Modified hypothermic circulatory arrest for emergent repair of acute aortic dissection type a: a single-center experience

The purpose of this case presentation is to present a simplified surgical technique when in a patient with acute aortic dissection type A (AAD), aortic arch, and ascending aorta is completely replaced without circulatory arrest. A 67-year old male was presented in our institution with severe chest and back pain at 12 h after the onset of the symptoms. Imaging studies by 3D contrast-enhanced thoracic computed tomography (CT-scan) and transesophageal echocardiography (TEE) revealed ascending aortic dissection towards the aortic arch, which was extending in the proximal descending aorta. We practiced emergency median sternotomy and established cardiopulmonary bypass (CBP) between the right atrium and the right femoral artery with successive cross-clamping of the ascending and descending aorta below the origin of the left subclavian artery (LSA). In normothermic condition without circulatory arrest and with antegrade cerebral perfusion, we replaced the ascending aorta and aortic arch with a four branched Dacron graft. Patient evolution was uneventful, and he was discharged, after fourteen days from the hospital. At a one-year follow-up, 3D CT-scan showed no residual dissection with a well-circulated lumen of the supra-aortic arteries. Using the described surgical approach, CPB was not interrupted, the brain was protected, and hypothermia was no used. This approach made these surgical procedures shorter, and known complications of hypothermia and circulatory arrest are avoided.Acute aortic dissection aortic type A, total arch replacement, normothermia

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Extensive aortic surgery in acute aortic dissection type A on outcome – insights from 25 years single center experience

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-1007-7 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 2

Author(s):

Bashar Dib ◽

Philipp Christian Seppelt ◽

Rawa Arif ◽

Alexander Weymann ◽

Gábor Veres ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Circulatory Arrest ◽

Early Mortality ◽

Single Center ◽

Term Survival ◽

Per Se ◽

Aortic Dissection Type A

Abstract Background This single center study compares the different surgical techniques used in the treatment of acute aortic dissection type A (AADA) analyzing the influence of the extent of the surgical approach on outcome. Methods From 1988 to 2012, 407 patients were operated for AADA. The cohort was divided into subgroups according to the surgical approach. These groups were compared with the supracommissural replacement group (SCR; n = 141). Groups included aortic valve sparing techniques (AVS; n = 29), Composite replacement (COMP; n = 119), COMP with total arch replacement (COMP+TAR; n = 27) and SCR with TAR (n = 75). Results Compared to SCR alone, operation (p = 0.005), bypass-, cross-clamp and circulatory arrest times were longer in SCR + TAR (all p < 0.001). Moreover, operation, bypass and cross clamp times were longer in COMP+TAR (p = 0.003, p = 0.002 and p < 0.001 respectively). COMP alone and AVS required longer cross-clamp time, too (p < 0,001 and p = 0.002, respectively). Overall 30-day mortality was 21% with the observed lowest rate after AVS (14%, SCR 18%, COMP 25%) but differences in 30-day mortality were not statistically significant. The estimated 10-year survival was 42%, especially AVS demonstrated a good 10-year survival (69%). David technique was superior to Yacoub technique concerning incidence of redo interventions (p = 0.036). Risk factors for early mortality included age, circulatory arrest, general malperfusion, bypass and operation time. Circulatory arrest per se was revealed as risk factor for long-term survival. Conclusions Within our single center retrospective study concomitant aortic root repair or aortic arch replacement for AADA demonstrated acceptable early and long-term survival. Circulatory arrest, long bypass and operation times per se might be important risk factors for early mortality. AVS techniques can be performed safely and have good outcomes in acute aortic dissection repair.

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Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?-insights from single center experience

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01234-8 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Wei Qin ◽

Cunhua Su ◽

Liangpeng Li ◽

Michael. Carmichael ◽

Fuhua Huang ◽

...

Keyword(s):

Aortic Dissection ◽

Elderly Patients ◽

Acute Aortic Dissection ◽

Type A ◽

Single Center ◽

Single Center Experience

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Risk Factors for Mortality in Acute Aortic Dissection Type A: A Centre Experience Over 15 Years

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1710002 ◽

2020 ◽

Author(s):

Mohamed Salem ◽

Christine Friedrich ◽

Alexander Thiem ◽

Katharina Huenges ◽

Thomas Puehler ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Mortality Rate ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Circulatory Arrest ◽

Kidney Injury ◽

Type A ◽

Aortic Dissection Type A

Abstract Introduction Acute aortic dissection Type A (AADA) is still associated with a high mortality rate and frequent postoperative complications. This study was designed to evaluate the risk factors for mortality in AADA patients. Patients and Methods This retrospective analysis included 344 consecutive patients who underwent surgery for AADA in moderate hypothermic circulatory arrest (20–24°C nasopharyngeal) between 2001 and 2016. Results The 30-day mortality rate was 18%. Nonsurvivors were significantly older (65.7 ± 12.0 years vs. 62.0 ± 12.5 years; p = 0.034) with significantly higher Euro-score II [15.4% (6.6; 23.0) vs. 4.63% (2.78; 9.88); p < 0.001)]. Intraoperatively, survivors had statistically shorter cardiopulmonary bypass times [163 (134; 206) vs. 198 min (150; 245); p = 0.001]. However, the hypothermic circulatory arrest time was similar between both groups. Postoperatively, the incidence of acute kidney injury (AKI) (55.9 vs. 15.2%; p < 0.001), stroke (27.9 vs. 12.1%; p = 0.002) and sepsis (18.0 vs. 2.1%; p < 0.001) were significantly higher among nonsurvivors. The multi-variable logistic regression confirmed that older age, previous cardiac surgery, preoperative cardiopulmonary resuscitation (CPR), blood transfusion and postoperative acute kidney injury (AKI) were independent risk factors for mortality. Conclusion Our analysis suggested that the reason for mortality was multifactorial, especially age, previous cardiac surgery, CPR, transfusion, as well as postoperative AKI were considered risk factors for mortality.

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The Result Surgical Treatment of Type A Acute Aortic Dissection. Clinical Study of Graft Replacement of Ascending Aorta With Deep Hypothermic Circulatory Arrest.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.21.443 ◽

1992 ◽

Vol 21 (5) ◽

pp. 443-446

Author(s):

Koji ISHII ◽

Yoshirou MATSUI ◽

Toshihiro GOHDA ◽

Makoto SAKUMA ◽

Kazuhiro MYOJIN ◽

...

Keyword(s):

Clinical Study ◽

Surgical Treatment ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Circulatory Arrest ◽

Type A ◽

Deep Hypothermic Circulatory Arrest ◽

Ascending Aorta ◽

Hypothermic Circulatory Arrest ◽

Graft Replacement

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Abstract 754: Ascending Aortic vs. Femoral Cannulation for Acute Aortic Dissection Type A

Circulation ◽

10.1161/circ.118.suppl_18.s_612-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Hiroyuki Kamiya ◽

Dominique Halmer ◽

Merve Oezsoez ◽

Kathrin Ilg ◽

Artur Lichtenberg ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Circulatory Arrest ◽

Operation Time ◽

Type A ◽

Patient Characteristics ◽

Study Cohort ◽

Aortic Cannulation ◽

Aortic Dissection Type A

Objectives: The site of cannulation for repair of ascending aortic dissection remains controversial. Here we present our experience with ascending aortic cannulation for acute aortic dissection type A (AADA). Methods: From 01/1988 to 09/2007, we operated on 242 patients for AADA. Medical records of 235 patients who received ascending aortic cannulation or femoral cannulation were retrospectively reviewed. Long term follow-up was complete in 97% of patients. Cannulation was accomplished in 82 patients through the ascending aorta and in 153 patients through the femoral artery. Results: There were no significant differences in preoperative characteristics between groups. Similarly, there were no differences in preoperative patient characteristics and intraoperative parameters including operation time (ascending 357±139 vs. peripheral 342±125 min.; p=0.40), bypass time (ascending 219±105 vs peripheral 206±96 min.; p=0.32), cross-clamp time (ascending 106±43 vs peripheral 106±51 min.; p=0.69), hypothermic circulatory arrest time (ascending 28±19 vs peripheral 27±23 min.; p=0.73), and percentage of total arch replacement (ascending 54.9% vs peripheral 55.7%; p=0.44). Hospital mortality was 12.2% in each group (p=0.98), and incidence of stroke was 4.9% in ascending group and 4.5% in peripheral group (p=0.86). During follow-up (mean 5.5 years), survival at 5 years and 10 years was 65% and 41% in ascending group and 64% and 46% in peripheral group, respectively (p=0.97). No persistent malperfusion by ECC was observed after aortic cannulation. Conclusions: Direct cannulation of the dissected aorta in patients with AADA was safe with acceptable results in our study cohort. The conventional femoral cannulation had no advantage on the direct cannulation strategy, and the avoidance of additional incision and possible peripheral vascular injury may favor the direct cannulation strategy.

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