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.

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 Impact of body mass index on early and mid-term outcomes after surgery for acute Stanford type A aortic dissection

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yanxiang Liu ◽  
Bowen Zhang ◽  
Shenghua Liang ◽  
Yaojun Dun ◽  
Luchen Wang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Adverse Events ◽  
Aortic Dissection ◽  
Body Mass ◽  
Surgical Outcomes ◽  
Type A ◽  
Term Survival ◽  
Type A Aortic Dissection ◽  
Prolonged Ventilation ◽  
The Impact

Abstract Background Obesity is dramatically increasing worldwide, and more obese patients may develop aortic dissection and present for surgical repair. The study aims to analyse the impact of body mass index (BMI) on surgical outcomes in patients with acute Stanford type A aortic dissection (ATAAD). Methods From January 2017 to June 2019, the clinical data of 268 ATAAD patients in a single centre were retrospectively reviewed. They were divided into three groups based on the BMI: normal weight (BMI 18.5 to < 25 kg/m2, n = 110), overweight (BMI 25 to < 30 kg/m2, n = 114) and obese (BMI ≥30 kg/m2, n = 44). Results There was no statistical difference among the three groups in terms of the composite adverse events including 30-day mortality, stroke, paraplegia, renal failure, hepatic failure, reintubation or tracheotomy and low cardiac output syndrome (20.9% vs 21.9% vs 18.2% for normal, overweight and obese, respectively; P = 0.882). No significant difference was found in the mid-term survival among the three groups. The proportion of prolonged ventilation was highest in the obese group followed by the overweight and normal groups (59.1% vs 45.6% vs 34.5%, respectively; P = 0.017). Multivariable logistic regression analysis suggested that BMI was not associated with the composite adverse events, while BMI ≥30 kg/m2 was an independent risk factor for prolonged ventilation (OR 2.261; 95% CI 1.056–4.838; P = 0.036). Conclusions BMI had no effect on the early major adverse outcomes and mid-term survival after surgery for ATAAD. Satisfactory surgical outcomes can be obtained in patients with ATAAD at all weights.

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.

Aortic root surgery improves long-term survival after acute type A aortic dissection

2015 ◽  
Vol 184 ◽  
pp. 285-290 ◽  
Author(s):  
Ilir Hysi ◽  
Francis Juthier ◽  
Olivier Fabre ◽  
Olivier Fouquet ◽  
Natacha Rousse ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Type A ◽  
Acute Type ◽  
Term Survival ◽  
Type A Aortic Dissection ◽  
Long Term Survival ◽  
Aortic Root Surgery
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