Faculty Opinions recommendation of Endovascular fenestration/stenting first followed by delayed open aortic repair for acute type A aortic dissection with malperfusion syndrome.

Abstract Introduction To determine the timing of operation might be the most important factors for surgical outcomes of acute type A aortic dissection (AADA), we analyzed our experience managing AADA complicated by malperfusion syndrome. Method Between 11/10 and 2/19, 184 patients with AADA were treated surgically, including 60 patients (32.6%) presented with malperfusion. The mean age of the patients was 71.3±13.3 and female was 94 (51.1%). Prevalences of malperfusions of brain, coronary, kidney, intestine, and extremities were 30 (16.3%), 16 (8.7%), 6 (3.3%), 3 (1.6%), and 23 (12.5%), respectively. Eighty-nine patients (48.4%) were repaired within 6 hours from onset of symptoms and 95 (51.6%) repaired after 6 hours from onset. Aortic repair included total arch replacement in 69 (37.5%) patients and hemiarch in 115 (62.5%). Effect of immediate aortic repair (within 6 hours from onset) and malperfusion syndromes on surgical outcomes of the patients were analyzed. Results Overall 30-days-survival rate after aortic repair for AADA was 93.5% (172/184). Early mortality after repairs with malperfusion was 13.3% (8/60): 11.9% (5/42) with immediate repair, and 16.7% (3/18) repaired after 6 hours from onset (late repair). Early mortality after repairs without malperfusion was 3.2% (4/124): 2.3% (1/44) with immediate repair, and 3.8% (3/80) with late repair. Early mortality after repairs with malperfusion was significantly higher than that without malperfusion. In each groups including 184 patients after aortic repair for AADA, 60 patients with malperfusion and 124 patients without malperfusion, there was no significant difference in early mortality rate between immediate repair group and late group. Conclusion Malperfusion syndrome was independent risk factor for aortic repairs of acute type-A aortic dissection, and time from onset to operation was not directly related to better outcomes in this patient cohort.

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Low postoperative blood platelet count may be a risk factor for 3-year mortality in patients with acute type A aortic dissection

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01623-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Guangyu Liu ◽

Hongbai Wang ◽

Qipeng Luo ◽

Liang Cao ◽

Lijing Yang ◽

...

Keyword(s):

Platelet Count ◽

Aortic Dissection ◽

Type A ◽

Blood Platelet ◽

Acute Type ◽

Elephant Trunk ◽

Type A Aortic Dissection ◽

Aortic Repair ◽

Case System ◽

Open Aortic Repair

Abstract Background Mortality and complications remain high after acute type A aortic dissection (ATAAD) open surgery and are associated with coagulation dysfunction. Platelets play an important role in the process of coagulation. This study explored the relationship between postoperative platelet counts and 3-year mortality after operation in patients with ATAAD undergoing open aortic repair surgery. Methods Patients with ATAAD who underwent Total Arch Replacement and Frozen Elephant Trunk in Fuwai Hospital from 2011 to 2015 were selected for this study. The perioperative data were collected and sorted through the electronic clinical case system. Multivariate Logistic regression was used to analyze the risk factors for death within three years after surgery. Results A total of 495 patients were included in the analysis. After correction for confounding factors, decreased postoperative platelet count remained an independent factor that was associated with lower mortality (OR = 0.918, 95% CI 0.853–0.988, P = 0.023). Conclusions The study indicated that decreased postoperative platelet count may lead to increased 3-year mortality, in patients with ATAAD who underwent open aortic repair surgery.

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Low postoperative blood platelet count may be a risk factor for mortality in patients with acute type A aortic dissection

10.21203/rs.3.rs-580972/v1 ◽

2021 ◽

Author(s):

Guangyu Liu ◽

Hongbai Wang ◽

Qipeng Luo ◽

Liang Cao ◽

Lijing Yang ◽

...

Keyword(s):

Platelet Count ◽

Aortic Dissection ◽

Postoperative Mortality ◽

Type A ◽

Blood Platelet ◽

Acute Type ◽

Elephant Trunk ◽

Type A Aortic Dissection ◽

Aortic Repair ◽

Open Aortic Repair

Abstract Background Mortality and complications remain high after Acute Type A Aortic Dissection (ATAAD) open surgery, which is associated with coagulation dysfunction. Platelets play an important role in the process of coagulation. This study was to explore the relationship between postoperative platelet counts and postoperative mortality in patients with ATAAD after open aortic repair surgery.Methods Patients with ATAAD who underwent Total Arch Replacement and Frozen Elephant Trunk in Fuwai Hospital from 2011 to 2015 were selected in this study. The perioperative data were collected and sorted through the electronic clinical case system. Multivariate Logistic regression was used to analyze the risk factors for death within three years after surgery.Results A total of 495 patients were included in the analysis. After correction with the confounding factors, postoperative platelets count remained as an independent factor that was associated with lower mortality (OR = 0.918, 95%CI 0.853-0.988, P = 0.023).Conclusions The study indicated that decreased postoperative platelet count may lead to increased mortality, in patients with ATAAD underwent open aortic repair surgery.

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Alternative management of proximal aortic dissection: concept and application

Indian Journal of Thoracic and Cardiovascular Surgery ◽

10.1007/s12055-021-01281-3 ◽

2021 ◽

Author(s):

Xun Yuan ◽

Andreas Mitsis ◽

David Mozalbat ◽

Christoph A. Nienaber

Keyword(s):

Aortic Dissection ◽

Case Reports ◽

Type A ◽

Ascending Aorta ◽

Recent Experience ◽

Acute Type ◽

Type A Aortic Dissection ◽

Aortic Repair ◽

Small Series ◽

Open Aortic Repair

AbstractOpen surgery remains the mainstay of treatment for acute type A aortic dissection and should be offered to most patients. However, there are elderly patients in which surgical treatment may be deemed extremely high risk or futile. Endovascular treatment approaches have been applied to a small number of these patients and data are limited to case reports and small series. The application of endovascular therapies to ascending aorta is currently limited by anatomical and technical challenges posed by the dynamic motion of the ascending aorta and the proximity of vital structures to intended landing zones (aortic valve, coronary arteries, and supra-aortic branches) and lack of specially designed endografts to address these issues. While thoracic endovascular aortic repair (TEVAR) has replaced open aortic repair for a suitable lesion in distal aortic dissection, some selected patients with type A aortic dissection at high surgical may be candidates. Hence, there is potential because, in proximal (Stanford type A) dissections, 10–30% of patients are not accepted for surgery, and 30–50% are technically amenable for TEVAR. Recent experience has shown that carefully selected patients with favorable anatomical characteristics may be subject to endovascular stent-graft treatment as a last resort with mixed results. Technical improvement is necessary to offer. satisfactory endovascular options in non-surgical candidates.

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