Mortality In Aortic Surgery Research Articles

Tranexamic acid in open aortic aneurysm surgery: a randomised clinical trial

BackgroundBleeding and transfusions affect mortality in aortic surgery. Although tranexamic acid significantly reduced bleeding in multiple settings, its role in major vascular surgery was never studied. The aim of this study was to determine if tranexamic acid reduces blood loss in open abdominal aortic aneurysm (AAA) surgery. MethodsA total of 100 patients undergoing elective open AAA repair were randomised to receive tranexamic acid (a loading dose of 500 mg and a continuous infusion of 250 mg h−1) or placebo. The primary outcome was intraoperative blood loss, and the secondary outcomes were the number of patients receiving red blood cells, occurrence of thromboembolic events, and mortality. Data were analysed using the intention-to-treat principle. ResultsFifty patients were randomised into each group. Median (inter-quartile range) intraoperative blood loss was 400 (300–1050) ml in the tranexamic acid group vs 500 (360–1000) ml in the placebo group (P=0.44). Transfusion rate was seven/50 (14%) in the tranexamic group vs 12/50 (24%) in the placebo group (P=0.20). No thrombosis was recorded. In a post hoc analysis, postoperative blood loss was reduced in the tranexamic group both at 4 h (60 [40–80] ml vs 100 [60–140] ml, P<0.001) and 24 h (180 [120–275] vs 275 [190–395] ml, P=0.003) after surgery. At 1 yr, three patients were dead, all in the placebo group (P=0.24) and all after 28 days. ConclusionsTranexamic acid did not reduce intraoperative blood loss or blood transfusions in open AAA repair, although it may reduce postoperative blood loss without increasing adverse effects. Clinical trial registrationNCT02335359.

Factors affecting neurological morbidity and early mortality in aortic surgery performed under circulatory arrest in Penang Hospital, Malaysia

safe and adds little burden to either the patient or surgeon. More investigations are needed with greater sample sizes and prospective data collection in order to truly assess the long-term efficacy of the procedure. If surgical management of AF is ever going to be a widely viable option, better postoperative management, long-term follow-up and collaboration between surgeons, cardiologists and patients is required in order to obtain the best possible outcomes. The many limitations, due to the retrospective nature of this study, highlight the merits of prospective data collection and the need for a national registry in Australia.

Penetrating atherosclerotic ulcer of the aorta: treatment by endovascular stent-graft placement.

To summarize the current clinical experience with endovascular stent-graft repair in patients presenting with penetrating atherosclerotic ulcer of the descending thoracic aorta. Penetrating atherosclerotic ulcer is increasingly acknowledged as a pathologic variant of classic false lumen aortic dissection with a high incidence of bleeding complications and rupture in up to 40% of patients. So far, no generally accepted therapeutic regimen has been established, as the natural history of penetrating atherosclerotic ulcer is not yet fully understood. Recently, however, penetrating atherosclerotic ulcer is increasingly considered to be treated more aggressively (preferentially surgically). Given the high morbidity and mortality of aortic surgery, endovascular stent-graft repair may be an attractive, less invasive alternative in selected patients with penetrating atherosclerotic ulcer. Sealing of a penetrating ulcer by the stent-graft reduces wall stress and thus provides stabilization of the diseased aortic segment. To date, there is limited experience with endovascular repair in penetrating atherosclerotic ulcer, suggesting that endovascular stent-graft repair is safe and effective. Long-term results are, however, required to fully establish the efficacy of endovascular repair in penetrating atherosclerotic ulcer.