Do Surgical Outcomes for Ascending Aortic Dissection Vary Based on Arterial Cannulation?

Abstract Background Obesity is dramatically increasing worldwide, and more obese patients may develop aortic dissection and present for surgical repair. The study aims to analyse the impact of body mass index (BMI) on surgical outcomes in patients with acute Stanford type A aortic dissection (ATAAD). Methods From January 2017 to June 2019, the clinical data of 268 ATAAD patients in a single centre were retrospectively reviewed. They were divided into three groups based on the BMI: normal weight (BMI 18.5 to < 25 kg/m2, n = 110), overweight (BMI 25 to < 30 kg/m2, n = 114) and obese (BMI ≥30 kg/m2, n = 44). Results There was no statistical difference among the three groups in terms of the composite adverse events including 30-day mortality, stroke, paraplegia, renal failure, hepatic failure, reintubation or tracheotomy and low cardiac output syndrome (20.9% vs 21.9% vs 18.2% for normal, overweight and obese, respectively; P = 0.882). No significant difference was found in the mid-term survival among the three groups. The proportion of prolonged ventilation was highest in the obese group followed by the overweight and normal groups (59.1% vs 45.6% vs 34.5%, respectively; P = 0.017). Multivariable logistic regression analysis suggested that BMI was not associated with the composite adverse events, while BMI ≥30 kg/m2 was an independent risk factor for prolonged ventilation (OR 2.261; 95% CI 1.056–4.838; P = 0.036). Conclusions BMI had no effect on the early major adverse outcomes and mid-term survival after surgery for ATAAD. Satisfactory surgical outcomes can be obtained in patients with ATAAD at all weights.

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Double Arterial Cannulation Versus Right Axillary Artery Cannulation for Acute Type A Aortic Dissection: a Retrospective Study

10.21203/rs.3.rs-764238/v1 ◽

2021 ◽

Author(s):

He Zhang ◽

Wei Xie ◽

Yuzhou Lu ◽

Tuo Pan ◽

Qing Zhou ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Dissection ◽

Lower Incidence ◽

Axillary Artery ◽

Type A ◽

Acute Type ◽

Arterial Cannulation ◽

Blood Gas ◽

Type A Aortic Dissection ◽

Significant Difference

Abstract Background: Cannulation strategy in surgery for acute type A aortic dissection (ATAAD) remains controversial. We aimed to retrospectively analyze the safety and efficacy of double arterial cannulation (DAC) compared with right axillary cannulation (RAC) for ATAAD.Methods: From January 2016 to December 2018, 431 ATAAD patients were enrolled in the study. Patients were divided into DAC group (n=341) and RAC group (n=90). Propensity score matching analysis was performed to compare the early and mid-term outcomes between these two groups. To confirm the organ protection effect by DAC, intraoperative blood gas results and cardiopulmonary bypass parameters were compared between the two groups.Results: Demographics and preoperative comorbidities were comparable between two groups, while patients in DAC group were younger than RAC group (51.55±13.21 vs. 56.07±12.16 years, P＜0.001 ) . DAC had a higher incidence of limb malperfusion (18.2% vs. 10.0%, P=0.063) and lower incidence of coronary malperfusion (5.3% vs. 12.2%, P=0.019). No significant difference in cardiopulmonary bypass and cross-clamp time was found between the two groups. The in-hospital mortality was 13.5% (58/431), while there was no difference between the two groups (13.5% vs. 13.3%; P=0.969). Patients who underwent DAC had higher incidence of postoperative stroke (5.9% vs. 0%, P=0.019) and lower incidence of postoperative acute kidney injury (AKI) (24.7% vs. 40.3%; P=0.015). During a mean follow-up period of 31.8 (interquartile range, 25-45) months, the overall survival was 81.5% for DAC group and 78.0% for RAC group (P=0.560). Intraoperative blood gas results and cardiopulmonary bypass parameters showed that DAC group had more intraoperative urine output volume than RAC group (P=0.05), and the time of cooling (P=0.04) and rewarming (P=0.04) were shorter in DAC group.Conclusions: DAC will not increase the surgical risks compared to RAC, but could reduce the incidence of postoperative AKI which may be benefit for renal protection.

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Direct Aortic Versus Peripheral Arterial Cannulation in Surgery for Type A Aortic Dissection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2020.02.010 ◽

2020 ◽

Vol 110 (4) ◽

pp. 1251-1258 ◽

Cited By ~ 2

Author(s):

Mikko Jormalainen ◽

Peter Raivio ◽

Caius Mustonen ◽

Hannu-Pekka Honkanen ◽

Antti Vento ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Arterial Cannulation ◽

Type A Aortic Dissection ◽

Peripheral Arterial

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Surgical Outcomes for Type-A Aortic Dissection in Septuagenarians and Octogenarians

Journal of Surgical Research ◽

10.1016/j.jss.2011.11.468 ◽

2012 ◽

Vol 172 (2) ◽

pp. 278

Author(s):

N. Dobrilovic ◽

A.K. Singh ◽

J.G. Fingleton ◽

A. Maslow ◽

J. Machan ◽

...

Keyword(s):

Aortic Dissection ◽

Surgical Outcomes ◽

Type A ◽

Type A Aortic Dissection

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Experience With the Axillary Artery as an Arterial Cannulation Site in Patients With Acute Type A Aortic Dissection

Heart Lung and Circulation ◽

10.1016/j.hlc.2018.03.019 ◽

2019 ◽

Vol 28 (2) ◽

pp. 342-347 ◽

Cited By ~ 3

Author(s):

Arpit Talwar ◽

Elvina Wiadji ◽

Manu N. Mathur

Keyword(s):

Aortic Dissection ◽

Axillary Artery ◽

Type A ◽

Acute Type ◽

Arterial Cannulation ◽

Type A Aortic Dissection ◽

Cannulation Site

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Surgical Outcomes of Acute Type A Aortic Dissection in Elderly Patients

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2014.01.045 ◽

2014 ◽

Vol 97 (5) ◽

pp. 1576-1581 ◽

Cited By ~ 12

Author(s):

Kazunori Komatsu ◽

Tamaki Takano ◽

Takamitsu Terasaki ◽

Yuko Wada ◽

Tatsuichiro Seto ◽

...

Keyword(s):

Aortic Dissection ◽

Elderly Patients ◽

Surgical Outcomes ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Impact of connective tissue disease on the surgical outcomes of aortic dissection in patients with cystic medial necrosis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-017-0663-8 ◽

2017 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Toshiki Fujiyoshi ◽

Kenji Minatoya ◽

Yoshihiko Ikeda ◽

Hatsue Ishibashi-Ueda ◽

Takayuki Morisaki ◽

...

Keyword(s):

Connective Tissue ◽

Aortic Dissection ◽

Connective Tissue Disease ◽

Surgical Outcomes ◽

Cystic Medial Necrosis ◽

Medial Necrosis

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Clinical Practice Variation and Outcomes for Stanford Type A Aortic Dissection Repair Surgery in Maryland: Report from a Statewide Quality Initiative

Aorta ◽

10.1055/s-0040-1714121 ◽

2020 ◽

Vol 08 (03) ◽

pp. 066-073

Author(s):

Michael Mazzeffi ◽

Mehrdad Ghoreishi ◽

Diane Alejo ◽

Clifford E. Fonner ◽

Kenichi Tanaka ◽

...

Keyword(s):

Clinical Practice ◽

Blood Transfusion ◽

Aortic Dissection ◽

Type A ◽

Practice Variation ◽

Left Ventricular Ejection ◽

Arterial Cannulation ◽

Brain Protection ◽

Type A Aortic Dissection ◽

Cannulation Site

Abstract Background Stanford Type A aortic dissection repair surgery is associated with high mortality and clinical practice remains variable among hospitals. Few studies have examined statewide practice variation. Methods Patients who had Stanford Type A aortic dissection repair surgery in Maryland between July 1, 2014 and June 30, 2018 were identified using the Maryland Cardiac Surgery Quality Initiative (MCSQI) database. Patient demographics, comorbidities, surgery details, and outcomes were compared between hospitals. We also explored the impact of arterial cannulation site and brain protection technique on outcome. Results A total of 233 patients were included from eight hospitals during the study period. Seventy-six percent of surgeries were done in two high-volume hospitals (≥10 cases per year), while the remaining 24% were done in low-volume hospitals. Operative mortality was 12.0% and varied between 0 and 25.0% depending on the hospital. Variables that differed significantly between hospitals included patient age, the percentage of patients in shock, left ventricular ejection fraction, creatinine level, arterial cannulation site, brain protection technique, tobacco use, and intraoperative blood transfusion. The percentage of patients who underwent aortic valve repair or replacement procedures differed significantly between hospitals (p < 0.001), although the prevalence of moderate-to-severe aortic insufficiency was not significantly different (p = 0.14). There were no significant differences in clinical outcomes including mortality, renal failure, stroke, or gastrointestinal complications between hospitals or based on arterial cannulation site (all p > 0.05). Patients who had aortic cross-clamping or endovascualr repair had more embolic strokes when compared with patients who had hypothermic circulatory arrest (p = 0.03). Conclusion There remains considerable practice variation in Stanford Type A aortic dissection repair surgery within Maryland including some modifiable factors such as intraoperative blood transfusion, arterial cannulation site, and brain protection technique. Continued efforts are needed within MCSQI and nationally to evaluate and employ the best practices for patients having acute aortic dissection repair surgery.

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Clinical Outcomes of Limited Repair And Conservative Approaches In Older Patients With Acute Type A Aortic Dissection

10.21203/rs.3.rs-772479/v1 ◽

2021 ◽

Author(s):

Yasumi Maze ◽

Toshiya Tokui ◽

Masahiko Murakami ◽

Bun Nakamura ◽

Ryosai Inoue ◽

...

Keyword(s):

Conservative Treatment ◽

Aortic Dissection ◽

Hospital Mortality ◽

Surgical Outcomes ◽

Older Patients ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Treatment Groups ◽

Significant Difference

Abstract Background: Surgical indication and the selection of surgical procedures for acute type A aortic dissection in older patients are controversial; therefore, we examined the surgical outcomes in older patients.Methods: From January 2012 through December 2019, 174 patients surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the older (≥80 years old) and below-80 (≤79 years old) age groups. Additionally, we compared the surgical and conservative treatment groups.Results: The primary entry was found in the ascending aorta in 51.6% and 32.8% of the older and below-80 groups, respectively (p = 0.049). Ascending or hemiarch replacement was performed in all older group cases and 57.3% of the below-80 group cases (total arch replacement was performed in the remaining 42.7%; p < 0.001). Hospital mortality rates were similar in both groups. The significant risk factors for hospital mortality were age, preoperative intubation, cardiopulmonary bypass time, and postoperative stroke. The 5-year survival rates were 48.4% ± 10.3% (older group) and 86.7% ± 2.9% (below-80 group; p < 0.001). The rates of freedom from aortic events at 5 years were 86.9% ± 8.7% (older group) and 86.5% ± 3.9% (below-80 group; p = 0.771). The 5-year survival rate of the conservative treatment group was 19.2% ± 8.0% in the older group. There was no significant difference between the surgical treatment groups (p = 0.103).Conclusion: The surgical approach did not achieve a significant survival advantage over conservative treatment and may not always be the reasonable treatment of choice for older patients.

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Femoral arterial cannulation remains a safe and reliable option for aortic dissection repair

Journal of Thoracic Disease ◽

10.21037/jtd-20-2549 ◽

2021 ◽

Vol 13 (2) ◽

pp. 1005-1010

Author(s):

Anthony Lemaire ◽

Joshua Chao ◽

Lauren Salgueiro ◽

Hirohisa Ikegami ◽

Leonard Y. Lee

Keyword(s):

Aortic Dissection ◽

Arterial Cannulation

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