Dissection Surgery Research Articles

One-Year Functional Outcome of Patients After Surgery for Acute Stanford Type AAortic Dissection.

Our aim was to report the functional outcome of Stanford type A aortic dissection (TAAD) after 1 year as well as morbidity and mortality. This is a retrospective analysis including 642 patients with TAAD from January 2005 to December 2021. Mean age at TAAD was 62 years (95% CI, 61-63), and 30% of the population were women. One year after surgery for TAAD, 75% of patients were living at home with New York Heart Association functional class I. No patients were observed with New York Heart Association functional class IV. Less than 2% resided in an assisted-living facility. Eighty-five percent of nonretired patients had returned to work. Two hundred twelve (33%) patients were retired after 1 year at a mean age of 73 years (95% CI, 72-74). Stroke (defined as any kind of neurological symptoms) occurred in 148 (23%) patients and was the cause of death in 33 patients. Of the remaining patients with stroke, 115 (30%) had no residual limitations 1 year after TAAD. The cross-clamp time was significantly higher in patients with stroke (98 minutes [95% CI, 94.0-101.1] in patients without stroke versus 106 minutes [95% CI, 98.5-114.1] in patients with stroke; P=0.026). Sixty-nine percent of patients with stroke lived at home, 28% lived at home with support, and 3% lived in an assisted-living facility. One year after stroke, 77% of the patients achieved a modified Rankin Scale score ≤2, whereas no patient had a modified Rankin Scale score of 5. There was no significant correlation between sex and recovery rate (P=0.48). However, experiencing a stroke significantly increased the likelihood of residing in an assisted-living facility or receiving support at home 1 year after TAAD (odds ratio, 9.46 [95% CI, 5.06-17.70]; P<0.001). Thirty-day mortality was 11.8%, and 92 patients (14%) died within the first year after TAAD. There was no significant sex difference in mortality (P=0.101). One year after surgery for Stanford acute type A aortic dissection, almost 3 out of 4 patients lived unassisted at home. Stroke survivors have a favorable outcome, with the majority having mild or no residual neurological deficits at 1 year.

Survival outcomes after surgery for type-a aortic dissection: a contemporary Dutch nationwide registry study.

To describe the nationwide survival outcomes after surgery for type-A dissection (TAAD). All patients who underwent surgery for TAAD in the Netherlands between 2018 and 2021 were identified in the Netherlands Heart Registration (NHR) database. The NHR data were linked to lifelong survival data from Statistics Netherlands (98% match). Time trends for in-hospital and mid-term mortality were described, and age- and sex-adjusted regression analysis was performed. The cause and location of death were reported and stratified according to survival time intervals. The study population consisted of 1317 patients with a mean age of 63.1 years (11.8). The number of surgeries increased from 284 in 2018 to 375 in 2021. The surgery included the ascending aorta in 99%, aortic arch in 73%, aortic root in 32.5% and the descending aorta in 5% of cases. In-hospital mortality decreased from 20.4% in 2018 to 13.9% (95% CI) in 2021. A total of 318 deaths were recorded and the majority (70%) of patients died from the consequences of their dissection. However, among 365-day survivors, only 14% died related to their dissection, while 37% of deaths were related to cardiovascular disease and 17% to cancer. The majority (84%) of patients died in the hospital but deaths after 365 days occurred most frequently (37%) at home. Over the recent years, the number of surgeries for type-A dissections in the Netherlands has increased and in-hospital mortality has decreased. For patients surviving one year after surgery, the main cause of death was not dissection, but other causes such as cardiovascular disease or cancer.

Surgical intervention patterns and long-term survival of bicuspid aortic valve patients: community-based versus tertiary-referral cohorts

Abstract Background Bicuspid aortic valve(BAV) disease carries a cumulative lifetime morbidity &amp;gt;80%. This morbidity includes surgery for aortic valve dysfunction, aortic dilatation, infective endocarditis, and aortic dissection. This study assessed surgical intervention patterns for BAV-related morbidity and long-term survival of these patients in a community-based cohort versus a tertiary referral cohort. Methods The tertiary-referral cohort included all patients with BAV-related surgeries across Mayo Clinic sites (Arizona, Florida, and Minnesota), from January 1990 to May 2024. The community-based cohort included all patients with BAV-related surgeries in Olmsted County, Minnesota, from January 1980 to May 2024. The tertiary-referral cohort comprised 2529 BAV patients of which 991(39%) [mean age 53±15 years, 76% males] underwent aortic valve surgery(AVR), aorta surgery, or a combination thereof, while the community-based cohort included 652 BAV patients of whom 262(40%) [mean age 43±20 year, 70% males] had the mentioned interventions. Cumulative survival was calculated by Kaplan-Meier method compared to the U.S population. Statistical significance was evaluated using one-sample log rank statistics. Results In the tertiary-referral cohort, 530/991(54%) patients underwent isolated AVR, 62/991(6%) had isolated aortic surgery, and 399(40%) underwent combined procedures. In the community-based cohort, 179/262(68%) patients underwent isolated AVR, 30/262(11%) underwent isolated aortic surgery, and 53(21%) had combined surgeries. In the tertiary-referral cohort, 940 patients underwent AVR; 57% for aortic stenosis(AS), 29% for aortic regurgitation(AR), 13% for mixed valvular disease, and 1% for endocarditis. In comparison, in the community-based cohort, 236 patients underwent AVR for AS in 71%, AR 20%, mixed valvular disease 7%, and endocarditis 2%. In the tertiary-referral cohort, 459 patients underwent aortic surgery; 21% for the root, 69% for the ascending aorta, 1% for the arch, &amp;lt;1% for aortic dissection, and 8% for coarctation repair. In comparison, 105 patients from the community-based cohort underwent aortic surgery; 33% for the root, 44% for the ascending aorta, 1% for the arch, 4% for aortic dissection and 18% coarctation repair. Compared to age- and sex-matched U.S. population, the relative risk for all cause death in the tertiary-referral cohort was 0.89 [95% CI: 0.70-1.11, p=0.35], whereas in the community-based cohort was 1.06 [95% CI: 0.85-1.32, p=0.57](Figure1). Conclusion Surgical intervention patterns were similar for community and tertiary BAV cohorts, with most patients undergoing isolated AVR or AVR plus aortic surgery, and isolated aortic surgery being uncommon. AVR indications were driven by AS, followed by AR and mixed valvular disease. Aortic surgery indications were driven by ascending aorta dilatation, followed by root dilatation and coarctation. Survival in both cohorts was similar to the U.S. general population.

Challenging sacred cows: does left ventricle end-systolic and end-diastolic diameter change significantly in long term follow up of patients with severe aortic regurgitation ?

Abstract Background American and European valvular heart disease guidelines suggest considering aortic valve surgery in patients with severe aortic regurgitation (AR) and progressive increase in left ventricle (LV) end diastolic diameter (LVEDD) into the severe range or progressive decrease in LV function. Surprisingly, there are almost no studies that actually examined systematically the rate of change over time in these widely used parameters in clinical practice in patients with severe AR. Purpose determine the rate of change in LVEDD, left ventricular end systolic diameter (LVESD) and fractional shortening (FS) in patients with significant AR over a long period of time. Methods we considered all consecutive patients with at least moderate to severe AR on index transthoracic echo study and at least four subsequent echo studies over a follow-up period longer than 1.5 years in a large tertiary hospital registry between April 1994 and April 2024. Exclusion criteria were concomitant greater than mild to moderate aortic stenosis or mitral valve disease, aortic dissection, previous aortic or mitral surgery, hypertrophic cardiomyopathy or complex congenital heart disease on index study. Aortic valve replacement (AVR) or death terminated follow-up in this study. Partial correlation corrected for repeated measures was determined for LVEDD/LVESD/FS and interval period (in days) between repeat studies. Results We included a cohort of 140 patients meeting the inclusion criteria study after excluding 31 patients as per above criteria. Aortic valve was bicuspid in 39 (27.9%) of the patients, and unicuspid in 4 (2.9%) patients. Median follow-up was 4.4 years (interquartile range (IQR) 1.9 to 8.8 years), median interval between consecutive studies was 255 days (IQR 172 to 367 days), 35 (25%) patients died and 61 (43.6%) patients underwent AVR. Partial correlation coefficients and p values for LVEDD, LVESD, and FS were respectively -0.3 (p&amp;lt;0.0001), -0.032 (p=0.24), and -0.18 (p&amp;lt;0.001). Conclusions Contrary to conventional wisdom, we didn’t find a significant trend of dilatation in left ventricular end diastolic and end-systolic LV diameter in patients with ≥ moderate to severe AR over a long follow-up, but a weak trend of fractional shortening decrease over time was noted. These findings cast doubt on the utility attributed to change in these parameters as part of the routine clinical follow up of patients with significant AR. LVEDD and LVESD change over time

Lingual Artery Identification for Ligation in Neck Dissection and Transoral Surgery for Oropharyngeal Tumors.

Transoral robotic surgery (TORS) and transoral laser microsurgery (TOLM) plus neck dissection are viable alternatives to radiotherapy as a treatment modality in select cases of oropharyngeal squamous cell carcinoma. Many centers advocate for elective ligation of the feeding arteries at index neck dissection prior to TORS/TOLM to mitigate the risk of catastrophic perioperative hemorrhage. Although there are multiple cadaveric studies in the literature to identify the lingual artery at multiple points throughout its course, there are no studies on the intraoperative identification of the lingual artery for elective ligation prior to TORS/TOLM. A retrospective review of all patients undergoing neck dissection with vessel ligation prior to TORS. Lingual artery was identified at its origin, and relation to hypoglossal nerve was recorded. Patient demographics, intraoperative findings including the relation between lingual artery and hypoglossal nerve measured in millimeters, and postoperative complications were extracted from medical records. Of the 33 cases eligible for this study, the lingual artery was identified directly deep to the hypoglossal nerve in 21 cases (63.6%). Of the remaining cases, seven were within 5 mm inferior to the hypoglossal nerve (21.2%), and only two cases (6.1%) were identified superior to the hypoglossal nerve. The hypoglossal nerve is a useful landmark for the intraoperative identification of the lingual nerve in elective neck dissection prior to TORS. The lingual artery can be identified either immediately deep to or within 5 mm inferior to the hypoglossal nerve in majority of cases. 4 Laryngoscope, 2025.

Endoscopic transfacet Decompression for Severe Lumbar Spinal Stenosis: A Technical Note, Illustrative Clinical Series, and Surgeon Survey Regarding Post-Decompression Instability

Background: Lumbar spinal stenosis (LSS) remains a predominant cause of debilitating back and leg pain, affecting many aging populations. Traditional decompression surgeries can be invasive and pose significant risks and recovery time. This study elucidates the techniques and preliminary outcomes of endoscopic transfacet decompression in treating severe LSS. Methods: A retrospective review was performed on 65 patients with severe LSS who underwent endoscopic transfacet decompression. The patient outcomes were analyzed using the VAS for leg pain and the modified Macnab criteria. Pre-operative and post-operative scores were compared, and any complications were analyzed. An online survey was administered to 868 surgeons using Likert-scale ratings to evaluate surgeons’ experience with endoscopic decompression in patients with painful spondylolisthesis. The survey responses were analyzed using descriptive statistics and Polytomous Rasch analysis to evaluate surgeon endorsement. Results: The study included 65 patients, of which 29 (44.6%) were female and 36 (55.4%) were male, with a mean age of 65.79 ranging from 38 to 84 years. The available mean post-operative follow-up period was 31.44 months, ranging from 24 to 39 months. The VAS score for leg pain reduced significantly from pre-operative 7.54 ± 1.67 to 2.20 ± 1.45 by 5.34 ± 2.03 (p &lt; 0.001) with a large effect size (Cohen’s d = 2.626). At the final follow-up, functional Macnab outcomes were reported as excellent by 20 (30.8%), good by 37 (56.9%), fair by 5 (7.7%), and poor by 3 (4.6%) of patients. There were no incidental durotomies, nerve root injuries, wound complications, or instances of post-operative instability. Only five patients (7.7%) developed post-operative dysesthesia. Incomplete decompression led to fair and poor outcomes in 8 (12.3%) patients. No revision surgeries were performed. post-operative instability was not observed. The surgeon survey corroborated these observations, where the polytomous Rasch analysis showed consensus on the effectiveness of the percutaneous endoscopic decompression of low-grade spondylolisthesis. Differential item functioning (DIF) analysis showed no significant bias in item responses between orthopaedic and neurosurgeons. Conclusions: The endoscopic transfacet decompression technique delineated herein showcased excellent Macnab outcomes in managing severe LSS, with a combined success rate of 87.7%. Patients also experienced a statistically significant reduction in leg pain. Dysesthesia rates were lower than with the transforaminal approach, likely because of limited exiting and traversing nerve root manipulation. This technique might represent a viable, less invasive alternative to open microsurgical dissection and decompression for patients with severe LSS, where fusion may be required. This approach was found to be highly accepted among endoscopic spine surgeons.

Machine Learning Model for Risk Stratification of Papillary Thyroid Carcinoma Based on Radiopathomics.

This study aims to develop a radiopathomics model based on preoperative ultrasoundand fine-needle aspiration cytology (FNAC) images to enable accurate, non-invasive preoperative risk stratification for patients with papillary thyroid carcinoma (PTC). The model seeks to enhance clinical decision-making by optimizing preoperative treatment strategies. A retrospective analysis was conducted on data from PTC patients who underwent thyroidectomy between October 2022 and May 2024 across six centers. Based on lymph node dissection outcomes, patients were categorized into high-risk and low-risk groups. Initially, a clinical predictive model was established based on the maximum diameter of the thyroid nodules. Radiomics features were extracted from preoperative two-dimensional ultrasound images, and pathomics features were extracted from 400x magnification H&E-stained tumor cell images from FNAC. The most predictive radiomics and pathomics features were identified through univariate analysis, Pearson correlation analysis and LASSO algorithm. The most valuable radiopathomics features were then selected by combining these predictive features. Finally, machine learningwith the XGBoost algorithm was employed to construct radiomics, pathomics, and radiopathomics models. The performance of the models was evaluated using the area under the curve (AUC), decision curve analysis, accuracy, specificity, sensitivity, positive predictive value, and negative predictive value. A total of 688 PTC patients were included, with 344 classified as intermediate/high-risk and 344 as low-risk. The multimodal radiopathomics model demonstrated excellent predictive performance, with AUCs of 0.886 (95% CI: 0.829-0.924) and 0.828 (95% CI: 0.751-0.879) in two external validation cohorts, significantly outperforming the clinical model (AUCs of 0.662 and 0.601), radiomics model (AUCs of 0.702 and 0.697), and pathomics model (AUCs of 0.741 and 0.712). The radiopathomics model exhibits significant advantages in accurately predicting preoperative risk stratification in PTC patients. Its application is expected to reduce unnecessary lymph node dissection surgeries, optimize treatment strategies, and improve therapeutic outcomes.

The optimal annual case volume for acute type A aortic dissection surgery in relation to long-term outcomes.

Previous analyses of the volume-outcome relationship have focused on short-term outcomes such as early mortality. The current study aims to update a novel statistical methodology, facilitating the evaluation of the relation between procedural volume and time-to-event outcomes such as long-term survival, using surgery for acute type A aortic dissection as an illustrative example. This study employed an existing dataset of type A dissection outcomes, retrieved from literature. Studies were included when reporting on annual case load and long-term survival, which served as the primary outcome of interest. Individual patient data were reconstructed from the included studies, and a hazard ratio was determined per study in relation to overall survival, after which the calculated hazard ratios were incorporated in a restricted cubic spline model, facilitating the application of the elbow-method. Fifty-two studies were included (n = 14878 patients), with a median follow-up of 5 years. One-, 3-, 5-, and 10-year survival of the overall cohort were 82% (95% CI 82-83%), 79% (95% CI 78-80%), 74% (95% CI 74-75%), and 60% (95% CI 59-62%) respectively. A significant non-linear volume-outcome relation for long-term survival was observed in both the unadjusted and adjusted analyses (p = 0.030 and p = 0.002), with an optimal annual case load of 32 cases/year (95% CI 31-33). Based on the available data, these findings imply that the annual case volume to achieve optimal long-term survival is located near a procedural volume of 32 cases/year. After accrual of more annual procedures, long-term survival may no longer significantly improve any further.

Potassium titanyl phosphate laser resection of tongue T1/T2 squamous cell carcinoma - a cross-sectional study of quality of life and nutritional outcomes.

Increasing emphasis has been placed on measurement of quality of life (QOL) as a central criterion for assessment of success of any medical treatment. The aim of our study was to assess the nutritional and quality of life of patient-reported outcomes among patients who have undergone laser resection of tongue cancer. A cross-sectional study was undertaken of patients treated with KTP laser resection of T1/T2 tongue squamous cell carcinoma (SCC) between 2011-2019. University of Washington Quality of life 4 questionnaire (UW-QOL) and the abridged scored patient-generated subjective global assessment (AB PG-SGA) were used. Scores were correlated to analyse the QOL and nutritional status. 20 patients participated and were categorised into three groups based on AB PG-SGA score. The physical and social-emotional QOL scores were higher for patients who had a better nutritional status. There was a linear negative correlation between the AB PG-SGA score, physical and social-emotional domains of the QOL. No association was found between histopathological differentiation, neck dissection surgeries and the AB PG-SGA score. The use of the KTP laser to excise tongue T1 and T2 SCC yields acceptable results in terms of QOL and patient-reported nutritional outcomes. There is a significant trend identifying that as a patient's nutritional status improves quality of life is enhanced and vice versa. The QOL and the nutritional status of patients were not affected by the different histopathological grades of SCC or whether they had undergone a neck dissection or not.

Protective effect of ulinastatin against negative inflammatory response and organ dysfunction in acute aortic dissection surgery: The PANDA trial.

Ulinastatin is a protease-inhibiting drug with anti-inflammatory and other pharmacological properties. Little is known regarding its role following acute type A aortic dissection (ATAAD) surgery. We perform a randomized controlled trial to investigate the protective effect of ulinastatin against negative inflammatory response and organ dysfunction in ATAAD surgery (PANDA). The primary outcome of mean daily Sequential Organ Failure Assessment (SOFA) score from baseline to 7days of surgery is 8.80 (SD, 4.11) in the ulinastatin group and 8.61 (SD, 4.47) in the control group (mean difference between groups was 0.04; 95% confidence interval [CI], -0.24 to 0.33; p= 0.765). Systemic inflammatory response syndrome (SIRS) within 7days of surgery is lower in the ulinastatin group than in the control group (p<0.001). Additional ulinastatin to standard treatment is likely to reduce SIRS rates instead of preventing organ dysfunction, highlighting the potential importance of the benefits of anti-inflammatory pharmacotherapeutics. The trial is registered on clinicaltrials.org (NCT04711889).

Unveiling the role of risk factors and predictive models in acute type-a aortic dissection surgery: OI downregulation and its association with immune disorders.

Background and Objective: Acute type A aortic dissection (ATAAD) represents a critical and life-threatening condition requiring urgent surgical intervention, which is often life-saving. However, postoperative acute lung injury (ALI) has emerged as a prominent complication that significantly impacts patient outcomes and prognosis. This study aims to systematically analyze the risk factors associated with the development of severe ALI following ATAAD surgery, providing insights to improve postoperative management strategies. Methods: A retrospective analysis was conducted using a comprehensive database comprising 483 patients diagnosed with ATAAD. Patients were stratified into two groups based on the severity of postoperative ALI: severe ALI group (n = 182) and non-severe ALI group (n = 301). Clinical data were systematically collected and compared between the two cohorts. Binary logistic regression analysis was employed to identify independent predictors of severe ALI following ATAAD surgery. The diagnostic accuracy of these risk factors was assessed using receiver operating characteristic (ROC) curve analysis, with the area under the curve (AUC) serving as the metric for prognostic performance. Results: The severe ALI group exhibited a higher prevalence of preoperative oxygenation index (OI) ≤ 200 mmHg, smoking history, and coronary artery disease compared to the non-severe ALI group (P < 0.001, P = 0.032, and P = 0.039, respectively), while the prevalence of Marfan syndrome was lower (P = 0.033). Moreover, significant differences were observed in several clinical and intraoperative parameters, including body mass index (BMI), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, white blood cell count (WBC), aortic cross-clamp time, moderate hypothermic circulatory arrest (MHCA) time, cardiopulmonary bypass (CPB) duration, and ICU length of stay (all P < 0.05). Multivariate logistic regression identified preoperative OI [P = 0.008, OR (95% CI): 0.002 (0.000-0.183)], BMI [P = 0.037, OR (95% CI): 1.569 (1.027-2.397)], CRP [P = 0.022, OR (95% CI): 1.292 (1.037-1.609)], D-dimer [P < 0.001, OR (95% CI): 3.841 (1.820-8.108)], MHCA time [P = 0.001, OR (95% CI): 3.306 (1.670-6.544)], and CPB duration [P = 0.017, OR (95% CI): 1.117 (1.020-1.223)] as independent predictors of severe ALI. ROC curve analysis revealed the diagnostic performance of preoperative OI, BMI, CRP, D-dimer, MHCA time, and CPB duration, with AUC values of 0.715, 0.844, 0.871, 0.955, 0.944, and 0.833, respectively (all P < 0.001). Conclusion: Preoperative oxygenation index, BMI, CRP, D-dimer levels, MHCA time, and CPB duration are independent risk factors for the development of severe ALI following ATAAD surgery. These findings underscore the importance of preoperative risk assessment and perioperative optimization to mitigate the risk of severe ALI and improve patient outcomes.

Stroke protection during surgery for Acute Aortic Dissection beyond preoperative hematocrit

Stroke protection during surgery for Acute Aortic Dissection beyond preoperative hematocrit

Effect of dexmedetomidine on postoperative delirium in patients undergoing type A aortic dissection surgery: a prospective cohort study

Effect of dexmedetomidine on postoperative delirium in patients undergoing type A aortic dissection surgery: a prospective cohort study

Presença de anormalidades anatômicas na eminência arqueada do osso temporal: um estudo em cadáveres

ABSTRACT Introduction: the arcuate eminence (AS) is an important anatomical repair to demarcate the location of the superior semicircular canal (SSC) during surgeries with access through the middle cranial fossa. However, its use has been questioned in the literature due to its varied presentation and questionable relationship with CSS. Objective: to elucidate the topography of the arcuate eminence and observe the presence of anatomical changes and/or variations in this structure. Methodology: this is a cross-sectional study developed from the open dissection of adult cadaver heads. All anatomical measurements were performed with the aid of a digital carbon fiber caliper with an accuracy of 0.1 mm. Results: the study consisted of the analysis of 40 antimeres from 20 specimens. It was possible to identify EA in 92.5% of these pieces and no CSS dehiscence was observed in any of the pieces studied. The distance from EA to cranial vault was on average 25.66mm with a standard deviation of ± 4.6; from the EA to the internal carotid arteries was 47.12mm with a standard deviation of ± 4.2 and from the EA to the internal auditory canal the distance was 18.23mm, with a standard deviation of ± 2.6. Conclusion: EA is a structure with varied presentation, such that an individualized and detailed preoperative study is necessary for a correct and safe surgical technique. CSS dehiscence is a rare variation that requires local studies on its prevalence.

Personalized Mobile App-Based Program for Preparation and Recovery After Radical Prostatectomy: Initial Evidence for Improved Outcomes From a Prospective Nonrandomized Study.

eHealth can help replicate the benefits of conventional surgical prehabilitation programs and overcome organizational constraints related to human resources and health care-related costs. We aimed to assess the impact of an optimized perioperative program using a personalized mobile app designed for preparation and recovery after radical prostatectomy (RP). We report on a series of 122 consecutive robot-assisted RP before and after the implementation of the betty.care app (cohort A: standard of care, n=60; cohort B: optimized program, n=62). The primary end point was continence recovery, defined as "0 or 1 safety pad per day" at 6 weeks after surgery. Secondary end points were length of stay, same-day discharge, complications, readmissions, and number of days alive and out of hospital within 30 days from surgery. Both cohorts were comparable in terms of age, prostate-specific antigen, prostate volume, and disease aggressiveness. Intraoperative parameters (lymph node dissection, operative time, and bilateral nerve-sparing surgery) were comparable in both groups, except for blood loss, which was significantly higher in cohort B (182 vs 125 cc; P=.008). The 6-week continence rate was improved in cohort B in both univariable and multivariable analyses (92% vs 75%; P=.01). There were trends favoring cohort B for all secondary end points with a minimal 30% benefit compared with cohort A. Grade 2 or more complications occurred less frequently in cohort B (13% vs 3.2%; P=.042). Same-day discharge and readmission rates were 35% and 53% (P=.043), and 3.3% and 1.6% (P=.54) in cohorts A and B, respectively. Mean length of stay was reduced by 0.2 days in cohort B (0.58 vs 0.78 days; P=.10). The main limitation was the absence of randomization. The implementation of a mobile app that provides a holistic approach to the perioperative period, integrating prehabilitation, rehabilitation, and remote monitoring, could lead to the improvement of important functional outcomes after RP and could replicate an on-site prehabilitation program. Multicenter validation is needed.

What Is the Efficacy of Bilateral Antegrade Cerebral Perfusion in Cerebral Protection?

Background/Objectives: Acute type A aortic dissection is among the many types of catastrophic cardiovascular emergencies. The development of serious morbidity, especially neurological complications after the operation, remains a huge threat. We aimed to present comparatively the results of using unilateral or bilateral antegrade cerebral perfusion to minimize these threats and to demonstrate the postoperative effects of antegrade cerebral perfusion choices. Methods: The 147 patients who underwent emergency acute type A aortic dissection surgery between January 2018 and January 2023 were evaluated retrospectively. The patients were divided into two groups: those who underwent unilateral antegrade cerebral perfusion (Group 1) (n = 89) and those who underwent bilateral antegrade cerebral perfusion (Group 2) (n = 59). Baseline demographics, and preoperative, operative, and postoperative data of patients were compared statistically. Results: When the analyses of baseline demographics, and preoperative and operative data were evaluated, no significant difference was found between the groups. In addition, when comparing postoperative results, no statistical difference was found between the groups except for new-onset permanent neurological complications. The rate of postoperative new-onset permanent neurological complications was found to be 17.9% in group 1, where unilateral antegrade cerebral perfusion was applied, and 5.1% in group 2, where bilateral antegrade cerebral perfusion was applied, and this comparison was statistically significant. Conclusions: The competence of the Willis Polygon should not be relied upon without any evidence, and we believe that bilateral antegrade cerebral perfusion can be performed with a technique that does not compromise surgical comfort.

A Review of the Literature on Videoscopic and Robotic Inguinal-Iliac-Obturator Lymphadenectomy in Patients with Cutaneous Melanoma.

Inguinal-iliac-obturator lymph node dissection is essential in the treatment of patients with cutaneous melanoma exhibiting the clinical or radiological involvement of pelvic lymph nodes. The open procedure is associated with elevated mortality rates. Numerous minimally invasive approaches have been suggested to mitigate the impact of this surgery on the patient's quality of life. The preliminary findings of robotic-assisted dissection have been documented in the literature. They demonstrate a decrease in potential issues linked to robotic-assisted treatments as compared to open or video laparoscopic methods. No implications have been reported for long-term oncological outcomes. The present study compares the outcomes in 64 patients with robotic procedures, 187 with videoscopic procedures, and 83 with open pelvic lymph node dissection (PLND). However, the quality of evidence is too low to draw any valid conclusions. The available literature shows that a robotic procedure is feasible and has similar complication rates and oncological outcomes to other methods. The reason for the shorter operative time is not clear, but is associated with lower hospital costs. It is probable that, from a surgeon's point of view, robotic techniques offer several advantages over videoendoscopic techniques, such as three-dimensional imaging, ergonomic control, and tools that mimic human hand movements. Randomized controlled trials are necessary to validate the benefits of robotic inguinal-iliac-obturator lymph node dissection (RIIOL) compared to videoscopic and open procedures, but the recruitment rate is very low because of the restricted indications for lymph node dissection against the background of the continuously evolving system of therapy.

Application of Bilateral Cerebral Perfusion + Balloon Occlusion of Descending Aorta + Antegrade Perfusion of Lower Body in Debakey Type I Aortic Dissection.

To evaluate the efficacy of a new perfusion method in DeBakey Type I aortic dissection surgery, with the goal of enhancing thorough organ protection and optimising patient outcomes. Descriptive study. Place and Duration of the Study: Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of the University of South China, from January 2020 to December 2021. Thirty-two patients undergoing total aortic arch replacement with descending aortic stenting were included in the study. The new perfusion method involved a combination of bilateral selective cerebral perfusion, descending aortic balloon occlusion, and antegrade lower body perfusion. Lower limb ischaemic complications and mortality rate were the main outcome measures. Surgical procedures and patient data were collected and analysed. No cases of paraplegia, intestinal necrosis, or lower-limb ischaemia were observed. The new perfusion method effectively protected lower-body organs, with a short duration of lower-body ischaemia during surgery. The overall mortality rate was 3.13%, and postoperative complications were minimal, resulting in satisfactory survival rates. The combination of perfusion techniques, including bilateral selective cerebral perfusion, descending aortic balloon occlusion, and anterograde lower body perfusion, proved effective in improving the outcomes for DeBakey Type I aortic dissection surgery. Further research is needed to confirm the long-term benefits of this approach. DeBakey type I aortic dissection, Descending aortic balloon blockade, Lower body anterograde perfusion, Bilateral selective cerebral perfusion.

A Systematic Approach to Reduce Blood Transfusions in Acute Type A Aortic Dissection Surgery

This study aimed to summarize our experience using a systematic approach to reduce blood transfusions in acute type A aortic dissection (ATAAD) surgery.From August 2016 to June 2020, 326 patients underwent ATAAD surgery in our center employing a systematic approach, which primarily included the following: Liu's aortic root repair technique, Liu's aortic arch inclusion technique with a frozen elephant trunk, moderate-to-mild hypothermia circulatory arrest, and application of centrifugal pump in cardiopulmonary bypass circuit. Patients were divided into two groups based on whether they had blood product transfusion during their hospital stay: transfusion group and transfusion-free group. Preoperative, intraoperative, and postoperative outcomes were compared between the 2 groups.In the transfusion group, 152 patients were included, and in the transfusion-free group, 174 patients were involved; the transfusion-free rate was 53.37%. Patients in the transfusion group were significantly older than those in the transfusion-free group, and there were more patients with preoperative anemia and malperfusion in the transfusion group. Overall in-hospital mortality was 5.21% (17/326), with 3 mortalities (1.72%) in the transfusion-free group and 14 mortalities (9.21%) in the transfusion group (P = 0.0025). At tested time points, the Hb levels of patients between the 2 groups were similar.In ATAAD patients, the transfusion group showed significantly older patient age, more incidences of preoperative anemia and malperfusion, and higher in-hospital mortality than the transfusion-free group. Through Liu's systematic approach, ATAAD surgery can be achieved and safely carried out in ATAAD patients without blood product transfusion in selected patients.

Abstract 4140120: Artificial intelligence-driven morbidity prediction in acute kidney injury after acute type A aortic dissection surgery

Background: Acute kidney injury (AKI) often complicates acute type A aortic dissection (ATAAD), with elevated comorbidity rates and a significant tie to in-hospital mortality. Identifying risk factors early can mitigate AKI severity. Research Questions: This research endeavors to develop and corroborate predictive models leveraging Machine Learning (ML) techniques from Artificial Intelligence to forecast AKI occurrences in ATAAD-afflicted individuals. Methods: The study employed various machine learning (ML) algorithms including Gradient Boosting Machine (GBM), LightGBM, Random Forest (RF), K-Nearest Neighbors (KNN), Multi-Layer Perceptron Neural Network (MLP-NN), Naive Bayes (NB), Logistic Regression (LR), and ensemble methods (combining LR&amp;LightGBM), employing tenfold cross-validation. Model performance was evaluated using SHapley Additive exPlanations (SHAP). A web-based tool for predicting AKI incidence was developed using Streamlit, based on the most effective model. The analysis involved 1350 ATAAD patients, among whom 586 (43.4%) developed post-operative AKI. Patients were divided into two cohorts: 85% for training and 15% for testing, with 126 features included in the predictive model. Results: Incorporating top 10 features, LightGBM (AUROC=0.886, 95% CI 0.841-0.930) excelled in predictive accuracy, calibration, and clinical utility, identifying key factors such as ventilation time in ICU, hourly urine output post-surgery, diuretic use, Scr, heart rate, urea, administration of recombinant human brain natriuretic peptide and ebrantil, MCHC, and blood glucose as associated with ATAAD-AKI. Conclusion(s): These ML models are robust tools for predicting AKI in ATAAD patients, with LightGBM's superior predictive ability standing out. They offer valuable support for clinical decision-making in ATAAD management, helping optimize postoperative strategies to minimize AKI occurrence after surgery.