scholarly journals Does Interhospital Transfer Influence the Outcomes of Patients Receiving Surgery for Acute Type A Aortic Dissection? Type A Aortic Dissection: Is Transfer Hazardous or Beneficial?

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Yuan-Hsi Tseng ◽  
Chih-Chen Kao ◽  
Chien-Chao Lin ◽  
Chien-Wei Chen ◽  
Ming-Shian Lu ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Aortic Dissection ◽  
Emergency Surgery ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Interhospital Transfer ◽  
Group 2 ◽  
Operative Findings ◽  
Group 1

Introduction. The progression of acute type A aortic dissection may cause immediate death, such that, in the event of its diagnosis, emergency surgery is indicated. Relatedly, an interhospital transfer may prolong the time from diagnosis to surgery. This study therefore investigated how interhospital transfers impact surgical outcomes for acute type A aortic dissection. Materials and Methods. After excluding those patients who received deferred surgery for acute type A aortic dissection, 112 patients who received emergency surgery for the condition at our hospital from January 2011 to January 2018 were enrolled. These patients were divided into two groups, one consisting of the patients who were sent directly to our emergency department (group 1) and the other consisting of the patients who were transferred from another hospital after first being diagnosed with type A aortic dissection (group 2). The collected data included the patient demographics, clinical characteristics, operative findings and methods, postoperative outcomes, latest follow-up time, and most recent status. Results. There were 59 patients in group 1 and 53 patients in group 2. Univariate analysis revealed that group 1 had significantly more patients with a previous stroke (p = 0.007). Moreover, the average length of time from receiving a computed tomography (CT) scan to entering the operating room (OR) was shorter for the group 1 patients (p < 0.001). However, except for the incidence of postoperative acute kidney injury (14.5% versus 33.3%, p = 0.024), there was no statistical difference between the groups in terms of the operative findings and outcomes, such as hypotension before cardiopulmonary bypass, hemopericardium, other complications, and survival rate. Multivariate analysis showed that the independent predictors of hospital mortality included age > 61.5 years (p = 0.017), respiratory rate upon admission > 18.5 breaths/minute (p = 0.046), and total bypass time > 265.6 minutes (p = 0.015). For the patients who survived to discharge, log-rank analysis demonstrated similar cumulative survival rates for the two groups (p = 0.62). Further multivariate analysis showed that the risk of death after discharge was associated with the interval between the CT scan and OR entry (hazard ratio = 0.97 per minute; 95% confidence interval, 0.950–0.998; p = 0.037). Conclusion. In this study, it was found that interhospital transfer did not influence the surgical outcomes of patients with acute type A aortic dissection. As such, it can be concluded that the transfer of the patients with type A aortic dissection to tertiary hospitals with experienced cardiac surgical teams may not increase the surgical risk.

scholarly journals Hemiarch versus Arch Replacement in Acute Type A Aortic Dissection: Is the Occam’s Razor Principle Applicable?

2021 ◽  
Vol 11 (1) ◽  
pp. 114
Author(s):  
Igor Vendramin ◽  
Daniela Piani ◽  
Andrea Lechiancole ◽  
Sandro Sponga ◽  
Concetta Di Nora ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Ascending Aorta ◽  
Long Term Results ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Group 2 ◽  
Hemiarch Replacement ◽  
Group 1

Background and aim of the study: In patients with acute Type A aortic dissection (A-AAD) whether repair should be limited to ascending aorta/hemiarch replacement or extended to include the aortic arch is still debated. We have analyzed our experience to compare outcomes of patients with A-AAD treated with these 2 different surgical strategies. Methods: From 2006 to 2020, a total of 213 patients have undergone repair of A-AAD at our Center; in 163 of them ascending aorta/hemiarch replacement (Group 1) and in 75 ascending aorta and arch replacement (Group 2) were performed. The primary endpoint was early survival and secondary endpoints late survival, freedom from late complications and reoperations. Patients were compared according to era of operation: 2006 to 2013 (Era 1) and 2014 to 2020 (Era 2). Results: Overall hospital mortality was 12% and 5% in Group 1 and 2; mortality remained stable in Era 1 and 2 for Group 1 (15%), while it decreased from 8% to 1% in Group 2 patients (p = 0.24). Actuarial survival at 5 and 10 years is 72 ± 4% and 49 ± 5% in Group 1 and 77 ± 6% and 66 ± 9% in Group 2 (p = 0.073). Actuarial freedom from reoperation in the entire series is 94 ± 2% and 92 ± 3% at 5 and 10 years. Freedom from reoperation at 5 and 10 years is 92 ± 2% and 89 ± 3% in Group 1 and 98 ± 1% at all intervals in Group 2 (p = 0.068). Conclusions: An aggressive approach to A-AAD provides superior long-term results without increasing mortality. Furthermore, arch replacement during A-AAD repair represents a more stable solution with lower incidence of late aortic-related complications. Immediate aortic arch replacement should be considered in the treatment of A-AAD especially in experienced centers.

Aortic Root Surgery Does Not Increase the Operative Risk of Acute Type A Aortic Dissection

2011 ◽  
Vol 77 (1) ◽  
pp. 88-92 ◽  
Author(s):  
Jose Montalvo ◽  
Anees Razzouk ◽  
Nan Wang ◽  
Ramesh Bansal ◽  
Alfredo Rasi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Cardiogenic Shock ◽  
Aortic Root ◽  
Operative Mortality ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aortic Root Surgery ◽  
Group 2 ◽  
Group 1

Controversy exists regarding aortic root reconstruction in the management of acute type A aortic dissection (AAD). One hundred fifty-four patients (mean age 56.9 ± 11.3 years) with AAD had surgical repair between 1996 and 2007. Group 1 (n = 110) required no aortic root surgery. Seventy-one patients had ascending aortic replacement. The aortic valve was repaired in 37 patients (34%) and replaced in one. Group 2 (n = 44) had aortic root surgery. Thirty-four patients had composite root replacement, and seven had a valve-sparing root replacement. Root reconstruction and separate valve replacement was accomplished in three. Hemiarch replacement was included in 39 (35.4%) Group 1 patients and in 12 (27.9%) Group 2 patients. Forty-nine of the 154 patients presented in cardiogenic shock. Multiple risk factors for operative mortality were analyzed. The overall operative mortality was 9.7 per cent: 11 per cent for Group 1 and 6.8 per cent for Group 2 ( P = NS). By multivariate analysis, preoperative shock ( P = 0.03, odds ratio [OR] = 5.48), postoperative ventricular arrhythmias ( P = 0.002, OR = 4.62), and packed red blood cell transfusion ( P = 0.002, OR = 1.15) were independent predictors of hospital death. Prompt surgical treatment of AAD before cardiogenic shock ensues can improve the outcome of patients. When indicated, aortic root surgery can be performed without increased mortality and morbidity.

scholarly journals Large Area of the False Lumen Favors Secondary Dilatation of the Aorta After Acute Type A Aortic Dissection

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Franz F. Immer ◽  
Eva Krähenbühl ◽  
Urs Hagen ◽  
Mario Stalder ◽  
Pascal A. Berdat ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Outpatient Clinic ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Large Area ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background— Since 1994 patients with acute aortic dissection type A (AADA) are followed-up in our outpatient clinic. Early diagnosis of secondary dilatation of the diseased aorta is crucial to reduce late mortality in these patients. Aim of the present study is to asses the impact of a large volume in the false lumen of the diseased downstream aorta on secondary dilatation. Methods and Results— 134 patients of 264 patients who underwent surgery for AADA (between January 1994 and June 2003) are followed-up at our outpatient clinic since 1994. 84 patients (62.7%) fulfilled the inclusion criteria. Areas of the true and the false lumens of the aorta were analyzed and a logistic regression was calculated at 5 levels of the aorta for each patient. Patients were divided in 3 groups: group 1 included 34 patients (40.5%) without progression, group 2 had 34 patients (40.5%) with slight progression, and group 3 had 16 patients (19.0%) with important progression, requiring surgery in all patients. In 87.5% of the patients the area of the original lumen was <0% in group 3, compared with 11.8% in group 2 and 8.8% in group 1 in relation to the total area of the aorta 6 months after surgery ( P <0.001). Conclusion— A large false lumen, with an area of the true lumen <30% 6 months after surgery, is the strongest predictor for secondary dilatation of the diseased downstream aorta.

scholarly journals Durable results of preserved valve and root after acute type A aortic dissection surgery in bicuspid aortic valve

2022 ◽  
Author(s):  
Tsu-Jui Hsu ◽  
Cheng-Wei Chen ◽  
Ron-Bin Hsu
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Valve Replacement ◽  
Bicuspid Aortic Valve ◽  
Emergency Surgery ◽  
Type A ◽  
Long Term Results ◽  
Acute Type ◽  
Type A Aortic Dissection

Background and aims of the study. Data on emergency surgery for acute type A aortic dissection in patients with bicuspid aortic valve were limited. Long-term results on the fate of the preserved bicuspid valve and aortic root were even rare. We sought to assess the clinical outcome of emergency acute type A aortic dissection surgery in patients with bicuspid aortic valve. Methods. From 2004 to 2021, 121 patients underwent emergency surgery for acute type A aortic dissection using a conservative aortic resection. Hospital and late outcomes were assessed in patients with bicuspid aortic valve. Results. Eight patients (6.6%) had bicuspid aortic valve with 6 males (75%) and median age of 49.5 years (range, 34 to 71). Four (50%) had significant aortic valve dysfunction. Operation included ascending aortic grafting with aortic valve preservation in 4, ascending aortic grafting with aortic valve replacement in 3 and ascending aortic grafting with Bentall root replacement in 1. Hospital mortality rate was 12.5% (1/8). With a median follow-up of 14.4 years, there was one late death and no proximal reoperation of 6 preserved roots and 3 preserved valves. Median diameter of preserved aortic roots changed from 42 (range, 33-43) to 38.5 mm (range, 35-46) with the average time of 11 years after surgery. Conclusions. Acute type A aortic dissection in bicuspid aortic valve was not associated with worse outcome. Aortic valve replacement was often required. Simultaneous root replacement was not always necessary. Preservation of normally functioning bicuspid valve and non-dilated root showed durable long-term results.

Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians

2006 ◽  
Vol 82 (2) ◽  
pp. 554-559 ◽  
Author(s):  
Motomi Shiono ◽  
Mitsumasa Hata ◽  
Akira Sezai ◽  
Mitsuru Iida ◽  
Shinya Yagi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Emergency Surgery ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

Midterm outcomes of emergency surgery for acute type A aortic dissection in octogenarians

2020 ◽  
Author(s):  
Markian M. Bojko ◽  
Maham Suhail ◽  
Joseph E. Bavaria ◽  
Alex Bueker ◽  
Robert W. Hu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Emergency Surgery ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection
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