scholarly journals Comparison of the left ventricular apex versus other arterial cannulation sites for the operative management of acute type A aortic dissection

2015 ◽  
Vol 10 (S1) ◽  
Author(s):  
Petar M Vukovic ◽  
Slobodan Micovic ◽  
Miodrag Peric ◽  
Predrag Milojevic ◽  
Ivan Nesic ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Operative Management ◽  
Left Ventricular ◽  
Acute Type ◽  
Arterial Cannulation ◽  
Type A Aortic Dissection ◽  
Left Ventricular Apex

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 Successful treatment of an acute type A aortic dissection presented with ST segment elevation on ECG and pericardial tamponade. Case report

2014 ◽  
Vol 155 (44) ◽  
pp. 1763-1767
Author(s):  
Miklós Pólos ◽  
Zoltán Szabolcs ◽  
Astrid Apor ◽  
István Édes ◽  
Erzsébet Paulovich ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Successful Treatment ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Pericardial Tamponade ◽  
Left Ventricular ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
St Segment Elevation ◽  
St Segment

Successful treatment of type A acute aortic dissection depends on the promptness of diagnostic evaluation and therapy. Fast diagnosis can be challenged by numerous complications such as myocardial ischemia, acute aortic insufficiency, and disturbances in organ perfusion and pericardial tamponade. The authors report the case history of a 72-year-old woman, who was admitted after resuscitation with ST segment elevation. Echocardiography revealed acute type A aortic dissection with signs of pericardial tamponade. An emergency operation consisting of the resection of the ascending aorta and the reconstruction of the aortic root was performed, which took six hours from admission until the end of the operation. Follow-up examinations demonstrated good left ventricular function and competent aortic valve. The authors propose that with the development of diagnostic and therapeutic options, faster and less invasive interventions will be introduced in near future for the treatment of acute aortic dissection, which may reduce the morbidity and mortality rates of this lethal illness. Orv. Hetil., 2014, 155(44), 1763–1767.

scholarly journals Double Arterial Cannulation Versus Right Axillary Artery Cannulation for Acute Type A Aortic Dissection: a Retrospective Study

2021 ◽  
Author(s):  
He Zhang ◽  
Wei Xie ◽  
Yuzhou Lu ◽  
Tuo Pan ◽  
Qing Zhou ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Lower Incidence ◽  
Axillary Artery ◽  
Type A ◽  
Acute Type ◽  
Arterial Cannulation ◽  
Blood Gas ◽  
Type A Aortic Dissection ◽  
Significant Difference

Abstract Background: Cannulation strategy in surgery for acute type A aortic dissection (ATAAD) remains controversial. We aimed to retrospectively analyze the safety and efficacy of double arterial cannulation (DAC) compared with right axillary cannulation (RAC) for ATAAD.Methods: From January 2016 to December 2018, 431 ATAAD patients were enrolled in the study. Patients were divided into DAC group (n=341) and RAC group (n=90). Propensity score matching analysis was performed to compare the early and mid-term outcomes between these two groups. To confirm the organ protection effect by DAC, intraoperative blood gas results and cardiopulmonary bypass parameters were compared between the two groups.Results: Demographics and preoperative comorbidities were comparable between two groups, while patients in DAC group were younger than RAC group (51.55±13.21 vs. 56.07±12.16 years, P＜0.001 ) . DAC had a higher incidence of limb malperfusion (18.2% vs. 10.0%, P=0.063) and lower incidence of coronary malperfusion (5.3% vs. 12.2%, P=0.019). No significant difference in cardiopulmonary bypass and cross-clamp time was found between the two groups. The in-hospital mortality was 13.5% (58/431), while there was no difference between the two groups (13.5% vs. 13.3%; P=0.969). Patients who underwent DAC had higher incidence of postoperative stroke (5.9% vs. 0%, P=0.019) and lower incidence of postoperative acute kidney injury (AKI) (24.7% vs. 40.3%; P=0.015). During a mean follow-up period of 31.8 (interquartile range, 25-45) months, the overall survival was 81.5% for DAC group and 78.0% for RAC group (P=0.560). Intraoperative blood gas results and cardiopulmonary bypass parameters showed that DAC group had more intraoperative urine output volume than RAC group (P=0.05), and the time of cooling (P=0.04) and rewarming (P=0.04) were shorter in DAC group.Conclusions: DAC will not increase the surgical risks compared to RAC, but could reduce the incidence of postoperative AKI which may be benefit for renal protection.

A case of acute type A aortic dissection with diastolic prolapse of the intimal flap into the left ventricular outflow tract

Choonpa Igaku ◽  
2009 ◽  
Vol 36 (4) ◽  
pp. 497-499
Author(s):  
Fumihiko HARA ◽  
Masahiko HARADA ◽  
Koichi YOSHIKAWA ◽  
Kyoko HAYASHI ◽  
Yuichi TAKARADA ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Left Ventricular Outflow Tract ◽  
Type A ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Intimal Flap ◽  
Left Ventricular Outflow

scholarly journals Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience

PLoS ONE ◽  
2019 ◽  
Vol 14 (2) ◽  
pp. e0211900 ◽  
Author(s):  
Chun-Yu Lin ◽  
Chi-Nan Tseng ◽  
Hsiu-An Lee ◽  
Heng-Tsan Ho ◽  
Feng-Chun Tsai
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Arterial Cannulation ◽  
Single Institution ◽  
Type A Aortic Dissection

scholarly journals A tale of three pumps and a mechanical heart

2020 ◽  
Vol 8 ◽  
pp. 2050313X2094054
Author(s):  
Tarek Omran ◽  
Cornelia S Carr ◽  
Lateef Wani ◽  
Imad Mahmoud ◽  
Rula Taha ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Acute Type ◽  
Ventricular Assist ◽  
Type A Aortic Dissection ◽  
Satisfactory Outcome ◽  
Left Ventricular Assist ◽  
Mechanical Circulatory Support Device

Temporary mechanical circulatory support device (tMCS) failure could qualify patients with advanced heart failure to receive a long-term solution. We report on a patient who presented with cardiorespiratory arrest that required a tMCS and developed acute type A aortic dissection. Data Sources: our case adds further evidence regarding the support of a patient with a second (or more) incidence of tMCS. This patient subsequently underwent left ventricular assist device insertion and type A aortic dissection repair, as a combined procedure, with a satisfactory outcome.

scholarly journals Systolic anterior motion of the mitral valve associated with acute type A aortic dissection: a case report describing one-step surgery of ascending aortic replacement and interventricular septal myectomy

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Naoki Yamamoto ◽  
Koji Onoda
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Left Ventricular ◽  
Acute Type ◽  
Systolic Anterior Motion ◽  
Type A Aortic Dissection ◽  
Septal Myectomy ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
One Step

Abstract Background Systolic anterior motion of the mitral valve associated with acute type A aortic dissection is rare in daily clinical practice. The prevention of systolic anterior motion is important, because once it occurs, the hemodynamics may become unstable, leading to a critical situation. In the surgical procedure to treat systolic anterior motion, the prevention of new iatrogenic aortic intimal tears is important in the context of acute type A aortic dissection. Case presentation We present a case of systolic anterior motion in a 68-year-old woman with an acute type A aortic dissection and suspected acute relative adrenal insufficiency. Preoperative transthoracic echocardiography revealed left ventricular outflow tract obstruction due to systolic anterior motion without left ventricular hypertrophy and interventricular septal bulging due to a narrow aorto-mitral angle. We successfully performed a one-step surgery for ascending aortic replacement and interventricular septal myectomy using the needle stick technique for the treatment of systolic anterior motion. Conclusions Concomitant interventricular septal myectomy using the needle stick technique with thoracic aortic replacement is a safe and feasible technique. Interventricular septal myectomy may be effective in preventing postoperative unstable hemodynamics due to systolic anterior motion in the management of acute aortic dissection.

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