scholarly journals Emergency surgery for Type A Aortic Dissection in Octogenarians -- do we still err on the side of caution?

2021 ◽  
Author(s):  
Amer Harky ◽  
Niraj Kumar ◽  
William Wang ◽  
Mark Field
Keyword(s):  
Aortic Dissection ◽  
Emergency Surgery ◽  
Type A ◽  
Type A Aortic Dissection

scholarly journals Surgery out of office hours for type A aortic dissection: does night-time and weekend surgery worsen outcome?

2020 ◽  
Vol 31 (6) ◽  
pp. 806-812
Author(s):  
Simone Gasser ◽  
Lukas Stastny ◽  
Markus Kofler ◽  
Vitalijs Zujs ◽  
Christoph Krapf ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Emergency Surgery ◽  
Odds Ratio ◽  
Surgical Repair ◽  
Type A ◽  
Skin Incision ◽  
Night Time ◽  
Femoral Access ◽  
Type A Aortic Dissection ◽  
Malperfusion Syndrome

Abstract OBJECTIVES Immediate surgical repair for type A aortic dissection is gold standard and at most centres is performed by the surgeon on call during night-time and weekends. The objective was to evaluate whether emergency surgery during night-time or weekends has an influence on 30-day mortality. METHODS In 319 patients undergoing surgery for type A aortic dissection, skin incision was documented. Patients were divided into 2 groups according to the time point of skin incision (05:00 a.m. to 07:00 p.m. = daytime group; 07:01 p.m. to 04:59 a.m. = night-time group). We also noted whether their surgeries were started on weekdays (Monday 00:00 to Friday 23:59) or weekends (Saturday 00:00 to Sunday 23:59). RESULTS The median age was 61 years (interquartile range 49–70) and 69.6% (n = 222) were male. Almost 50% (n = 149) of patients presented in a critical preoperative state. Forty-one percent of patients (n = 131) underwent night-time surgery. There were no differences in baseline data, time from onset of symptoms to surgery or surgical treatment between groups, except from preferred femoral access for arterial cannulation during night-time. Advanced age [odds ratio 1.042, 95% confidence interval (CI) 1.014–1.070], preoperative malperfusion syndrome (odds ratio 2.542, 95% CI 1.279–5.051) and preoperative tamponade (odds ratio 2.562, 95% CI 1.215–5.404) emerged as risk factors for 30-day mortality. Night-time or weekend surgery did not have any impact on 30-day mortality when covariates were considered. CONCLUSIONS Based on the natural course of the disease and our results, surgery for type A aortic dissection should be performed as an emergency surgery regardless of time and day.

scholarly journals Durable results of preserved valve and root after acute type A aortic dissection surgery in bicuspid aortic valve

2022 ◽  
Author(s):  
Tsu-Jui Hsu ◽  
Cheng-Wei Chen ◽  
Ron-Bin Hsu
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Valve Replacement ◽  
Bicuspid Aortic Valve ◽  
Emergency Surgery ◽  
Type A ◽  
Long Term Results ◽  
Acute Type ◽  
Type A Aortic Dissection

Background and aims of the study. Data on emergency surgery for acute type A aortic dissection in patients with bicuspid aortic valve were limited. Long-term results on the fate of the preserved bicuspid valve and aortic root were even rare. We sought to assess the clinical outcome of emergency acute type A aortic dissection surgery in patients with bicuspid aortic valve. Methods. From 2004 to 2021, 121 patients underwent emergency surgery for acute type A aortic dissection using a conservative aortic resection. Hospital and late outcomes were assessed in patients with bicuspid aortic valve. Results. Eight patients (6.6%) had bicuspid aortic valve with 6 males (75%) and median age of 49.5 years (range, 34 to 71). Four (50%) had significant aortic valve dysfunction. Operation included ascending aortic grafting with aortic valve preservation in 4, ascending aortic grafting with aortic valve replacement in 3 and ascending aortic grafting with Bentall root replacement in 1. Hospital mortality rate was 12.5% (1/8). With a median follow-up of 14.4 years, there was one late death and no proximal reoperation of 6 preserved roots and 3 preserved valves. Median diameter of preserved aortic roots changed from 42 (range, 33-43) to 38.5 mm (range, 35-46) with the average time of 11 years after surgery. Conclusions. Acute type A aortic dissection in bicuspid aortic valve was not associated with worse outcome. Aortic valve replacement was often required. Simultaneous root replacement was not always necessary. Preservation of normally functioning bicuspid valve and non-dilated root showed durable long-term results.

Frequency and Detection of Stanford Type A Aortic Dissection in Hyperacute Stroke Management

2016 ◽  
Vol 42 (1-2) ◽  
pp. 110-116 ◽  
Author(s):  
Yuki Sakamoto ◽  
Masatoshi Koga ◽  
Tomoyuki Ohara ◽  
Satoshi Ohyama ◽  
Soichiro Matsubara ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Acute Stroke ◽  
Emergency Surgery ◽  
Type A ◽  
Neurological Symptoms ◽  
Stroke Patients ◽  
Type A Aortic Dissection ◽  
The Right ◽  
D Dimer

Background and Purpose: Acute Stanford type A aortic dissection (AAD) is a devastating aortic disease, and prompt diagnosis is sometimes difficult to make. Identification of AAD in suspected acute stroke patients is especially challenging. Nevertheless, the frequencies and predictive factors of AAD in suspected acute stroke patients have not been well investigated. The aim of this study was to elucidate the prevalence of and predictors for AAD in patients with suspected acute stroke. Methods: From January 2012 through January 2013, consecutive patients who visited our emergency department (ED) due to suspected acute (<24 h from onset) stroke were retrospectively enrolled. Clinical parameters including systolic blood pressure (SBP) and laboratory data were collected. Frequency of AAD in suspected acute stroke patients and acute ischemic stroke (AIS) subjects were assessed, and factors associated with AAD among AIS patients were investigated. Results: A total of 1,637 patients were included in this study. Five patients (0.31%, 95% CI 0.04-0.57) were diagnosed as having AAD. The prevalence of AAD in all AIS individuals during the study period was 1.09% (95% CI 0.14-2.05), and AAD accounted for 1.70% (95% CI 0.05-3.36) of AIS patients who appeared at the hospital within 4 h from onset. Most AAD patients presented with disturbed consciousness, and none of the AAD patients complained of chest pain. Neck ultrasonography detected an intimal flap in AAD patients. Two AAD cases died soon after ED arrival. The remaining 3 were promptly diagnosed as having AAD in the ED and underwent emergency surgery; all were discharged with only mild neurological symptoms. Low SBP in the right arm (cut-off value ≤110 mm Hg, sensitivity 100%, specificity 94.4%) and high D-dimer level (cut-off value ≥5.0 μg/ml, sensitivity 100%, specificity 91.7%) had high predictive values for detecting AAD in patients with AIS presenting within 4 h from onset. Conclusions: AAD was seen in 0.31% of suspected acute stroke patients and 1.70% of AIS patients presenting within 4 h from onset. AAD patients who were initially suspected as having acute stroke had severe neurological symptoms, including disturbance of consciousness, did not complain of typical chest pain, and when emergency surgery was performed, favorable neurological and survival outcomes were achieved. Low SBP in the right arm and high D-dimer level could predict AAD.

Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians

2006 ◽  
Vol 82 (2) ◽  
pp. 554-559 ◽  
Author(s):  
Motomi Shiono ◽  
Mitsumasa Hata ◽  
Akira Sezai ◽  
Mitsuru Iida ◽  
Shinya Yagi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Emergency Surgery ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

Midterm outcomes of emergency surgery for acute type A aortic dissection in octogenarians

2020 ◽  
Author(s):  
Markian M. Bojko ◽  
Maham Suhail ◽  
Joseph E. Bavaria ◽  
Alex Bueker ◽  
Robert W. Hu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Emergency Surgery ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

scholarly journals Does Interhospital Transfer Influence the Outcomes of Patients Receiving Surgery for Acute Type A Aortic Dissection? Type A Aortic Dissection: Is Transfer Hazardous or Beneficial?

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Yuan-Hsi Tseng ◽  
Chih-Chen Kao ◽  
Chien-Chao Lin ◽  
Chien-Wei Chen ◽  
Ming-Shian Lu ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Aortic Dissection ◽  
Emergency Surgery ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Interhospital Transfer ◽  
Group 2 ◽  
Operative Findings ◽  
Group 1

Introduction. The progression of acute type A aortic dissection may cause immediate death, such that, in the event of its diagnosis, emergency surgery is indicated. Relatedly, an interhospital transfer may prolong the time from diagnosis to surgery. This study therefore investigated how interhospital transfers impact surgical outcomes for acute type A aortic dissection. Materials and Methods. After excluding those patients who received deferred surgery for acute type A aortic dissection, 112 patients who received emergency surgery for the condition at our hospital from January 2011 to January 2018 were enrolled. These patients were divided into two groups, one consisting of the patients who were sent directly to our emergency department (group 1) and the other consisting of the patients who were transferred from another hospital after first being diagnosed with type A aortic dissection (group 2). The collected data included the patient demographics, clinical characteristics, operative findings and methods, postoperative outcomes, latest follow-up time, and most recent status. Results. There were 59 patients in group 1 and 53 patients in group 2. Univariate analysis revealed that group 1 had significantly more patients with a previous stroke (p = 0.007). Moreover, the average length of time from receiving a computed tomography (CT) scan to entering the operating room (OR) was shorter for the group 1 patients (p < 0.001). However, except for the incidence of postoperative acute kidney injury (14.5% versus 33.3%, p = 0.024), there was no statistical difference between the groups in terms of the operative findings and outcomes, such as hypotension before cardiopulmonary bypass, hemopericardium, other complications, and survival rate. Multivariate analysis showed that the independent predictors of hospital mortality included age > 61.5 years (p = 0.017), respiratory rate upon admission > 18.5 breaths/minute (p = 0.046), and total bypass time > 265.6 minutes (p = 0.015). For the patients who survived to discharge, log-rank analysis demonstrated similar cumulative survival rates for the two groups (p = 0.62). Further multivariate analysis showed that the risk of death after discharge was associated with the interval between the CT scan and OR entry (hazard ratio = 0.97 per minute; 95% confidence interval, 0.950–0.998; p = 0.037). Conclusion. In this study, it was found that interhospital transfer did not influence the surgical outcomes of patients with acute type A aortic dissection. As such, it can be concluded that the transfer of the patients with type A aortic dissection to tertiary hospitals with experienced cardiac surgical teams may not increase the surgical risk.

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