scholarly journals Comparison of Outcome of Total Arch Replacement for Type A Aortic Dissection using Trifurcated Branch Graft vs Island Technique- A Single Centre Experience

2021 ◽  
Author(s):  
Kamran Yunus Inamdar ◽  
Hua shan Xu ◽  
Wen Bing ◽  
Zhao Guochang ◽  
Chhatrapratap Singh ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Elective Surgery ◽  
Axillary Artery ◽  
Circulatory Arrest ◽  
Type A ◽  
Adverse Outcomes ◽  
Total Arch Replacement ◽  
Single Centre ◽  
Type A Aortic Dissection ◽  
Island Group

Abstract Objective: To compare the outcome between trifurcated graft vs island technique for the treatment of type A aortic dissection in a single centre.Method: From september 2017 to september 2020, we studied 87 patients retrospectively, who underwent total arch replacement for type A aortic dissection. Out of which 51 patients, age(47.45 ± 10.47) years, 39(76.47%) males and 12(23.52%) females were surgically corrected by trifurcated branch graft technique and 36 patients age(52.75 ± 10.32) years, 27(75%) males and 9(25%) females with island technique. In both the groups, peri- operative outcomes were compared. Patients were followed up for 3 months and 6 months in both the groups.Result: Elective Surgery was done in 16(31.37%) and 6(16.66%) in trifurcated branch graft and island group respectively. Selective antegrade cerebral perfusion (SACP) was given by the Axillary artery in {48(94.11%) in trifurcated group and 3(8.33%) in island group, p=<.00001}.SACP was given by Innominate artery {5(9.83%) in trifurcated group and 33(91.66%) in island group, p=<.00001}. Trifurcated branch group and Island group had Cardiopulmonary Bypass time, cross clamp time, total circulatory arrest time of (245 ± 33.30),(117.62 ± 29.38),(54.33 ± 13.19) min and (195.88 ± 32.83),(70.11 ± 20.62),(33.52 ± 8.683)(p=<.00001); respectively. 30 day mortality was 5(9.83%) in trifurcated group and 3(8.33%) in island group (p=0.815).Conclusion: Trifurcated branched graft and island technique, have comparable results, only prerequisite being surgeons comfortability and experience. Trifurcated branch graft being associated with longer CPB, cross clamp and circulatory arrest time, but with no difference in overall adverse outcomes or mortality.

The Circulatory Arrest Time in Patients with Acute Type A Aortic Dissection: Does It Influence the Outcome?

2020 ◽  
Author(s):  
J. Kapahnke ◽  
K. Huenges ◽  
M. Salem ◽  
P. Kolat ◽  
J. Schoettler ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

Surgical outcomes of total arch replacement with modified elephant trunk technique in type A aortic dissection: insights from single-center experience

2022 ◽  
pp. 021849232110701
Author(s):  
Jian Li ◽  
Yueyun Zhou ◽  
Wei Qin ◽  
Cunhua Su ◽  
Fuhua Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Total Arch Replacement ◽  
Hospital Death ◽  
Acute Type ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Visceral Malperfusion ◽  
Cerebral Malperfusion

Background Total arch replacement with modified elephant trunk technique plays an important role in treating acute type A aortic dissection in China. We aim to summarize the therapeutic effects of this procedure in our center over a 17-year period. Methods Consecutive patients treated at our hospital due to type A aortic dissection from January 2004 to January 2021 were studied. Relevant data of these patients undergoing total arch replacement with modified elephant trunk technique were collected and analyzed. Results A total of 589 patients were included with a mean age of 53.1 ± 12.2 years. The mean of cardiopulmonary bypass, cross-clamping, and selected cerebral perfusion time were 199.6 ± 41.9, 119.0 ± 27.2, and 25.1 ± 5.0 min, respectively. In-hospital death occurred in 46 patients. Multivariate analysis identified four significant risk factors for in-hospital mortality: preexisting renal hypoperfusion (OR 5.43; 95% CI 1.31 – 22.44; P = 0.020), cerebral malperfusion (OR 11.87; 95% CI 4.13 – 34.12; P < 0.001), visceral malperfusion (OR 4.27; 95% CI 1.01 – 18.14; P = 0.049), and cross-clamp time ≥ 130 min (OR 3.26; 95% CI 1.72 – 6.19; P < 0.001). The 5, 10, and 15 years survival rates were 86.4%, 82.6%, and 70.2%, respectively. Conclusions Total arch replacement with modified elephant trunk technique is an effective treatment for acute type A aortic dissection with satisfactory perioperative results. Patients with preexisting renal hypoperfusion, cerebral malperfusion, visceral malperfusion, and long cross-clamp time are at a higher risk of in-hospital death.

scholarly journals Preoperative hematological parameters are inadequate for predicting mortality in Stanford Type A aortic dissection repair

2021 ◽  
Vol 5 (2) ◽  
pp. 01-06
Author(s):  
Selim Durmaz ◽  
◽  
Ömer Faruk Rahman ◽  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Roc Analysis ◽  
Circulatory Arrest ◽  
Hematological Parameters ◽  
Demographic Data ◽  
Type A ◽  
Hospital Death ◽  
Acute Type ◽  
Type A Aortic Dissection

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

scholarly journals Femoral artery cannulation combined with axillary artery cannulation is safe for Stanford type A aortic dissection

2020 ◽  
Author(s):  
Ling-chen Huang ◽  
Qi-chen Xu ◽  
Dao-zhong Chen ◽  
Xiao-fu Dai ◽  
Liang-wan Chen
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Femoral Artery ◽  
Axillary Artery ◽  
Type A ◽  
Clinical Results ◽  
Type A Aortic Dissection ◽  
Artery Cannulation ◽  
Surgical Data ◽  
Perfusion Time

Abstract Background The optimal cannulation strategy in surgery for Stanford type A aortic dissection is critical to the patients’ survival, but remains controversial. Different cannulation strategies have their own advantages and drawbacks during cardiopulmonary bypass. Our center used femoral and axillary artery cannulation for Stanford type A aortic dissection. The purpose of this study was to review and clarify the clinic outcome of femoral artery cannulation combined with axillary artery cannulation for the treatment of type A aortic dissection. Methods We performed a retrospective study that included 327 patients who were surgically treated for type A aortic dissection in our institution from January 2017 to June 2019.Using femoral and axillary artery cannulation to establish cardiopulmonary bypass in patients with type A aortic dissection. The demographics data and surgical data, clinical results of the patients were calculated. Results Femoral artery combined with axillary artery cannulation was technically successful in 327 patients. The cardiopulmonary bypass time was 141.60 ± 34.89 minutes, and the selective antegrade cerebral perfusion time was 14.94 ± 2.76 minutes. The early mortality was 3.06%. The incidence of permanent neurologic dysfunction was 0.92%. Sixteen patients had post-operative renal insufficiency and five patients with liver failure. Two patients ended up with paraplegia. Conclusion Femoral artery combined with axillary artery cannulation for type A aortic dissection can significantly reduce the occurrence of malperfusion syndrome and nervous system complications, especially for cerebral protection.

Sign in / Sign up

Export Citation Format

Share Document