Browsing by Subject "Aortic dissection"

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  • Jormalainen, Mikko; Raivio, Peter; Mustonen, Caius; Honkanen, Hannu-Pekka; Vento, Antti; Biancari, Fausto; Juvonen, Tatu (2020)
    Background It is controversial whether peripheral arterial cannulation may achieve better results than direct aortic cannulation during surgery for Stanford type A aortic dissection (TAAD). Methods Three-hundred and nine consecutive patients underwent surgical repair for acute TAAD from January 2005 to December 2017 at the Helsinki University Hospital, Finland. The early outcomes of patients who underwent surgery with direct aortic cannulation were compared with those in whom peripheral arterial cannulation was employed. Results Direct aortic cannulation was employed in 80 patients and peripheral arterial cannulation in 229 patients. Patients who underwent surgery with direct aortic cannulation had hospital mortality (13.8% vs. 13.5%, p=0.962) and stroke/global brain ischemia (22.3% vs. 25.0%, p=0.617) similar to those with peripheral arterial cannulation. The other secondary outcomes were equally distributed between the unmatched study cohorts. Among 74 propensity score matched pairs, direct aortic cannulation had hospital mortality (12.2% vs. 9.5%, p=0.804) and stroke/global brain ischemia rates (21.6% vs. 21.6%, p=1.000) comparable to peripheral arterial cannulation. The composite outcome of hospital mortality/stroke/global brain ischemia (29.7% vs. 27.0%, p=0.855), multiple stroke (16.2% vs. 17.6%, p=1.000), renal replacement therapy (11.8% vs. 13.0%, p=1.000) and length of stay in the intensive care unit (mean, 4.9±4.5 vs. 4.8±4.9 days, p=0.943) were also equally distributed between these matched cohorts. Conclusions In this institutional series, central arterial cannulation allowed a straightforward surgical repair of TAAD and achieved similar early outcomes to those of peripheral arterial cannulation.
  • Biancari, Fausto; Mariscalco, Giovanni; Yusuff, Hakeem; Tsang, Geoffrey; Luthra, Suvitesh; Onorati, Francesco; Francica, Alessandra; Rossetti, Cecilia; Perrotti, Andrea; Chocron, Sidney; Fiore, Antonio; Folliguet, Thierry; Pettinari, Matteo; Dell'Aquila, Angelo M.; Demal, Till; Conradi, Lenard; Detter, Christian; Pol, Marek; Ivak, Peter; Schlosser, Filip; Forlani, Stefano; Chetty, Govind; Harky, Amer; Kuduvalli, Manoj; Field, Mark; Vendramin, Igor; Livi, Ugolino; Rinaldi, Mauro; Ferrante, Luisa; Etz, Christian; Noack, Thilo; Mastrobuoni, Stefano; De Kerchove, Laurent; Jormalainen, Mikko; Laga, Steven; Meuris, Bart; Schepens, Marc; El Dean, Zein; Vento, Antti; Raivio, Peter; Borger, Michael; Juvonen, Tatu (2021)
    Background: Acute Stanford type A aortic dissection (TAAD) is a life-threatening condition. Surgery is usually performed as a salvage procedure and is associated with significant postoperative early mortality and morbidity. Understanding the patient's conditions and treatment strategies which are associated with these adverse events is essential for an appropriate management of acute TAAD. Methods: Nineteen centers of cardiac surgery from seven European countries have collaborated to create a multicentre observational registry (ERTAAD), which will enroll consecutive patients who underwent surgery for acute TAAD from January 2005 to March 2021. Analysis of the impact of patient's comorbidities, conditions at referral, surgical strategies and perioperative treatment on the early and late adverse events will be performed. The investigators have developed a classification of the urgency of the procedure based on the severity of preoperative hemodynamic conditions and malperfusion secondary to acute TAAD. The primary clinical outcomes will be in-hospital mortality, late mortality and reoperations on the aorta. Secondary outcomes will be stroke, acute kidney injury, surgical site infection, reoperation for bleeding, blood transfusion and length of stay in the intensive care unit. Discussion: The analysis of this multicentre registry will allow conclusive results on the prognostic importance of critical preoperative conditions and the value of different treatment strategies to reduce the risk of early adverse events after surgery for acute TAAD. This registry is expected to provide insights into the long-term durability of different strategies of surgical repair for TAAD.
  • Jormalainen, Mikko; Kesavuori, Risto; Raivio, Peter; Vento, Antti; Mustonen, Caius; Honkanen, Hannu-Pekka; Rosato, Stefano; Simpanen, Jarmo; Teittinen, Kari; Biancari, Fausto; Juvonen, Tatu (2022)
    OBJECTIVES: We investigated whether the selective use of supracoronary ascending aorta replacement achieves late outcomes comparable to those of aortic root replacement for acute Stanford type A aortic dissection (TAAD). METHODS: Patients who underwent surgery for acute type A aortic dissection from 2005 to 2018 at the Helsinki University Hospital, Finland, were included in this analysis. Late mortality was evaluated with the Kaplan-Meier method and proximal aortic reoperation, i.e. operation on the aortic root or aortic valve, with the competing risk method. RESULTS: Out of 309 patients, 216 underwent supracoronary ascending aortic replacement and 93 had aortic root replacement. At 10 years, mortality was 33.8% after aortic root replacement and 35.2% after ascending aortic replacement (P = 0.806, adjusted hazard ratio 1.25, 95% confidence interval, 0.77-2.02), and the cumulative incidence of proximal aortic reoperation was 6.0% in the aortic root replacement group and 6.2% in the ascending aortic replacement group (P = 0.65; adjusted subdistributional hazard ratio 0.53, 95% confidence interval 0.15-1.89). Among 71 propensity score matched pairs, 10-year survival was 34.4% after aortic root replacement and 36.2% after ascending aortic replacement surgery (P = 0.70). Cumulative incidence of proximal aortic reoperation was 7.0% after aortic root replacement and 13.0% after ascending aortic replacement surgery (P = 0.22). Among 102 patients with complete imaging data [mean follow-up, 4.7 (3.2) years], the estimated growth rate of the aortic root diameter was 0.22 mm/year, that of its area 7.19 mm(2)/year and that of its perimeter 0.43 mm/year. CONCLUSIONS: When stringent selection criteria were used to determine the extent of proximal aortic reconstruction, aortic root replacement and ascending aortic replacement for type A aortic dissection achieved comparable clinical outcomes.
  • PC-ECMO group; Mariscalco, Giovanni; Fiore, Antonio; Ragnarsson, Sigurdur; Juvonen, Tatu; Settembre, Nicla; Biancari, Fausto (2020)
    Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support for postcardiotomy cardiogenic shock (PCS) in patients undergoing surgery for acute type A aortic dissection (TAAD) is controversial and the available evidence is confined to limited case series. We aimed to evaluate the impact of this salvage therapy in this patient population. Between January 2010 and March 2018, all TAAD patients receiving VA-ECMO for PCS were retrieved from the PC-ECMO registry. Hospital mortality and other secondary outcomes were compared with PCS patients undergoing surgery for other cardiac pathologies and treated with VA-ECMO. Among the 781 patients in the PC-ECMO registry, 62 (7.9%) underwent TAAD repair and required VA-ECMO support for PCS. In-hospital mortality accounted for 46 (74.2%) patients, while 23 (37.1%) were successfully weaned from VAECMO. No significant differences were observed between the TAAD and non-TAAD cohorts with reference to in-hospital mortality (74.2% vs 63.4%, p = 0.089). However, patients in the TAAD group had a higher rate of neurological events (33.9% vs 17.6%, p = 0.002), but similar rates of reoperation for bleeding/tamponade (48.4% vs 41.5%, p = 0.29), transfusion of >= 10 red blood cell units (77.4% vs 69.5%, p = 0.19), new-onset dialysis (56.7% vs 53.1%, p = 0.56), and other secondary outcomes. VA-ECMO provides a valid support for patients affected by PCS after surgery for TAAD. (C) 2020 Elsevier Inc. All rights reserved.