Dataset Information

Open and closed distal anastomosis for acute type A aortic dissection repair.

ABSTRACT:

Objectives

The current consensus favours an open distal anastomosis for aortic dissection repair. A small number of experiences have compared early and long-term outcomes between closed and open distal anastomosis in the setting of acute aortic dissection.

Methods

We reviewed our experience in 204 patients who underwent repair of spontaneous acute type A aortic dissection between January 2000 and December 2013. Open distal repair was performed in 109 patients, whereas 95 patients received a closed anastomosis. The clinical presentation, anatomical characteristics of aortic dissection, surgical techniques and the outcomes were analysed in the overall population and in the subgroup of patients (n = 100; open = 39, closed = 61) with Type 1 DeBakey dissection and a proximal intimal tear. Twenty-six preoperative and operative variables were studied to determine their impact on hospital mortality and postoperative neurological deficits. Imaging follow-up was available in 83 patients.

Results

A more extensive involvement of the aortic arch characterized the open repair group. No differences in terms of mortality, morbidity and survival rates were observed between the two groups of patients. Open repair with cerebral perfusion was associated with a better neurological outcome. Patients who underwent an open distal anastomosis showed a significant higher rate of complete thrombosis of the false lumen.

Conclusions

An open repair does not increase the risk of early mortality and positively affect the evolution of the false lumen in distal unresected aortic segments. The use of cerebral perfusion reduces the risk of perioperative neurological injury.

SUBMITTER: Malvindi PG

PROVIDER: S-EPMC4986788 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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Publications

Open and closed distal anastomosis for acute type A aortic dissection repair.

Malvindi Pietro G PG Modi Amit A Miskolczi Szabolcs S Kaarne Markku M Velissaris Theodore T Barlow Clifford C Ohri Sunil K SK Tsang Geoffrey G Livesey Steven S

Interactive cardiovascular and thoracic surgery 20160307 6

<h4>Objectives</h4>The current consensus favours an open distal anastomosis for aortic dissection repair. A small number of experiences have compared early and long-term outcomes between closed and open distal anastomosis in the setting of acute aortic dissection.<h4>Methods</h4>We reviewed our experience in 204 patients who underwent repair of spontaneous acute type A aortic dissection between January 2000 and December 2013. Open distal repair was performed in 109 patients, whereas 95 patients ...[more]

PMID: 26956706

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Project description:ObjectiveThe study objective was to determine the optimal treatment for patients with acute type A aortic dissection and previous cardiac surgery.MethodsA total of 545 patients underwent open repair of an acute type A aortic dissection (July 1996 to January 2017), including patients with (n = 50) and without previous cardiac surgery (n = 495). Data were collected through the University of Michigan Cardiac Surgery Data Warehouse, medical record review, and the National Death Index database.ResultsCompared with patients without previous cardiac surgery, patients with previous cardiac surgery were older (62 vs 59 years, P = .24) and had significantly more coronary artery disease (48% vs 14%, P < .001), peripheral arterial disease (24% vs 11%, P = .01), connective tissue disorders (15% vs 4.5%, P = .004), and acute renal failure on presentation (28% vs 15%, P = .02); and significantly more concomitant mitral or tricuspid procedures, longer cardiopulmonary bypass time, and more intraoperative blood transfusions. There were no statistically significant differences in postoperative major complications between previous cardiac surgery and no previous cardiac surgery groups, including stroke, myocardial infarction, new-onset dialysis, and 30-day mortality (8.9% vs 6.3%, P = .55). Multivariable logistic model showed the significant risk factors for operative mortality were cardiogenic shock (odds ratio, 9.6; P < .0001) and male gender (odds ratio, 3.7; P = .006). The 5- and 10-year unadjusted survivals were significantly lower in the previous cardiac surgery group compared with the no previous cardiac surgery group (66% vs 80% and 42% vs 66%, respectively, P = .02). However, previous cardiac surgery itself was not a significant risk factor for operative mortality (odds ratio, 1.6; P = .36) or all-time mortality (hazard ratio, 1.3; P = .33).ConclusionsAcute type A aortic dissection in patients with previous cardiac surgery can be repaired with favorable operative mortality and long-term survival, and should be treated surgically.

Project description:ObjectiveThe study objective was to assess the radiological properties of acute type A aortic dissection-related neurological injuries and identify predictors of neurological injury.MethodsOur single-center, retrospective, observational study included all patients who underwent acute type A aortic dissection repair between January 1998 and December 2021. Multivariable analyses and Cox regression were performed to identify predictors of embolic lesions, watershed lesions, neurological injury, 30-day mortality, and late mortality.ResultsA total of 538 patients were included. Of these, 120 patients (22.3%) experienced postoperative neurological injury; 74 patients (13.8%) had postoperative stroke, and 36 patients (6.8%) had postoperative coma. The 30-day mortality was 22.7% in the neurological injury group versus 5.8% in the no neurological injury group (P < .001). We identified several independent predictors of neurological injury. Cerebral malperfusion (odds ratio, 2.77; 95% confidence interval, 1.53-5.00), systemic hypotensive shock (odds ratio, 1.97; 95% confidence interval, 1.13-3.43), and aortic arch replacement (odds ratio, 3.08; 95% confidence interval, 1.17-8.08) predicted embolic lesions. Diabetes mellitus (odds ratio, 5.35; 95% confidence interval, 1.85-15.42), previous cardiac surgery (odds ratio, 8.62; 95% confidence interval, 1.47-50.43), duration of hypothermic circulatory arrest (odds ratio, 1.05; 95% confidence interval, 1.01-1.08), cardiopulmonary bypass time (odds ratio, 1.01; 95% confidence interval, 1.00-1.01), ascending aortic/arch cannulation (odds ratio, 5.68; 95% confidence interval, 1.88-17.12), and left ventricular cannulation (odds ratio, 17.81; 95% confidence interval, 1.69-188.01) predicted watershed lesions. Retrograde cerebral perfusion (odds ratio, 0.28; 95% confidence interval, 0.01-0.84) had a protective effect against watershed lesions.ConclusionsIn this study, we demonstrated that the radiological features of neurological injury may be as important as clinical characteristics in understanding the pathophysiology and causality behind neurological injury related to acute type A aortic dissection repair.

Project description:Background Female sex is known to have increased perioperative mortality in cardiac surgery. Studies reporting effects of sex on outcome following surgical repair for acute Type A aortic dissection (ATAAD) have been limited by small cohorts of heterogeneous patient populations and have shown diverging results. This study aimed to compare perioperative characteristics, operative management, and postoperative outcome between sexes in a large and well-defined cohort of patients operated for ATAAD.Methods The Nordic Consortium for Acute Type A Aortic Dissection study included patients with surgical repair of ATAAD at eight Nordic centers between January 2005 and December 2014. Independent predictors of 30-day mortality were identified using multivariable logistic regression.Results Females represented 373 (32%) out of 1,154 patients and were significantly older (65 ± 11 vs. 60 ± 12 years, p < 0.001), had lower body mass index (25.8 ± 5.4 vs. 27.2 ± 4.3 kg/m2, p < 0.001), and had more often a history of hypertension (59% vs. 48%, p = 0.001) and chronic obstructive pulmonary disease (8% vs. 4%, p = 0.033) compared with males. More females presented with DeBakey class II as compared with males with dissection of the ascending aorta alone (33.4% vs. 23.1%, p = 0.003). Hypothermic cardiac arrest time (28 ± 16 vs. 31 ± 19 minutes, p = 0.026) and operation time (345 ± 133 vs. 374 ± 135 minutes, p < 0.001) were shorter among females. There was no difference between the sexes in unadjusted intraoperative death (9.1% vs. 6.7%, p = 0.17) or 30-day mortality (17.7% vs. 17.4%, p = 0.99). In a multivariable analysis including perioperative factors influencing mortality, no difference was found between females and males in 30-day mortality (odds ratio: 0.92, 95% confidence interval: 0.62-1.38, p = 0.69).Conclusions This study found no association between sex and early mortality following surgery for ATAAD, despite females being older and having more comorbidities, yet also presenting with a less widespread dissection than males.

Dataset Information

Open and closed distal anastomosis for acute type A aortic dissection repair.

Objectives

Methods

Results

Conclusions

Publications

Open and closed distal anastomosis for acute type A aortic dissection repair.

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