Sedatives during circulatory arrest are not necessary for aortic arch repair in acute type A aortic dissection

Acute Type A Dissection ◽

Feasible Option

Acute type A aortic dissection remains a high-risk surgical condition, and mortality among those presenting with malperfusion is up to 3-fold higher. Despite the added technical challenge of distal aortic arch interventions in the acute setting, it may be necessary to resolve distal malperfusion in patients with this disorder. The ideal arch intervention to address acute type A aortic dissection complicated by malperfusion should address the following objectives: (1) to relieve distal malperfusion by expanding the distal true lumen and depressurizing the false lumen; (2) to avoid compromising arch branches without requiring additional arch branch interventions; (3) to minimize the risk of spinal cord ischemia; and (4) to minimize the operative duration and circulatory arrest time. The use of an uncovered aortic arch stent that is delivered in an antegrade manner during circulatory arrest, concomitantly with hemiarch replacement, therefore represents an attractive solution in the management of acute type A aortic dissection complicated by malperfusion. This strategy does not require complex arch reconstruction and may thus be a feasible option among cardiac and vascular surgeons in lower volume aortic centers. Here we present a step-by-step approach to acute type A aortic dissection repair with hemiarch repair and delivery of an uncovered arch stent for a patient presenting with malperfusion.

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

10.1055/s-0040-1705505 ◽

2020 ◽

Author(s):

J. Kapahnke ◽

K. Huenges ◽

M. Salem ◽

P. Kolat ◽

J. Schoettler ◽

...

Keyword(s):

Aortic Dissection ◽

Circulatory Arrest ◽

Type A ◽

Acute Type ◽

Hemoperfusion in Acute Type A Aortic Dissection Patients Undergoing Aortic Arch Operation (HPAO)

Case Medical Research ◽

10.31525/ct1-nct04007484 ◽

2019 ◽

Author(s):

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Type A ◽

Acute Type ◽

101 Total Aortic Arch Repair Without Circulatory Arrest Using Hybrid Techniques - A Novel Treatment For Acute Type A Dissection

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2012.07.110 ◽

2012 ◽

Vol 28 (5) ◽

pp. S125-S126

Author(s):

J.J. Appoo ◽

E.J. Herget ◽

W.D. Kent ◽

S.K. Smith ◽

J.K. Wong

Keyword(s):

Aortic Arch ◽

Circulatory Arrest ◽

Type A ◽

Acute Type ◽

Hybrid Techniques ◽

Acute Type A Dissection ◽

Novel Treatment ◽

Type A Dissection ◽

Aortic Arch Repair

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

Clinical surgery research communications ◽

10.31491/csrc.2021.06.075 ◽

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 ◽

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

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

Journal of Thoracic Disease ◽

10.21037/jtd.2019.10.47 ◽

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 ◽

Clamp Technique

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

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa197 ◽

2020 ◽

Vol 58 (5) ◽

pp. 1027-1034 ◽

Cited By ~ 1

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 ◽

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 < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 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 < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27–2.23; P < 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.

Selective Aortic Arch and Root Replacement in Repair of Acute Type A Aortic Dissection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2017.07.016 ◽

2018 ◽

Vol 105 (2) ◽

pp. 505-512 ◽

Cited By ~ 1

Author(s):

Fernando Fleischman ◽

Ramsey S. Elsayed ◽

Robbin G. Cohen ◽

James M. Tatum ◽

S. Ram Kumar ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Type A ◽

Acute Type ◽

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

Case Reports in Medicine ◽

10.1155/2012/631494 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 3

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 ◽

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.