scholarly journals Optimal Degree of Hypothermia in Total Arch Replacement for Type A Aortic Dissection

2021 ◽  
Vol 8 ◽  
Author(s):  
Jinlin Wu ◽  
Juntao Qiu ◽  
Zhongrong Fang ◽  
Qipeng Luo ◽  
Yao Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Odds Ratio ◽  
Type A ◽  
The Elderly ◽  
Total Arch Replacement ◽  
Sensitivity Analyses ◽  
Paradigm Change ◽  
Type A Aortic Dissection ◽  
Primary Endpoints ◽  
Significant Protective Effect

Background: We sought to investigate the best degree of hypothermic cardiac arrest (HCA) in type A aortic dissection (TAAD) with a cohort of 1,018 cases receiving total arch replacement from 2013 to 2018 in Fuwai Hospital.Method: The cohort was divided by DHCA (≤24°C, n = 580) vs. MHCA (>24°C, n = 438), and interquartile range (Q1–Q4). Primary endpoints included mortality, stroke, paraplegia, and continuous renal replacement therapy (CRRT), which were summarized as composite major outcomes (CMO).Results: The Odds Ratio (OR) of CMO for MHCA was 0.7 (95% CI: 0.5–1.0, p = 0.06) (unadjusted) and 0.6 (95% CI: 0.4–1.0, p = 0.055) (adjusted). DHCA group tended to have a significantly longer CPB time (175.6 ± 45.6 vs. 166.8 ± 49.8 min, p = 0.003), longer hospital stay (16.0 ± 13.6 vs. 13.5 ± 6.8 days, p < 0.001), and ICU stay [5.0 (3.9–6.6) vs. 3.8 (2.0–5.6) days]. A significantly greater blood loss was observed in DHCA group, with a greater requirement for RBC and platelet transfusion. Of note, MHCA showed a significant protective effect (60% risk reduction) for older patients (above 60 years) (OR 0.4; 95% CI: 0.2–0.8; p = 0.009). By quartering, Q1 had significantly higher mortality (10.9%) than Q4 (5.2%) (p = 0.035). For other comparisons, the gap was significantly widened in quartering between Q1 and Q4, i.e., the lower the temperature, the worse the outcomes, and vice versa. Propensity score matching and sensitivity analyses confirmed the above findings.Conclusions: A paradigm change from DHCA to MHCA may be encouraged in TAAD arch operation, especially for the elderly.

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.

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.

Prior reconstruction of an isolated left vertebral artery for Stanford type A aortic dissection

2020 ◽  
Author(s):  
Yi Zuo ◽  
Zheng-Chun Zhou ◽  
Jian-Jun Ge
Keyword(s):  
Carotid Artery ◽  
Aortic Dissection ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Type A ◽  
Left Common Carotid Artery ◽  
Total Arch Replacement ◽  
Left Vertebral Artery ◽  
Elephant Trunk ◽  
Type A Aortic Dissection

Abstract Although isolated left vertebral artery is a supra-aortic trunk variant, it is not so rare. It may pose additional difficulties during total arch replacement surgeries. The aim of this study was to present our experience with prior reconstruction of isolated left vertebral artery by isolated left vertebral artery–left common carotid artery during total arch replacement combined with stented elephant trunk implantation.

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