scholarly journals Unilateral versus bilateral anterograde cerebral perfusion in acute type A aortic dissection repair: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Panagiotis T. Tasoudis ◽  
Dimitrios N. Varvoglis ◽  
Evangelos Vitkos ◽  
John Ikonomidis ◽  
Thanos Athanasiou
Keyword(s):  
Systematic Review ◽  
Renal Failure ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Neurological Deficit ◽  
Cerebral Perfusion ◽  
Type A ◽  
Cochrane Library ◽  
Acute Type ◽  
Type A Aortic Dissection

Objectives: The aim of the study is to compare the safety and efficacy of unilateral anterograde cerebral perfusion (UACP) and bilateral anterograde cerebral perfusion (BACP) for acute type A aortic dissection (ATAAD). Methods: A systematic review of MEDLINE (PubMed), Scopus, and Cochrane Library databases (last search: August 7 , 2021) was performed according to the PRISMA statement. Studies directly comparing UACP versus BACP for ATAAD were included. Random-effects meta-analyses were performed. Results: Eight retrospective cohort studies were identified, incorporating 2416 patients (UACP: 843, BACP: 1573). No statistically significant difference was observed regarding in-hospital mortality (odds ratio [OR]:1.05 [95% Confidence Interval (95%CI):0.70-1.57]), permanent neurological deficit (PND) (OR: 0.94 [95%CI:0.52-1.70]), transient neurological deficit (TND) (OR: 1.37 [95%CI:0.98-1.92]), renal failure (OR: 0.96 [95%CI:0.70-1.32]), and re-exploration for bleeding (OR: 0.77 [95%CI:0.48-1.22]). Meta-regression analysis revealed that PND and TND were not influenced by differences in rates of total arch repair, Bentall procedure and concomitant CABG in UACP and BACP groups. Cardiopulmonary bypass time (Standard Mean Difference [SMD]:-0.11 [95%CI:-0.22, 0.44]), Cross clamp time (SMD:-0.04 [95%CI:-0.38, 0.29]) and hypothermic circulatory arrest time (SMD:-0.12 [95%CI:-0.55, 0.30]) were comparable between UACP and BACP. Intensive care unit stay was shorter in BACP arm (SMD:0.16 [95%CI:0.01, 0.31]), however, length of hospital stay was shorter in UACP arm (SMD:-0.25 [95%CI:-0.45, -0.06]). Conclusions: UACP and BACP had similar results in terms of in-hospital mortality, PND, TND, renal failure and re-exploration for bleeding rate in patients with ATAAD. ICU stay was shorter in the BACP arm while LOS was shorter in the UACP arm.

scholarly journals Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up

2021 ◽  
Vol 10 (22) ◽  
pp. 5370
Author(s):  
Miriam Freundt ◽  
Philipp Kolat ◽  
Christine Friedrich ◽  
Mohamed Salem ◽  
Matthias Gruenewald ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Neurological Deficit ◽  
Prolonged Mechanical Ventilation ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Acute Renal Insufficiency

Background: Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predictive of undesirable outcome to help guide perioperative management. Methods: We performed retrospective analysis of 394 cases of AAAD who underwent repair in our institution between 2001 and 2018. A combined endpoint of parameters was defined as (1) 30-day versus hospital mortality, (2) new neurological deficit, (3) new acute renal insufficiency requiring postoperative renal replacement, and (4) prolonged mechanical ventilation with need for tracheostomy. Results: Total survival/ follow-up time averaged 3.2 years with follow-up completeness of 94%. Endpoint was reached by 52.8%. Those had higher EuroSCORE II (7.5 versus 5.5), higher incidence of coronary artery disease (CAD) (9.2% versus 3.2%), neurological deficit (ND) upon presentation (26.4% versus 11.8%), cardiopulmonary resuscitation (CPR) (14.4% versus 1.6%) and intubation (RF) before surgery (16.9% versus 4.8%). 7-day mortality was 21.6% versus 0%. Hospital mortality 30.8% versus 0%. Conclusions: This 15-year follow up shows, that unfavorable postoperative clinical outcome is related to ND, CAD, CPR and RF on arrival.

scholarly journals Peri-operative risk factors for in-hospital mortality in acute type A aortic dissection

2019 ◽  
Vol 11 (9) ◽  
pp. 3887-3895
Author(s):  
Miaoyun Wen ◽  
Yongli Han ◽  
Jingkun Ye ◽  
Gengxin Cai ◽  
Wenxin Zeng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Type A ◽  
Operative Risk ◽  
Acute Type ◽  
Type A Aortic Dissection

scholarly journals Acute type A aortic dissection in non-agenarians: to cut or not

2020 ◽  
Vol 31 (1) ◽  
pp. 102-107
Author(s):  
Shigeru Hattori ◽  
Kenichiro Noguchi ◽  
Yusuke Gunji ◽  
Motoki Nagatsuka ◽  
Ikuo Katayama
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Comprehensive Evaluation ◽  
Case Reports ◽  
Type A ◽  
Rank Test ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Conservative Group ◽  
Surgical Group

Abstract OBJECTIVES Surgery for acute type A aortic dissection (type AAD) in non-agenarians is usually contraindicated due to advanced age. The aim of this study was to assess and compare outcomes after surgical or conservative treatment for acute type AAD in non-agenarians by evaluating frailty. METHODS Between October 2012 and September 2018, 273 patients underwent open repair for type AAD at the Shonan Kamakura General Hospital and the Shonan Fujisawa Tokushukai Hospital, and here, we retrospectively reviewed the case reports of 10 surgically treated non-agenarians and 15 conservatively treated non-agenarians. Exclusion criteria for surgery were the patient’s refusal of surgery, severe dementia and coma. In patients considered to be at a high risk, our judgements were based on the results of comprehensive evaluation. RESULTS Both in-hospital mortality and 30-day mortality in the surgical group were zero, while in-hospital mortality in conservatively treated non-agenarians was 73.3%. Importantly, 1-year survival in the surgical group and conservative group was 90% and 25%, respectively. The 5-year survival in the surgical group and conservative group was 49.2% and 25%, respectively (log-rank test, P = 0.0105). Four of 6 patients with preoperative clinical frailty scores not higher than 4 were still alive at 1 year with the same level of preoperative frailty. CONCLUSIONS Surgery for acute type AAD in non-agenarians can be performed with acceptable outcomes in carefully selected patients, particularly in those with preoperative clinical frailty scores not higher than 4.

Neutrophil–lymphocyte ratio may predict in-hospital mortality in patients with acute type A aortic dissection

Herz ◽  
2014 ◽  
Vol 40 (4) ◽  
pp. 716-721 ◽  
Author(s):  
S. Karakoyun ◽  
M.O. Gürsoy ◽  
T. Akgün ◽  
L. Öcal ◽  
M. Kalçık ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

scholarly journals Effect of different types of cerebral perfusion for acute type A aortic dissection, unilateral versus bilateral

2020 ◽  
Author(s):  
zhengqin liu ◽  
Chen Wang ◽  
Xiquan Zhang ◽  
Shuming Wu ◽  
changcun fang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Lower Incidence ◽  
Cerebral Perfusion ◽  
Type A ◽  
Neurological Complications ◽  
Neurological Dysfunction ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Neurologic Dysfunction ◽  
Ventilation Time

Abstract Background: Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used way for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research was aimed to investigate the clinical effects between u-ACP and b-ACP. Methods: 321 of 356 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP and 197 patients(61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. We also analyzed perioperative variables in order to find the potential associated factors for neurolocial dysfunction (ND). Results: For u-ACP group, 54 patients (43.5%) had postoperative neurological complications including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p=0.016), higher nasopharyngeal temperature (p≦0.000), shorter ventilation time (p=0.018) and lower incidence of hypoxia (p=0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR=1.20, P= 0.028), CPB duration (OR=3.21, P=0.002 ) and type of cerebral perfusion (OR=1.48, P=0.017) were strongly associated with postoperative ND. Conclusions: In our study, we found that b-ACP procedure had shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia and neurological dysfunction compared to u-ACP. Meanwhile, we discovered the incidence of ND was independently associated with there factors, including preoperative neurological dysfunction, CPB time and type of cerebral perfusion.

scholarly journals A nomogram for predicting in-hospital mortality in acute type A aortic dissection patients

2020 ◽  
Vol 12 (3) ◽  
pp. 264-275 ◽  
Author(s):  
Guifang Yang ◽  
Yang Zhou ◽  
Huaping He ◽  
Xiaogao Pan ◽  
Xizhao Li ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

Common carotid artery true lumen flow impairment in patients with type A aortic dissection

2020 ◽  
Author(s):  
Maximilian Kreibich ◽  
Nimesh D Desai ◽  
Joseph E Bavaria ◽  
Wilson Y Szeto ◽  
Prashanth Vallabhajosyula ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Common Carotid Artery ◽  
Type A ◽  
Acute Type ◽  
Imaging Data ◽  
True Lumen ◽  
Type A Aortic Dissection ◽  
Logistic Regression Models

Abstract OBJECTIVES Our aim was to evaluate clinical and neurological effects of common carotid artery (CCA) true lumen flow impairment or occlusion in patients with type A aortic dissection. METHODS Characteristics and imaging data of patients with dissected CCA secondary to acute type A aortic dissection from 3 institutions were analysed. We defined true lumen blood flow as unimpaired when the maximum true lumen diameter exceeded 50% of the complete CCA diameter, as impaired when the true lumen was compressed to ˃50% of the complete lumen, or as occluded. RESULTS Out of 440 patients, 207 presented unimpaired CCA flow, 172 impaired CCA flow and CCA occlusion was present in 61 patients. Preoperative shock (P = 0.045) or a neurological deficit (P < 0.001) were least common in patients with unimpaired CCA flow and most common in those with CCA occlusion. Non-cerebral, other-organ malperfusion was common in 37% of all patients, but the incidence was similar (P = 0.69). In patients with CCA occlusion, postoperative stroke (P < 0.001) and in-hospital mortality (0.011) were significantly higher, while the incidences were similar between patients with unimpaired and impaired CCA flow. Mixed-effects logistic regression models showed that CCA flow impairment (P = 0.23) or occlusion (P = 0.55) was not predictive for in-hospital mortality, but CCA occlusion was predictive for in-hospital stroke (odds ratio 2.166, P = 0.023) CONCLUSIONS Shock and non-cerebral, other-organ malperfusion are common in patients with CCA dissection. While there is a high risk for stroke in patients with CCA occlusion, CCA flow impairment and occlusion were not predictive for in-hospital mortality. Surgery should not be denied to patients with CCA flow impairment or occlusion.

Prognostic nutritional index predicts in-hospital mortality in patients with acute type A aortic dissection

Heart & Lung ◽  
2021 ◽  
Vol 50 (1) ◽  
pp. 159-164
Author(s):  
Yanjuan Lin ◽  
Qiong Chen ◽  
Yanchun Peng ◽  
Yiping Chen ◽  
Xizhen Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Prognostic Nutritional Index ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Nutritional Index
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