scholarly journals Techniques of Proximal Root Reconstruction and Outcomes Following Repair of Acute Type A Aortic Dissection

Aorta ◽  
2016 ◽  
Vol 04 (02) ◽  
pp. 33-41 ◽  
Author(s):  
Tyler Gunn ◽  
Sotiris Stamou ◽  
Nicholas Kouchoukos ◽  
Kevin Lobdell ◽  
Kamal Khabbaz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Operative Mortality ◽  
Survival Rates ◽  
Surgical Techniques ◽  
Type A ◽  
Acute Type ◽  
Actuarial Survival ◽  
Type A Aortic Dissection ◽  
Replacement Procedure

Background: The goal of this study was to compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute Type A aortic dissection, including aortic valve (AV) resuspension, aortic valve replacement (AVR), and a root replacement procedure. Methods: All patients who underwent acute Type A aortic dissection repair between January 2000 and October 2010 at four academic institutions were compiled from each institution’s Society of Thoracic Surgeons Database. This included 189 patients who underwent a concomitant aortic valve (AV) procedure; 111, 21, and 57 patients underwent AV resuspension, AVR, and the Bentall procedure, respectively. The median age of patients undergoing a root replacement procedure was significantly younger than the other two groups. Early clinical outcomes and 10-year actuarial survival rates were compared. Trends in outcomes and surgical techniques throughout the duration of the study were also analyzed. Results: The operative mortality rates were 17%, 29%, and 18%, for AV resuspension, AVR, and root replacement, respectively. Operative mortality (p = 0.459) was comparable between groups. Hemorrhage related re-exploration did not differ significantly between groups (p = 0.182); however, root replacement procedures tended to have decreased rates of bleeding when compared to AVR (p = 0.067). The 10-year actuarial survival rates for the AV resuspension, Bentall, and AVR groups were 72%, 56%, and 36%, respectively (log-rank p = 0.035). Conclusions: The 10-year actuarial survival was significantly lower in those receiving AVR compared to those receiving root replacement procedures or AV resuspension. Operative mortality was comparable between the three groups.

scholarly journals Repair of Acute Type-A Aortic Dissection in the Present Era: Outcomes and Controversies

Aorta ◽  
2019 ◽  
Vol 07 (06) ◽  
pp. 155-162 ◽  
Author(s):  
Ellie Moeller ◽  
Marcos Nores ◽  
Sotiris C. Stamou
Keyword(s):  
Aortic Dissection ◽  
Operative Mortality ◽  
Cochrane Review ◽  
False Lumen ◽  
Surgical Techniques ◽  
Type A ◽  
Acute Type ◽  
Close Monitoring ◽  
Type A Aortic Dissection ◽  
The Past

AbstractAcute Type-A aortic dissection (AAAD) remains a surgical emergency with a relatively high operative mortality despite advances in medical and surgical management over the past three decades. In spite of the severity of disease, there is a paucity of studies reviewing key controversies surrounding AAAD repair and management. A systematic literature search was performed using Cochrane review and PubMed bibliography review. Abstracts were first reviewed for general pertinence and then articles were reviewed in full. Literature review indicates that use of moderate hypothermia and antegrade cerebral perfusion is a safe alternative to deep hypothermia. In hemodynamically stable patients, axillary cannulation may be substituted for femoral cannulation. With regard to the technical aspects of repair, preserving the aortic root whenever possible and performing the distal anastomosis with the open distal technique rather than with the clamp on is the preferred approach. In patients with a patent false lumen, close monitoring is indicated. As demonstrated by the literature, significant improvement of early and late mortality over the past years has occurred in patients presenting with AAAD. Repair of acute Type-A aortic dissection remains a challenge with high operative mortality; however, improvement of surgical techniques and management have resulted in improvement of early and late clinical outcomes.

scholarly journals Role of Moderate Hypothermia and Antegrade Cerebral Perfusion during Repair of Type A Aortic Dissection

2018 ◽  
Vol 27 (04) ◽  
pp. 190-195 ◽  
Author(s):  
Michael McHugh ◽  
Brian Conway ◽  
Marcos Nores ◽  
Sotiris Stamou
Keyword(s):  
Aortic Dissection ◽  
Operative Mortality ◽  
Circulatory Arrest ◽  
Academic Medical Center ◽  
Type A ◽  
Deep Hypothermia ◽  
Moderate Hypothermia ◽  
Acute Type ◽  
Actuarial Survival ◽  
Type A Aortic Dissection

The goal of this study was to compare early postoperative outcomes and actuarial survival between patients who underwent repair of acute type A aortic dissection with deep or moderate hypothermia.A total of 132 consecutive patients from a single academic medical center underwent repair of acute type A aortic dissection between January 2000 and June 2014. Of those, 105 patients were repaired under deep hypothermia (< 24 C°), while 27 patients were repaired under moderate hypothermia (≥24 C°). Median ages were 62 years (range: 27–86) and 59 years (range: 35–83) for patients repaired under deep hypothermia compared with patients repaired under moderate hypothermia, respectively (p = 0.451). Major morbidity, operative mortality, and 10-year actuarial survival were compared between groups.Operative mortality was 17.1 and 7.4% in the deep and moderate hypothermia groups, respectively (p = 0.208). Incidence of permanent stroke was 12.4% in the deep hypothermic circulatory arrest group and 0% in the moderate hypothermia group (p = 0.054). Actuarial 5- and 10-year survival demonstrated a trend for lower long-term mortality with moderate hypothermia compared with deep hypothermia (69% 5-year and 54% 10-year for deep hypothermia vs. 79% 5-year and 10-year for moderate hypothermia, log-rank p = 0.161).Moderate hypothermia is a safe and efficient alternative to deep hypothermia and may have protective benefits. Stroke rate was lower with moderate hypothermia.

scholarly journals Axillary Versus Femoral Arterial Cannulation During Repair of Type A Aortic Dissection?

Aorta ◽  
2016 ◽  
Vol 04 (04) ◽  
pp. 115-123 ◽  
Author(s):  
Sotiris Stamou ◽  
Derek Gartner ◽  
Nicholas Kouchoukos ◽  
Kevin Lobdell ◽  
Kamal Khabbaz ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Operative Mortality ◽  
Cox Regression ◽  
Type A ◽  
Acute Type ◽  
Arterial Cannulation ◽  
Actuarial Survival ◽  
Type A Aortic Dissection ◽  
Artery Cannulation ◽  
Cannulation Site

Background: The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation. Methods: A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n = 107) or femoral (n = 198) artery cannulation between January 2000 and December 2010. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality, and Cox regression hazard ratios were calculated to determine predictors of long-term mortality. Results: Operative mortality was not influenced by cannulation site (16% for axillary cannulation vs. 19% for femoral cannulation, p = 0.64). In multivariate logistic regression analysis, hemodynamic instability (p < 0.001) and prolonged cardiopulmonary bypass time (>200 min; p = 0.05) emerged as independent predictors of operative mortality. Stroke rates were comparable between the two techniques (14% for axillary and 17% for femoral cannulation, p = 0.52). Five-year actuarial survival was comparable between the groups (55.1% for axillary and 65.7% for femoral cannulation, p = 0.36). In Cox regression analysis, predictors of long-term mortality were: age (p < 0.001), stroke (p < 0.001), prolonged cardiopulmonary bypass time (p = 0.001), hemodynamic instability (p = 0.002), and renal failure (p = 0.001). Conclusions: The outcomes of femoral versus axillary arterial cannulation in patients with acute Type A aortic dissection are comparable. The choice of arterial cannulation site should be individualized based on different patient risk profiles.

scholarly journals Interfacility Transfer of Medicare Beneficiaries With Acute Type A Aortic Dissection and Regionalization of Care in the United States

Circulation ◽  
2019 ◽  
Vol 140 (15) ◽  
pp. 1239-1250 ◽  
Author(s):  
Andrew B. Goldstone ◽  
Peter Chiu ◽  
Michael Baiocchi ◽  
Bharathi Lingala ◽  
Justin Lee ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Operative Mortality ◽  
Type A ◽  
High Volume ◽  
The United States ◽  
Acute Type ◽  
Medicare Beneficiaries ◽  
Type A Aortic Dissection ◽  
High Volume Hospital

Background: The feasibility and effectiveness of delaying surgery to transfer patients with acute type A aortic dissection—a catastrophic disease that requires prompt intervention—to higher-volume aortic surgery hospitals is unknown. We investigated the hypothesis that regionalizing care at high-volume hospitals for acute type A aortic dissections will lower mortality. We further decomposed this hypothesis into subparts, investigating the isolated effect of transfer and the isolated effect of receiving care at a high-volume versus a low-volume facility. Methods: We compared the operative mortality and long-term survival between 16 886 Medicare beneficiaries diagnosed with an acute type A aortic dissection between 1999 and 2014 who (1) were transferred versus not transferred, (2) underwent surgery at high-volume versus low-volume hospitals, and (3) were rerouted versus not rerouted to a high-volume hospital for treatment. We used a preference-based instrumental variable design to address unmeasured confounding and matching to separate the effect of transfer from volume. Results: Between 1999 and 2014, 40.5% of patients with an acute type A aortic dissection were transferred, and 51.9% received surgery at a high-volume hospital. Interfacility transfer was not associated with a change in operative mortality (risk difference, –0.69%; 95% CI, –2.7% to 1.35%) or long-term mortality. Despite delaying surgery, a regionalization policy that transfers patients to high-volume hospitals was associated with a 7.2% (95% CI, 4.1%–10.3%) absolute risk reduction in operative mortality; this association persisted in the long term (hazard ratio, 0.81; 95% CI, 0.75–0.87). The median distance needed to reroute each patient to a high-volume hospital was 50.1 miles (interquartile range, 12.4–105.4 miles). Conclusions: Operative and long-term mortality were substantially reduced in patients with acute type A aortic dissection who were rerouted to high-volume hospitals. Policy makers should evaluate the feasibility and benefits of regionalizing the surgical treatment of acute type A aortic dissection in the United States.

scholarly journals 101 * AORTIC VALVE REPAIR IN ACUTE TYPE A AORTIC DISSECTION

2013 ◽  
Vol 17 (suppl 2) ◽  
pp. S93-S93
Author(s):  
R. Saczkowski ◽  
T. Malas ◽  
G. El Khoury ◽  
T. Mesana ◽  
M. Boodhwani
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Type A ◽  
Aortic Valve Repair ◽  
Acute Type ◽  
Valve Repair ◽  
Type A Aortic Dissection

scholarly journals Florida Sleeve is a Safe and Effective Technique for Valve Salvage in Acute Stanford Type A Aortic Dissection

2021 ◽  
Author(s):  
Mahmoud Alhussaini ◽  
Eric Jeng ◽  
Tomas Martin ◽  
Amber Filion ◽  
Thomas Beaver ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Type A ◽  
Long Term Results ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Valve Sparing

Objective: Valve-sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute Type-A Aortic Dissection (ATAAD). The Florida Sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the Florida Sleeve (FS) repair in patients with dilated roots in the setting of an ATAAD. Methods: We retrospectively reviewed 24 consecutive patients (2002-2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow-up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. Results: Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal-perfusion or shock. The FS was combined with hemi-arch replacement in 15 (62.5%) patients and a zone-2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow-up period was 46 months (range; 0.3-146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. Conclusion: FS is simplified and reproducible valve-sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type-A aortic dissection with excellent early and long-term results.

Aortic Valve Function at Medium-term Follow-up after Resuspension During Repair of Acute Type A Aortic Dissection. Royal Brompton and Harefield Hospitals, Experience

2019 ◽  
Vol 3 (sup1) ◽  
pp. 66-66
Author(s):  
Alessia Gambaro ◽  
Marco Morosin ◽  
Micheal Murphy ◽  
John Pepper ◽  
Jullien Gaer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Medium Term ◽  
Type A Aortic Dissection ◽  
Valve Function

Comparison of Risk Scores for the Prediction of Outcomes after Surgery for Acute Type A Aortic Dissection

2019 ◽  
pp. 1-4
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Operative Mortality ◽  
External Validation ◽  
Type A ◽  
Risk Scores ◽  
Acute Type ◽  
Risk Models ◽  
Type A Aortic Dissection ◽  
Malperfusion Syndrome

We compared the performance of four existing risk models and a newly developed risk score for type A acute aortic dissection surgery. In 327 consecutives with type A aortic dissection surgery patients during 2003/03-2017/03 at our centre, operative mortality occurred in 65 (19.9%). Independent predictors of operative mortality were critical pre-operative state and malperfusion syndrome, and a novel additive “CritMal” Score was constructed from this. C-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.60 (0.52-0.67), EuroSCORE II 0.64 (0.57-0.72), Rampoldi 0.68 (0.59-0.76), Leontyev 0.56 (0.48-0.64), and CritMal 0.72 (0.64-0.80) respectively. This is the first study externally assessing surgical scores for aortic dissection surgery, with modest accuracy for all and moderate for CritMal. There is room for improvement of these risk models, and further refinements and external validation are warranted for clinical application.

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