mg OD for 3 days, 30 mg single dose, and 60 mg single dose, in subsequent 6 groups. A paraplegic model was created by clamping both infrarenal aorta and inferior vena cava (IVC) for 45 min. Motor evoked potentials (MEPs), modified Tarlov score (0-5), serum memantine concentration, and histopathology of the spinal cord were evaluated. Results Half of all rabbits (21/42) showed spinal protection. Receiver operating characteristic (ROC) curve analysis showed serum level of 4.5 ng/ml as a cutoff value for spinal protection (sensitivity 86%, specificity 62%, area under the curve (AUC) 0.785, P = .002). Sixteen rabbits had serum level ≥ 4.5 ng/ml (group A), with 26 rabbits having < 4.5 ng/ml (group B). Further comparison was done between groups A and B. The mean modified Tarlov score at 6, 24, 48, and 72 h was 4.5 ± 0.9 and 2.4 ± 1.6, in groups A and B, respectively (P < .001). The modified Tarlov score showed positive correlation with serum memantine level (Spearman's rho = 0.618, P = .01). Results of MEP and histopathology were significantly better for group A. Conclusions We showed that memantine is protective against SCI at serum levels ≥ 4.5 ng/ml in a rabbit model; thus, it can be a potential adjunct for spinal protection during thoracic/thoracoabdominal aortic surgeries.

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Thoracic aortic surgery: An overview of 40 years clinical practice

Abstract: Thoracic aortic operations were performed increasingly during a 40-year time period. Early mortality decreased and late survival increased significantly in all patient groups. A significant proportion of patients required multiple operations.

Cited by 15 publications

References 24 publications

Favorable late survival after aortic surgery under straight deep hypothermic circulatory arrest

Favorable late survival after aortic surgery under straight deep hypothermic circulatory arrest

Association between institutional case volume and mortality following thoracic aorta replacement: A nationwide Korean cohort study

Evaluation of spinal cord protective threshold of serum memantine, an NMDA receptor antagonist, in a rabbit model of paraplegia

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