scholarly journals Management of cerebral malperfusion in surgical repair of acute type A aortic dissection

2017 ◽  
Vol 52 (2) ◽  
pp. 327-332 ◽  
Author(s):  
Tomokuni Furukawa ◽  
Naomichi Uchida ◽  
Shinya Takahashi ◽  
Yoshitaka Yamane ◽  
Shingo Mochizuki ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Surgical Repair ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Cerebral Malperfusion

Type A aortic dissection: involvement of carotid artery and impact on cerebral malperfusion

2020 ◽  
pp. 021849232098432
Author(s):  
Wahaj Munir ◽  
Jun Heng Chong ◽  
Amer Harky ◽  
Mohamad Bashir ◽  
Benjamin Adams
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Type A ◽  
Current Evidence ◽  
Management Approach ◽  
Complex Nature ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Cerebral Malperfusion ◽  
The Impact

Acute type A aortic dissection is a surgical emergency and management of such pathology can be complex with poor outcomes when there is organ malperfusion. Carotid artery involvement is present in 30% of patients diagnosed with acute type A aortic dissection, and given its emergency and complex nature, there is much controversy regarding the approach, extent of treatment, and timing of the intervention. It is clear that the occurrence of cerebral malperfusion adds an extra layer of complexity to the decision-making framework for treatment. Standardization and validation of the optimal management approach is required, and this should ideally be addressed with large-scale studies. Nonetheless, current literature supports the need for rapid recognition and diagnosis of acute type A aortic dissection with cerebral malperfusion, immediate and extensive surgical repair, and the appropriate use of cerebral perfusion techniques. This paper aims to discuss the current evidence regarding the impact of carotid artery involvement in both the management and outcomes of acute type A aortic dissection.

Surgical outcomes of total arch replacement with modified elephant trunk technique in type A aortic dissection: insights from single-center experience

2022 ◽  
pp. 021849232110701
Author(s):  
Jian Li ◽  
Yueyun Zhou ◽  
Wei Qin ◽  
Cunhua Su ◽  
Fuhua Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Total Arch Replacement ◽  
Hospital Death ◽  
Acute Type ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Visceral Malperfusion ◽  
Cerebral Malperfusion

Background Total arch replacement with modified elephant trunk technique plays an important role in treating acute type A aortic dissection in China. We aim to summarize the therapeutic effects of this procedure in our center over a 17-year period. Methods Consecutive patients treated at our hospital due to type A aortic dissection from January 2004 to January 2021 were studied. Relevant data of these patients undergoing total arch replacement with modified elephant trunk technique were collected and analyzed. Results A total of 589 patients were included with a mean age of 53.1 ± 12.2 years. The mean of cardiopulmonary bypass, cross-clamping, and selected cerebral perfusion time were 199.6 ± 41.9, 119.0 ± 27.2, and 25.1 ± 5.0 min, respectively. In-hospital death occurred in 46 patients. Multivariate analysis identified four significant risk factors for in-hospital mortality: preexisting renal hypoperfusion (OR 5.43; 95% CI 1.31 – 22.44; P = 0.020), cerebral malperfusion (OR 11.87; 95% CI 4.13 – 34.12; P < 0.001), visceral malperfusion (OR 4.27; 95% CI 1.01 – 18.14; P = 0.049), and cross-clamp time ≥ 130 min (OR 3.26; 95% CI 1.72 – 6.19; P < 0.001). The 5, 10, and 15 years survival rates were 86.4%, 82.6%, and 70.2%, respectively. Conclusions Total arch replacement with modified elephant trunk technique is an effective treatment for acute type A aortic dissection with satisfactory perioperative results. Patients with preexisting renal hypoperfusion, cerebral malperfusion, visceral malperfusion, and long cross-clamp time are at a higher risk of in-hospital death.

scholarly journals Risk factors for hypoxemia following surgical repair of acute type A aortic dissection

2016 ◽  
pp. ivw272
Author(s):  
Nan Liu ◽  
Wei Zhang ◽  
Weiguo Ma ◽  
Wei Shang ◽  
Jun Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Surgical Repair ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

scholarly journals Effects of Sex on Early Outcome following Repair of Acute Type A Aortic Dissection: Results from The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

Aorta ◽  
2019 ◽  
Vol 07 (01) ◽  
pp. 007-014
Author(s):  
Raphaelle A. Chemtob ◽  
Vibeke Hjortdal ◽  
Anders Ahlsson ◽  
Jarmo Gunn ◽  
Ari Mennander ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Surgical Repair ◽  
Multivariable Analysis ◽  
Operation Time ◽  
Postoperative Outcome ◽  
Type A ◽  
Operative Management ◽  
Chronic Obstructive ◽  
Acute Type ◽  
Type A Aortic Dissection

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.

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 Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

2020 ◽  
Vol 58 (5) ◽  
pp. 1027-1034 ◽  
Author(s):  
Raphaelle A Chemtob ◽  
Simon Fuglsang ◽  
Arnar Geirsson ◽  
Anders Ahlsson ◽  
Christian Olsson ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Pericardial Tamponade ◽  
Acute Type ◽  
Aortic Arch Replacement ◽  
Type A Aortic Dissection ◽  
Total Aortic Arch Replacement ◽  
Cerebral Malperfusion ◽  
Mortality Hazard Ratio

Abstract OBJECTIVES Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients. METHODS The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014. RESULTS Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P &lt; 0.001), syncope (30.6% vs 17.6%, P &lt; 0.001), cardiogenic shock (33.1% vs 20.7%, P &lt; 0.001) and pericardial tamponade (25.9% vs 14.7%, P &lt; 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34–3.05; P &lt; 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27–2.23; P &lt; 0.001). CONCLUSIONS Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.

Sign in / Sign up

Export Citation Format

Share Document