scholarly journals The Impact of Dedicated Aortic Teams and Centralisation of Aortic Services, and Surgeon or Centre Specific Volumes on Outcomes of Acute Type A Aortic Dissection

2018 ◽  
Vol 12 (1) ◽  
Author(s):  
Amer Harky
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
The Impact ◽  
Specific Volumes

Type A aortic dissection: involvement of carotid artery and impact on cerebral malperfusion

2020 ◽  
pp. 021849232098432
Author(s):  
Wahaj Munir ◽  
Jun Heng Chong ◽  
Amer Harky ◽  
Mohamad Bashir ◽  
Benjamin Adams
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Type A ◽  
Current Evidence ◽  
Management Approach ◽  
Complex Nature ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Cerebral Malperfusion ◽  
The Impact

Acute type A aortic dissection is a surgical emergency and management of such pathology can be complex with poor outcomes when there is organ malperfusion. Carotid artery involvement is present in 30% of patients diagnosed with acute type A aortic dissection, and given its emergency and complex nature, there is much controversy regarding the approach, extent of treatment, and timing of the intervention. It is clear that the occurrence of cerebral malperfusion adds an extra layer of complexity to the decision-making framework for treatment. Standardization and validation of the optimal management approach is required, and this should ideally be addressed with large-scale studies. Nonetheless, current literature supports the need for rapid recognition and diagnosis of acute type A aortic dissection with cerebral malperfusion, immediate and extensive surgical repair, and the appropriate use of cerebral perfusion techniques. This paper aims to discuss the current evidence regarding the impact of carotid artery involvement in both the management and outcomes of acute type A aortic dissection.

scholarly journals The Impact of Pre-Operative Malperfusion on Outcome in Acute Type A Aortic Dissection

2015 ◽  
Vol 65 (24) ◽  
pp. 2628-2635 ◽  
Author(s):  
Martin Czerny ◽  
Florian Schoenhoff ◽  
Christian Etz ◽  
Lars Englberger ◽  
Nawid Khaladj ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
The Impact

Abstract 17497: Management of Acute Type A Aortic Dissection in an Hybrid Operating Room: - Feasibility and Added Value of Preoperative Angiography and Intravascular Ultrasound

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Rolf A Janosi ◽  
Konstantinos Tsagakis ◽  
Philipp Kahlert ◽  
Eva Kottenberg ◽  
Riccardo Gorla ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Operating Room ◽  
Intravascular Ultrasound ◽  
Type A ◽  
Time Interval ◽  
Acute Type ◽  
Hybrid Operating Room ◽  
Type A Aortic Dissection ◽  
The Impact

Introduction: Acute type A aortic dissection (ATAAD) is rapidly lethal and requires comprehensive tactics and decision making. To refine our respective approach we retrospectively analyzed our patients undergoing urgent surgery in our hybrid operating room over a 10 year period for the impact of immediate preoperative coronary angiography (CA), aortography, and/or intravascular ultrasound (IVUS) for the detection of coronary artery disease (CAD) and/or arterial malperfusion. Methods: 136 patients (mean age: 60.6 y ± 13; 63% male, March 2004-February 2014) underwent preoperative CA with or without IVUS. We assessed the time interval from preoperative CA to surgery and the impact for concomitant coronary artery bypass grafting (CABG) or endovascular interventions. Results: The delay to proceed with surgery due to preoperative catheterization averaged 32 min ± 26 (Fig. 1) in the setting of the hybrid OR. CA revealed CAD in 47/136 (35%) patients, with CABG consequently performed in 38 (28%). In 12 (9%) patients, CABG was necessary due to ostium obstruction by the dissection. 30-day mortality more than doubled in patients with concomitant CAD (27.7% vs. 11.2%, respectively, p<0.01). However in patients with confirmed CAD, mortality was less 19% (6/31), in those undergoing CABG, compared to 44% (7/16) for isolated aortic repair (p=0.08). Conclusions: In a hybrid operating room setting, preoperative coronary and aortic angiography do not unduly delay surgery, facilitate diagnosis of coronary malperfusion, and allowing concomitant CABG in as much as 28% of patients.

scholarly journals Impact of time between diagnosis to treatment in Acute Type A Aortic Dissection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Caleb R. Matthews ◽  
Mackenzie Madison ◽  
Lava R. Timsina ◽  
Niharika Namburi ◽  
Zainab Faiza ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Symptom Onset ◽  
Onset Time ◽  
Type A ◽  
Time Interval ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Elevated Creatinine ◽  
Group B ◽  
The Impact

AbstractThere is a paucity of data describing the effect of time interval between diagnosis and surgery for Acute Type A Aortic Dissection. We describe our 8-year experience and investigate the impact of time interval between symptom onset, diagnosis and surgery on outcomes. Retrospective single-center study utilizing our Society of Thoracic Surgeons registry and patient records. Subjects were grouped by time interval between radiographic diagnosis and surgical treatment: Group A (0–4 h), Group B (4.1–8 h), Group C (8.1–12 h), and Group D (12.1 + h). Data were analyzed to identify factors associated with mortality and outcomes. 164 patients were included. Overall mortality was 21.3%. Group C had the greatest intervals between symptom onset to diagnosis to surgery, and also the highest mortality (66.7%). Preoperative tamponade, cardiac arrest, malperfusion, elevated creatinine, cardiopulmonary bypass time, and blood transfusions were associated with increased mortality, while distance of referring hospital was not. Time intervals between symptom onset, diagnosis and surgery have a significant effect on mortality. Surgery performed 8–12 h after diagnosis carries the highest mortality, which may be exacerbated by longer interval since symptom onset. Time-dependent effects should be considered when determining optimal strategy especially if inter-facility transfer is necessary.

scholarly journals The Impact of Age in Acute Type A Aortic Dissection: a Retrospective Study

2021 ◽  
Author(s):  
Junxia Wang ◽  
Yunxing Xue ◽  
Xiyu Zhu ◽  
Hoshun Chong ◽  
Zhong Chen ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Aortic Dissection ◽  
Surgical Therapy ◽  
Age Groups ◽  
Type A ◽  
Acute Type ◽  
Term Survival ◽  
Type A Aortic Dissection ◽  
Surgical Methods ◽  
The Impact

Abstract Background: Acute type A aortic dissection (aTAAD) is a lethal disease and age is an important risk factor for outcomes. This retrospective study was to analyze the impact of age stratification in aTAAD, and to provide clues for surgeons when they make choices of therapy strategies. Methods: From January 2011 to December 2019, 1092 aTAAD patients from Nanjing Drum Tower Hospital received surgical therapy. Patients were divided into 7 groups according to every ten-year interval (20s-80s). The differences between the groups were analyzed in terms of the baseline preoperative conditions, surgical methods and postoperative outcomes of patients of different age groups. During a median follow-up term of 17 months, the survival rates were compared among 7 groups through Kaplan-Meier analysis.Results: The median age was 52.0 years old in whole cohort. The multiple comorbidities were more common in old age groups (60s, 70s, 80s), while the 20s group patients had the highest proportion of Marfan syndrome (28.1%). Preoperative hypotension was highest in 80s (16.7%, P=0.038). Young age groups (20s-60s) had a higher rate of root replacement and total arch replacement, which led to a longer duration of operation and hypothermic circulation arrest. The overall mortality was 14.1%, the tendency of mortality was increased with age except 20s group (33.3% in 80s, P=0.016). The postoperative morbidity of gastrointestinal bleeding and bowel ischemia were 16.7% and 11.1% in 80s group. Conclusions: Age is a major impact factor for aTAAD surgery. Old patients presented more comorbidities before surgery, the mortality and complications rate were significantly higher even with less invasive and conservative surgical therapy. But the favorable long term survival indicated that the simple or less extensive arch repair is the preferred surgery for patients over 70 years old.

scholarly journals The Impact of CK-MB Elevation in Patients With Acute Type A Aortic Dissection With Coronary Artery Involvement

2021 ◽  
Author(s):  
Naoshi Minamidate ◽  
Tomoaki Suzuki
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Statistical Significance ◽  
Artery Bypass ◽  
Type A ◽  
Coronary Perfusion ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Coronary Artery Involvement ◽  
The Impact

Abstract Background Acute coronary artery involvement (ACI) is a lethal complication of acute type A aortic dissection. Although ACI has been reported as one of the prognostic factors of acute type A aortic dissection, it does not always cause coronary ischemia. The extent of myocardial damage varies from case to case. Moreover, since the definition of ACI varies from paper to paper, it is unknown what the difference is between ACI with and without myocardial necrosis. In general, it can be assumed that cases with myocardial infarction have worse results. However, it is unknown how poor ACI is with myocardiac ischemia and how optimistic it is without it. This study compared the surgical results between the two groups of ACI with or without myocardiac ischemia. Methods Among 348 patients who underwent an emergency operation for acute type A aortic dissection, there were 28 (8.0%) patients complicated by ACI and underwent additional coronary artery bypass grafting. We divided 26 of those patients into two groups; the MI group ( with CK-MB elevation) and the NMI group (without CK-MB elevation) and compared both groups. Results Of the 26, sixteen were in the MI group, and ten were in the NMI group. The average CK-MB in the MI group was 225.5 IU/L, and that in the NMI group was 13.5 IU/L. The mean time from onset to surgery was 248 minutes in the MI group, 250 minutes in the NMI group. There was statistical significance in mortality ( 69% vs. 13%, p=0.03). There was no significance in major complications (ICU days, reintubation, reoperation, pneumonia, sepsis). Conclusions Acute coronary artery involvement was associated with 8.0% of patients with ATAAD, and 62% of them had myocardial ischemia with CK-MB elevation. As expected, the MI group had significantly higher mortality than the NMI group. It is crucial for cases with suspected ACI to obtain coronary perfusion as soon as possible to prevent CK-MB from elevationg.

scholarly journals The Impact of Obesity on the Outcome of Surgical Repair for Acute Type A Aortic Dissection

2019 ◽  
Author(s):  
D.S. Dohle ◽  
L. Brendel ◽  
H. El Beyrouti ◽  
P. Pfeiffer ◽  
K. Buschmann ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Surgical Repair ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
The Impact
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