scholarly journals Role of Moderate Hypothermia and Antegrade Cerebral Perfusion during Repair of Type A Aortic Dissection

2018 ◽  
Vol 27 (04) ◽  
pp. 190-195 ◽  
Author(s):  
Michael McHugh ◽  
Brian Conway ◽  
Marcos Nores ◽  
Sotiris Stamou
Keyword(s):  
Aortic Dissection ◽  
Operative Mortality ◽  
Circulatory Arrest ◽  
Academic Medical Center ◽  
Type A ◽  
Deep Hypothermia ◽  
Moderate Hypothermia ◽  
Acute Type ◽  
Actuarial Survival ◽  
Type A Aortic Dissection

The goal of this study was to compare early postoperative outcomes and actuarial survival between patients who underwent repair of acute type A aortic dissection with deep or moderate hypothermia.A total of 132 consecutive patients from a single academic medical center underwent repair of acute type A aortic dissection between January 2000 and June 2014. Of those, 105 patients were repaired under deep hypothermia (< 24 C°), while 27 patients were repaired under moderate hypothermia (≥24 C°). Median ages were 62 years (range: 27–86) and 59 years (range: 35–83) for patients repaired under deep hypothermia compared with patients repaired under moderate hypothermia, respectively (p = 0.451). Major morbidity, operative mortality, and 10-year actuarial survival were compared between groups.Operative mortality was 17.1 and 7.4% in the deep and moderate hypothermia groups, respectively (p = 0.208). Incidence of permanent stroke was 12.4% in the deep hypothermic circulatory arrest group and 0% in the moderate hypothermia group (p = 0.054). Actuarial 5- and 10-year survival demonstrated a trend for lower long-term mortality with moderate hypothermia compared with deep hypothermia (69% 5-year and 54% 10-year for deep hypothermia vs. 79% 5-year and 10-year for moderate hypothermia, log-rank p = 0.161).Moderate hypothermia is a safe and efficient alternative to deep hypothermia and may have protective benefits. Stroke rate was lower with moderate hypothermia.

scholarly journals Techniques of Proximal Root Reconstruction and Outcomes Following Repair of Acute Type A Aortic Dissection

Aorta ◽  
2016 ◽  
Vol 04 (02) ◽  
pp. 33-41 ◽  
Author(s):  
Tyler Gunn ◽  
Sotiris Stamou ◽  
Nicholas Kouchoukos ◽  
Kevin Lobdell ◽  
Kamal Khabbaz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Operative Mortality ◽  
Survival Rates ◽  
Surgical Techniques ◽  
Type A ◽  
Acute Type ◽  
Actuarial Survival ◽  
Type A Aortic Dissection ◽  
Replacement Procedure

Background: The goal of this study was to compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute Type A aortic dissection, including aortic valve (AV) resuspension, aortic valve replacement (AVR), and a root replacement procedure. Methods: All patients who underwent acute Type A aortic dissection repair between January 2000 and October 2010 at four academic institutions were compiled from each institution’s Society of Thoracic Surgeons Database. This included 189 patients who underwent a concomitant aortic valve (AV) procedure; 111, 21, and 57 patients underwent AV resuspension, AVR, and the Bentall procedure, respectively. The median age of patients undergoing a root replacement procedure was significantly younger than the other two groups. Early clinical outcomes and 10-year actuarial survival rates were compared. Trends in outcomes and surgical techniques throughout the duration of the study were also analyzed. Results: The operative mortality rates were 17%, 29%, and 18%, for AV resuspension, AVR, and root replacement, respectively. Operative mortality (p = 0.459) was comparable between groups. Hemorrhage related re-exploration did not differ significantly between groups (p = 0.182); however, root replacement procedures tended to have decreased rates of bleeding when compared to AVR (p = 0.067). The 10-year actuarial survival rates for the AV resuspension, Bentall, and AVR groups were 72%, 56%, and 36%, respectively (log-rank p = 0.035). Conclusions: The 10-year actuarial survival was significantly lower in those receiving AVR compared to those receiving root replacement procedures or AV resuspension. Operative mortality was comparable between the three groups.

scholarly journals Axillary Versus Femoral Arterial Cannulation During Repair of Type A Aortic Dissection?

Aorta ◽  
2016 ◽  
Vol 04 (04) ◽  
pp. 115-123 ◽  
Author(s):  
Sotiris Stamou ◽  
Derek Gartner ◽  
Nicholas Kouchoukos ◽  
Kevin Lobdell ◽  
Kamal Khabbaz ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Operative Mortality ◽  
Cox Regression ◽  
Type A ◽  
Acute Type ◽  
Arterial Cannulation ◽  
Actuarial Survival ◽  
Type A Aortic Dissection ◽  
Artery Cannulation ◽  
Cannulation Site

Background: The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation. Methods: A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n = 107) or femoral (n = 198) artery cannulation between January 2000 and December 2010. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality, and Cox regression hazard ratios were calculated to determine predictors of long-term mortality. Results: Operative mortality was not influenced by cannulation site (16% for axillary cannulation vs. 19% for femoral cannulation, p = 0.64). In multivariate logistic regression analysis, hemodynamic instability (p < 0.001) and prolonged cardiopulmonary bypass time (>200 min; p = 0.05) emerged as independent predictors of operative mortality. Stroke rates were comparable between the two techniques (14% for axillary and 17% for femoral cannulation, p = 0.52). Five-year actuarial survival was comparable between the groups (55.1% for axillary and 65.7% for femoral cannulation, p = 0.36). In Cox regression analysis, predictors of long-term mortality were: age (p < 0.001), stroke (p < 0.001), prolonged cardiopulmonary bypass time (p = 0.001), hemodynamic instability (p = 0.002), and renal failure (p = 0.001). Conclusions: The outcomes of femoral versus axillary arterial cannulation in patients with acute Type A aortic dissection are comparable. The choice of arterial cannulation site should be individualized based on different patient risk profiles.

The Circulatory Arrest Time in Patients with Acute Type A Aortic Dissection: Does It Influence the Outcome?

2020 ◽  
Author(s):  
J. Kapahnke ◽  
K. Huenges ◽  
M. Salem ◽  
P. Kolat ◽  
J. Schoettler ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

Moderate Hypothermia (30°C) for surgery of acute type A aortic dissection

2004 ◽  
Vol 52 (S 1) ◽  
Author(s):  
A Zierer ◽  
T Aybek ◽  
S Dogan ◽  
G Wimmer-Greinecker ◽  
A Moritz
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Moderate Hypothermia ◽  
Acute Type ◽  
Type A Aortic Dissection

scholarly journals Preoperative hematological parameters are inadequate for predicting mortality in Stanford Type A aortic dissection repair

2021 ◽  
Vol 5 (2) ◽  
pp. 01-06
Author(s):  
Selim Durmaz ◽  
◽  
Ömer Faruk Rahman ◽  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Roc Analysis ◽  
Circulatory Arrest ◽  
Hematological Parameters ◽  
Demographic Data ◽  
Type A ◽  
Hospital Death ◽  
Acute Type ◽  
Type A Aortic Dissection

Background: Mortality in acute Type A aortic dissection is still high and unpredictable. We aimed to investigate the validity of preoperative hematological markers and possible risk factors in predicting in-hospital mortality in patients operated with deep hypothermic circulatory arrest method. Methods: 78 consecutive patients who were admitted to the emergency service and operated on were retrospectively analyzed. Risk factors for in-hospital death were investigated to develop a predictive model. Results: There was no difference between patients in terms of the were demographic data of the patients. In the mortality group, only preoperative creatinine levels were found to be higher (p < 0.05). Factors affecting mortality were found as total circulatory arrest (TCA) and cross-clamp (X-clamp) times when intraoperative data were examined (p < 0.05). ROC analysis was performed to determine the power to predict mortality and to determine the cut-off point. In ROC analysis to predict mortality, X-Clamp time > 71 minutes, 68.2% sensitivity and 66.1% specificity, TCA > 44.5 minutes, 72.7% sensitivity and 73.2% specificity were found. In the mortality group, these values were found to be significantly higher than those who were discharged. Conclusion: In the surgical treatment of Type A aortic dissection under deep hypothermia, hematologic biomarkers may be insufficient in estimating the risk for mortality. Keywords: Acute; aortic dissection; biomarker; mortality

scholarly journals Interfacility Transfer of Medicare Beneficiaries With Acute Type A Aortic Dissection and Regionalization of Care in the United States

Circulation ◽  
2019 ◽  
Vol 140 (15) ◽  
pp. 1239-1250 ◽  
Author(s):  
Andrew B. Goldstone ◽  
Peter Chiu ◽  
Michael Baiocchi ◽  
Bharathi Lingala ◽  
Justin Lee ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Operative Mortality ◽  
Type A ◽  
High Volume ◽  
The United States ◽  
Acute Type ◽  
Medicare Beneficiaries ◽  
Type A Aortic Dissection ◽  
High Volume Hospital

Background: The feasibility and effectiveness of delaying surgery to transfer patients with acute type A aortic dissection—a catastrophic disease that requires prompt intervention—to higher-volume aortic surgery hospitals is unknown. We investigated the hypothesis that regionalizing care at high-volume hospitals for acute type A aortic dissections will lower mortality. We further decomposed this hypothesis into subparts, investigating the isolated effect of transfer and the isolated effect of receiving care at a high-volume versus a low-volume facility. Methods: We compared the operative mortality and long-term survival between 16 886 Medicare beneficiaries diagnosed with an acute type A aortic dissection between 1999 and 2014 who (1) were transferred versus not transferred, (2) underwent surgery at high-volume versus low-volume hospitals, and (3) were rerouted versus not rerouted to a high-volume hospital for treatment. We used a preference-based instrumental variable design to address unmeasured confounding and matching to separate the effect of transfer from volume. Results: Between 1999 and 2014, 40.5% of patients with an acute type A aortic dissection were transferred, and 51.9% received surgery at a high-volume hospital. Interfacility transfer was not associated with a change in operative mortality (risk difference, –0.69%; 95% CI, –2.7% to 1.35%) or long-term mortality. Despite delaying surgery, a regionalization policy that transfers patients to high-volume hospitals was associated with a 7.2% (95% CI, 4.1%–10.3%) absolute risk reduction in operative mortality; this association persisted in the long term (hazard ratio, 0.81; 95% CI, 0.75–0.87). The median distance needed to reroute each patient to a high-volume hospital was 50.1 miles (interquartile range, 12.4–105.4 miles). Conclusions: Operative and long-term mortality were substantially reduced in patients with acute type A aortic dissection who were rerouted to high-volume hospitals. Policy makers should evaluate the feasibility and benefits of regionalizing the surgical treatment of acute type A aortic dissection in the United States.

scholarly journals “Aorta-clamp” technique for surgical repair of acute type A aortic dissection—5 min circulatory arrest at 30 °C

2019 ◽  
Vol 11 (11) ◽  
pp. 4717-4724
Author(s):  
Jie He ◽  
Jihai Peng ◽  
Wei Li ◽  
Dingwen Zheng ◽  
Shihao Cai ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Surgical Repair ◽  
Circulatory Arrest ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Clamp Technique

scholarly journals Deep Hypothermic Circulatory Arrest with Lung Perfusion/Ventilation in a Patient with Acute Type A Aortic Dissection

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Yiliam F. Rodriguez-Blanco ◽  
Lester Garcia ◽  
Tania Brice ◽  
Marco Ricci ◽  
Tomas A. Salerno
Keyword(s):  
Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Deep Hypothermic Circulatory Arrest ◽  
Lung Perfusion ◽  
Hypothermic Circulatory Arrest ◽  
Acute Type ◽  
Perfusion Technique ◽  
Type A Aortic Dissection ◽  
Potential Benefits

A 50-year-old black male presented with acute type A aortic dissection. Surgical repair was performed under deep hypothermic circulatory arrest (DHCA) with lung perfusion/ventilation throughout the procedure. Details of the lung perfusion technique and its potential benefits and drawbacks are discussed.

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