P5597Impact of time from onset to operation on surgical outcomes of acute type-A aortic dissection complicated with malperfusion syndrome

Abstract Introduction To determine the timing of operation might be the most important factors for surgical outcomes of acute type A aortic dissection (AADA), we analyzed our experience managing AADA complicated by malperfusion syndrome. Method Between 11/10 and 2/19, 184 patients with AADA were treated surgically, including 60 patients (32.6%) presented with malperfusion. The mean age of the patients was 71.3±13.3 and female was 94 (51.1%). Prevalences of malperfusions of brain, coronary, kidney, intestine, and extremities were 30 (16.3%), 16 (8.7%), 6 (3.3%), 3 (1.6%), and 23 (12.5%), respectively. Eighty-nine patients (48.4%) were repaired within 6 hours from onset of symptoms and 95 (51.6%) repaired after 6 hours from onset. Aortic repair included total arch replacement in 69 (37.5%) patients and hemiarch in 115 (62.5%). Effect of immediate aortic repair (within 6 hours from onset) and malperfusion syndromes on surgical outcomes of the patients were analyzed. Results Overall 30-days-survival rate after aortic repair for AADA was 93.5% (172/184). Early mortality after repairs with malperfusion was 13.3% (8/60): 11.9% (5/42) with immediate repair, and 16.7% (3/18) repaired after 6 hours from onset (late repair). Early mortality after repairs without malperfusion was 3.2% (4/124): 2.3% (1/44) with immediate repair, and 3.8% (3/80) with late repair. Early mortality after repairs with malperfusion was significantly higher than that without malperfusion. In each groups including 184 patients after aortic repair for AADA, 60 patients with malperfusion and 124 patients without malperfusion, there was no significant difference in early mortality rate between immediate repair group and late group. Conclusion Malperfusion syndrome was independent risk factor for aortic repairs of acute type-A aortic dissection, and time from onset to operation was not directly related to better outcomes in this patient cohort.

Download Full-text

Faculty Opinions recommendation of Endovascular fenestration/stenting first followed by delayed open aortic repair for acute type A aortic dissection with malperfusion syndrome.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734501733.793555873 ◽

2019 ◽

Author(s):

Joseph Emmerich

Keyword(s):

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Aortic Repair ◽

Open Aortic Repair ◽

Malperfusion Syndrome

Download Full-text

Endovascular Fenestration/Stenting First Followed by Delayed Open Aortic Repair for Acute Type A Aortic Dissection With Malperfusion Syndrome

Circulation ◽

10.1161/circulationaha.118.036328 ◽

2018 ◽

Vol 138 (19) ◽

pp. 2091-2103 ◽

Cited By ~ 24

Author(s):

Bo Yang ◽

Carlo Maria Rosati ◽

Elizabeth L. Norton ◽

Karen M. Kim ◽

Minhaj S. Khaja ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Aortic Repair ◽

Open Aortic Repair ◽

Malperfusion Syndrome

Download Full-text

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.

Download Full-text

Surgical outcomes of aortic repair via transapical cannulation and the adventitial inversion technique for acute Type A aortic dissection†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezy014 ◽

2018 ◽

Vol 54 (2) ◽

pp. 369-374 ◽

Cited By ~ 6

Author(s):

Junichi Shimamura ◽

Shin Yamamoto ◽

Susumu Oshima ◽

Kensuke Ozaki ◽

Takuya Fujikawa ◽

...

Keyword(s):

Aortic Dissection ◽

Surgical Outcomes ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Inversion Technique ◽

Aortic Repair

Download Full-text

Short- and long-term outcomes of aortic root-sparing repair and replacement in acute type A aortic dissection repair

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211015087 ◽

2021 ◽

pp. 021849232110150

Author(s):

Tillana Nirav Tarkas ◽

Carla Stoicescu ◽

Wahaj Munir ◽

Mohamad Bashir ◽

Benjamin Adams

Keyword(s):

Decision Making ◽

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Definitive Answer ◽

Significant Difference ◽

Current Controversy ◽

Short And Long Term

Acute type A aortic dissection is a surgical emergency with a high mortality rate if left untreated. Management of the aortic root in this setting constitutes an intricate decision-making framework, further complicated by the emergent nature of the dissection. There exists much controversy regarding pursuit of the aggressive aortic root replacement versus a conservative root-sparing repair, alongside considerations for valve-sparing root replacement. In this review, we critically appraise the current controversy in the literature considering the fate of the aortic root, discussing the aforementioned root interventions for which provides better outcomes for mortality and risk of re-intervention. Literature search was performed using electronic database through PubMed, Google scholar, and Embase focussing on studies reporting outcomes and re-intervention rates for these approaches. Limited by the heterogeneity in surgical strategy, with most studies being single-centred retrospective experiences, further fuel this ongoing debate. The literature reveals rather contrasting results whilst comparing root-sparing repair, versus the extensive root replacement; whilst some studies report no statistically significant difference, others show one superior over the other. There is greater consensus when considering risk of re-operation, with studies showing higher rates of re-operation in root-sparing group compared to replacement; however, many others show no statistically significant difference. In conclusion, the conflicting outcomes reported in the literature, with their inherent limitations, results in the current inability to reach a definitive answer. There remains support in the current literature for both approaches with much of the decision-making being surgeon-bound with many significant influencing factors on a case-by-case basis.

Download Full-text