“Aorta-clamp” technique for surgical repair of acute type A aortic dissection—5 min circulatory arrest at 30 °C

Background: Mortality in acute Type A aortic dissection is still high and unpredictable. We aimed to investigate the validity of preoperative hematological markers and possible risk factors in predicting in-hospital mortality in patients operated with deep hypothermic circulatory arrest method. Methods: 78 consecutive patients who were admitted to the emergency service and operated on were retrospectively analyzed. Risk factors for in-hospital death were investigated to develop a predictive model. Results: There was no difference between patients in terms of the were demographic data of the patients. In the mortality group, only preoperative creatinine levels were found to be higher (p < 0.05). Factors affecting mortality were found as total circulatory arrest (TCA) and cross-clamp (X-clamp) times when intraoperative data were examined (p < 0.05). ROC analysis was performed to determine the power to predict mortality and to determine the cut-off point. In ROC analysis to predict mortality, X-Clamp time > 71 minutes, 68.2% sensitivity and 66.1% specificity, TCA > 44.5 minutes, 72.7% sensitivity and 73.2% specificity were found. In the mortality group, these values were found to be significantly higher than those who were discharged. Conclusion: In the surgical treatment of Type A aortic dissection under deep hypothermia, hematologic biomarkers may be insufficient in estimating the risk for mortality. Keywords: Acute; aortic dissection; biomarker; mortality

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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 ◽

10.1055/s-0039-1687900 ◽

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.

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Deep Hypothermic Circulatory Arrest with Lung Perfusion/Ventilation in a Patient with Acute Type A Aortic Dissection

Case Reports in Medicine ◽

10.1155/2012/631494 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Yiliam F. Rodriguez-Blanco ◽

Lester Garcia ◽

Tania Brice ◽

Marco Ricci ◽

Tomas A. Salerno

Keyword(s):

Aortic Dissection ◽

Circulatory Arrest ◽

Type A ◽

Deep Hypothermic Circulatory Arrest ◽

Lung Perfusion ◽

Hypothermic Circulatory Arrest ◽

Acute Type ◽

Perfusion Technique ◽

Type A Aortic Dissection ◽

Potential Benefits

A 50-year-old black male presented with acute type A aortic dissection. Surgical repair was performed under deep hypothermic circulatory arrest (DHCA) with lung perfusion/ventilation throughout the procedure. Details of the lung perfusion technique and its potential benefits and drawbacks are discussed.

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Hybrid total arch repair without deep hypothermic circulatory arrest for acute type A aortic dissection (R1)

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2012.09.041 ◽

2013 ◽

Vol 146 (6) ◽

pp. 1393-1398 ◽

Cited By ~ 15

Author(s):

Qian Chang ◽

Chuan Tian ◽

Yizhen Wei ◽

Xiangyang Qian ◽

Xiaogang Sun ◽

...

Keyword(s):

Aortic Dissection ◽

Circulatory Arrest ◽

Type A ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Acute Type ◽

Type A Aortic Dissection

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Alternative cannulation techniques in surgical repair for acute type A aortic dissection

The European Research Journal ◽

10.18621/eurj.2016.2.1.1 ◽

2016 ◽

Vol 2 (1) ◽

pp. 1 ◽

Cited By ~ 4

Author(s):

Senol Yavuz

Keyword(s):

Aortic Dissection ◽

Surgical Repair ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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A Modified Hypothermic Circulatory Arrest Technique Improves Early and Near-Midterm Results in Patients with Acute Type A Aortic Dissection

The Heart Surgery Forum ◽

10.1532/hsf.3879 ◽

2021 ◽

Vol 24 (4) ◽

pp. E675-E679

Author(s):

Huadong Li ◽

Hong Yu ◽

Nianguo Dong ◽

Long Wu

Keyword(s):

Treatment Group ◽

Aortic Dissection ◽

Conventional Treatment ◽

Circulatory Arrest ◽

Type A ◽

Hypothermic Circulatory Arrest ◽

Acute Type ◽

Midterm Results ◽

Type A Aortic Dissection ◽

Conventional Treatment Group

Background: The hypothermic circulatory arrest (HCA) is an indispensable step in the surgical treatment of an acute type A aortic dissection (ATAAD), which could greatly affect the postoperative outcome. We modified the HCA technique and validated the feasibility and superiority of the new approach relative to the conventional method. Methods and results: Eighty-eight patients with ATAAD were enrolled in this study between May 2016 and April 2018. Of those, 36 patients in the Conventional treatment group had circulatory arrest at 25°C for about 16-28 minutes, while 52 patients in the Modification group underwent a circulatory arrest at 28°C for only 1-3 minutes. The preoperative clinical data and postoperative clinical outcomes were compared between the two groups. No intraoperative mortality occurred in any of the cases. No significant differences were observed in the aortic cross-clamp times during the cardiopulmonary bypass (CPB) between the two groups. In the Modification group, several indicators, such as mechanical ventilation time, postoperative 48-h drainage volume, blood transfusion volume, the ICU-stay time and postoperative hospital stay, were reduced significantly as compared with those in the Conventional group. Whereas three postoperative deaths in the hospital occurred in the Conventional treatment group, all the patients in the Modification group were cured. There is no difference in the incidence of postoperative complications between the two groups. The patients had a 100% follow up with a mean of 17 ± 6 months. Conclusions: A moderate hypothermia with a short circulatory arrest is a safe and effective HCA approach that provides satisfactory early and near-midterm results in the patients who received ATAAD treatment.

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