Surgical Treatment Of Aortic Dissection Research Articles

Association of the high-sensitive cardiac troponin T levels and long-term mortality in patients with acute aortic dissection type A.

Acute aortic dissection type A is a life-threatening cardiovascular emergency necessitating rapid diagnosis and treatment. We sought a new prognostic tool with cardiac biomarkers and simple inflammatory factors. from 2003 to 2014, 50 patients with documented acute aortic dissection type A were entered to this study. These patients were followed up until December 2020; within median follow up of 93.6 months. The patients were evaluated on the association of the baseline characteristics, first laboratory investigation, echocardiographic findings, surgical approach, and long-term mortality. Total number of mortality during the follow up was 29 (58%) patients, which was significantly higher in medical group (89.4% vs 38.7%, P value=0.001). Multivariable analysis showed only an increase in hs-cTnT levels was suggested as a predictor of mortality (95% CI: 1.06-1.38; HR=1.21; P=0.005), so that for every 100 units increase, patients were 21% more likely to have mortality in long term. Also, performing surgical treatment for aortic dissection was determined as the independent predictor of surviving, so that death was 74.6% less than those who received medical treatment (95% CI: 0.13-0.58; HR=0.27; P=0.001). hs-cTnT is a potential predictor of mortality in patients with acute aortic dissection type A.

Use and safety of aprotinin in routine clinical practice: A European postauthorisation safety study conducted in patients undergoing cardiac surgery.

BACKGROUNDAprotinin has been used to reduce blood loss and blood product transfusions in patients at high risk of major blood loss during cardiac surgery. Approval by the European Medicines Agency (EMA) for its current indication is limited to patients at high risk of major blood loss undergoing isolated coronary artery bypass graft surgery (iCABG).OBJECTIVETo report current real-world data on the use and certain endpoints related to the safety of aprotinin in adult patients.DESIGNThe Nordic aprotinin patient registry (NAPaR) received data from 83 European centres in a noninterventional, postauthorisation safety study (PASS) performed at the request of the EMA.SETTINGCardiac surgical centres committed to enrolling patients in the NAPaR.PATIENTSPatients receiving aprotinin agreeing to participate.INTERVENTIONThe decision to administer aprotinin was made by the treating physicians.MAIN OUTCOME MEASURESAprotinin safety endpoints were in-hospital death, thrombo-embolic events (TEEs), specifically stroke, renal impairment, re-exploration for bleeding/tamponade.RESULTSFrom 2016 to 2020, 5309 patients (male 71.5%; >75 years 18.9%) were treated with aprotinin; 1363 (25.7%) underwent iCABG and 3946 (74.3%) another procedure, including a surgical treatment for aortic dissection (n = 660, 16.7%); 54.5% of patients received the full-dose regimen. In-hospital mortality in iCABG patients was 1.3% (95% CI, 0.66 to 1.84%) vs. 8.3% (7.21 to 8.91%) in non-iCABG patients; incidence of TEEs and postoperative rise in creatinine level greater than 44 μmol l−1 2.3% (1.48 to 3.07%) and 2.7% (1.79 to 3.49%) vs. 7.2% (6.20 to 7.79%) and 15.5% (13.84 to 16.06%); patients undergoing re-exploration for bleeding 1.4% (0.71 to 1.93%) vs. 3.0% (2.39 to 3.44%). Twelve cases of hypersensitivity/anaphylactic reaction (0.2%) were reported as Adverse Drug Reactions.CONCLUSIONThe data in the NApaR indicated that in this patient population, at high risk of death or blood loss undergoing cardiac surgery, including complex cardiac surgeries other than iCABG, the incidence of adverse events is in line with data from current literature, where aprotinin was not used.TRIAL REGISTRATIONEU PAS register number: EUPAS11384.

Aortic remodeling and competitive flow after surgical treatment of aortic dissection

Aortic remodeling after dissection is poorly understood and remains a focus of current research. In the present report, we have described the cases of two patients with acute lower extremity ischemia related to malperfusion from aortic dissection treated with extra-anatomic axillobifemoral bypass. During long-term follow-up, aortic remodeling led to reinstitution of flow through the native aorta. This resulted in competitive flow, leading to complete thrombosis of the extra-anatomic conduits. These cases highlight the occurrence of spontaneous aortic recanalization and subsequent competitive flow, two vascular phenomena that are not well understood but can significantly affect patient outcomes.

Eral carotid dissection in a patient with a previous surgical treatment for aortic dissection

eral carotid dissection in a patient with a previous surgical treatment for aortic dissection

Renal artery involvement in acute aortic dissection: Prevalence and impact on renal atrophy in non-interventional treatment patients

BackgroundTo evaluate the frequency of renal artery dissection (RAD) and renal hypoperfusion in aortic dissection (AD) and its effect on subsequent renal atrophy in patients who did not undergo therapeutic intervention. MethodsInitial CT data of 155 patients with acute AD (Stanford type A = 88, B = 67) were retrospectively analyzed. The false lumen statuses were patent (n = 94), partially thrombosed (n = 25), and completely thrombosed (n = 36) (also called as intramural hematoma (IMH)). Follow-up CT images of the surviving 122 patients (6–62.6 months, median, 28.9 months) were reviewed for analysis of sequential changes in renal volume. A regional decrease of ≧20 Hounsfield units in the renal cortex was defined as a renal hypo-enhancement sign (RHS). Simplified CT estimations of renal volume and estimated glomerular filtration rates (eGFR) were calculated. The generalized estimating equations (GEE) method was used to predict renal atrophy. ResultsFifty of the 122 patients presented with 59 RAD in the current study, and a positive RHS was noted in 33.9% (20/59) of these involved kidneys. GEE analysis showed hypertension, surgical treatment for AD, presence of RAD, and positive RHS as significant risk factors for renal atrophy. Patients with RHS had the most severe form of renal atrophy. The severity of renal atrophy was mildly correlated with GFR change (γ2 = 0.044, p < 0.001). ConclusionRenal atrophy in AD was predicted by the CT findings of RAD and RHS. The severity of renal atrophy was weakly reflected by eGFR.

Impact of connective tissue disease on the surgical outcomes of aortic dissection in patients with cystic medial necrosis

BackgroundA retrospective analysis was performed to determine the impact of genetically diagnosed connective tissue disease (CTD) on the early and late outcomes of surgical treatment for aortic dissection in patients having aortic pathology associated with cystic medial necrosis (CMN).MethodsBetween 2003 and 2013, a total of 43 patients (37 ± 12.8 years old, 23 men, 20 women) who had undergone surgery for aortic dissection associated with CMN in the aortic wall underwent genetic examinations. Subsequently, there were 30 patients with CTD (CTD group) and 13 without CTD (non-CTD group).ResultsThere were no early or late deaths (the follow-up rate was 100% for 57.1 ± 43.0 months). The median age was significantly lower in the CTD group (p = 0.030). The rate of elastic fiber loss was significantly higher in the CTD group (p = 0.014). In the long-term follow-up, there were no significant differences in the incidences of re-dissection (p = 0.332). However, re-operations were required more frequently in the CTD group (p = 0.037).ConclusionsIn patients with CTD as well as CMN, the onset of aortic dissection tends to be earlier, which would result in higher rates of re-operation, compared with the non-CTD group. Closer and stricter follow-up with medication and adequate surgical treatments with appropriate timing are mandatory for such high-risk patients.

Surgical treatment of aortic dissection with lower extremity ischemia

Objective: To explore the clinical outcome of the surgical treatment for aortic dissection with lower extremity ischemia. Methods: Between March 2009 and April 2013, 14 patients with type A aortic dissection and lower extremity ischemia underwent Sun's procedure in Beijing Anzhen Hospital. Ascending aorta-iliac artery bypass, ascending aorta-femoral artery bypass, femoral-femoral artery bypass and axillary -femoral artery bypass were performed on some severe patients at the same time. Results: Two death occurred, and the others were improved or recovered from symptoms. Follow-up was complete with an average time of 24 months and no aortic relevant complications occurred. Conclusion: As for patients with type A aortic dissection and lower extremity ischemia, simultaneous radical femoral artery bypass procedure is effective in improving their survival rate and quality of life.目的：探讨Stanford A型急性主动脉夹层合并下肢缺血的外科治疗效果。方法：回顾性分析2009年3月至2013年4月首都医科大学附属北京安贞医院心脏外科中心14例合并下肢缺血的急性A型主动脉夹层患者资料，14例患者均接受孙氏手术治疗，并同期行升主动脉－髂动脉转流、升主动脉－股动脉转流、股动脉－股动脉转流或腋动脉－股动脉转流手术。结果：术后患者死亡2例，死亡原因均为并发多器官功能障碍综合征。其余患者术后均顺利康复出院，下肢缺血症状消失或改善，术后平均随访24个月，患者无主动脉相关并发症发生。结论：对于合并下肢缺血的A型主动脉夹层患者，积极行股动脉转流术，有助于降低手术死亡发生率，提高生存率和术后生活质量。.

Surgical treatment of aortic dissection with lower extremity ischemia

Objective: To explore the clinical outcome of the surgical treatment for aortic dissection with lower extremity ischemia. Methods: Between March 2009 and April 2013, 14 patients with type A aortic dissection and lower extremity ischemia underwent Sun's procedure in Beijing Anzhen Hospital. Ascending aorta-iliac artery bypass, ascending aorta-femoral artery bypass, femoral-femoral artery bypass and axillary -femoral artery bypass were performed on some severe patients at the same time. Results: Two death occurred, and the others were improved or recovered from symptoms. Follow-up was complete with an average time of 24 months and no aortic relevant complications occurred. Conclusion: As for patients with type A aortic dissection and lower extremity ischemia, simultaneous radical femoral artery bypass procedure is effective in improving their survival rate and quality of life.

Этапное хирургическое лечение при расслоении аорты типа B с формированием аневризмы грудного отдела нисходящей аорты, аневризмы правой общей подвздошной артерии и развитием синдрома мальперфузии

Этапное хирургическое лечение при расслоении аорты типа B с формированием аневризмы грудного отдела нисходящей аорты, аневризмы правой общей подвздошной артерии и развитием синдрома мальперфузии

A technique modification in the cannulation to the innominate artery in the surgical treatment of aortic dissection

BackgroundA modified cannulation strategy to innominate artery was introduced which differs from traditional cannulation method used in aortic surgeries.Case presentationFour patients suffering from aortic dissections with or without other cardiac diseasees underwent surgical treatment by using the modified canulation technique. All patients had an uneventful perioperative period and discharged from the hospital without any complications.ConclusionsInnominate artery cannulation using the modified cannula with “a hole in the back” is an easy and effective strategy for arch surgery.

Invited Commentary

Invited Commentary

O tratamento operatório da dissecção aórtica crônica tipo A em pacientes submetidos à revascularização cirúrgica do miocárdio

Surgical treatment of aortic dissection is a challenge for the cardiac surgeon, especially in patients undergoing cardiac operations. Our objective in this case report is to demonstrate how we treat the chronic type A aortic dissection in patients revascularized using percutaneous arterial and venous cannulae.

2. Surgical Treatment of Aortic Dissection.

2. Surgical Treatment of Aortic Dissection.

Hemolytic Anemia After Operation for Aortic Dissection Using Teflon Felt Strips

We report three cases of hemolytic anemia caused by anastomotic stenosis after surgical treatment for aortic dissection in which internal and external Teflon (DuPont, Wilmington, DE) felt strips were used for reinforcement of the aortic stump. To detect this complication, laboratory findings typical of red cell fragmentation syndrome as well as appropriate imaging modalities are necessary. As a precaution, it is necessary to be meticulous when stitching the internal felt strip.

Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis in a Patient with Acute Ischemic Stroke Secondary to Aortic Dissection

BackgroundAcute ischemic stroke secondary to aortic dissection (AoD) is challenging in the era of thrombolysis owing to the diagnostic difficulty within a narrow time window and the high risk of complications.Case ReportA 64-year-old woman with middle cerebral artery occlusion syndrome admitted to the emergency room within intravenous recombinant tissue plasminogen activator (rt-PA) time window. Her neurological symptoms improved during thrombolysis, but chest and abdominal pain developed. Repeated history-taking, physical examination, and imaging studies led to the timely diagnosis and surgical treatment of AoD, which produced a successful outcome.ConclusionsClinical suspicion is invaluable for the diagnosis of this rare cause of stroke. Considering the stroke mechanism and complications, the risks of thrombolysis might outweigh its benefits.

Surgical treatment of aortic dissection. H. G. Borst, M. K. Heinemann and C. D. Stone. 286 × 220 mm. Pp. 357. Illustrated. 1996. Edinburgh: Churchill Livingstone. £90

Surgical treatment of aortic dissection. H. G. Borst, M. K. Heinemann and C. D. Stone. 286 × 220 mm. Pp. 357. Illustrated. 1996. Edinburgh: Churchill Livingstone. £90

P10-09 Surgical treatment of aortic dissection at Cheng Hsin General Hospital

P10-09 Surgical treatment of aortic dissection at Cheng Hsin General Hospital

Successful treatment of acute dissection of the donor aorta after orthotopic heart transplantation

Acute aortic dissection is one of the rare aortic complications that occur after orthotopic heart transplantation. We report the second case of successful surgical treatment of aortic dissection confined to the donor aorta in a recipient of an orthotopic cardiac allograft. A 68-year-old patient was admitted with chest pain and shortness of breath 7 years after orthotopic heart transplantation. He previously had undergone twice coronary artery bypass grafting. Echocardiography revealed acute dissection of the donor aorta. The patient underwent urgent Bentall procedure with a prosthetic conduit. The post-operative course was uneventful. The heart donor was a 40-year-old man with known arterial hypertension and who had received long-term ergotamine tartrate therapy for migraine. This case demonstrates that heart-transplant recipients with arterial hypertension and donor-related risk factors are prone to aortic complications and require careful follow-up.

Transapical aortic cannulation for acute aortic dissection with diffuse atherosclerosis

Transapical aortic cannulation for acute aortic dissection with diffuse atherosclerosis

Glue aortoplasty repair of aortic dissection after coronary angioplasty

Aortic dissection complicating percutaneous transluminal coronary angioplasty is rare. We report the case of a 45-year-old man who after right coronary artery angioplasty with stenting, dissected that vessel to involve the aorta to the bifurcation. Surgical repair with Gelatin-Resorcinol-Formaldehyde (GRF) glue as opposed to prosthetic graft replacement of the ascending aorta was successful. The use of GRF glue is effective in the surgical treatment of aortic dissection after coronary angioplasty.