Analysis of Acute Type A Aortic Dissection in Japan Registry of Aortic Dissection (JRAD)

Inoue, Yosuke; Matsuda, Hitoshi; Uchida, Keiji; Komiya, Tatsuhiko; Koyama, Tadaaki; Yoshino, Hideaki; Ito, Toshiaki; Shiiya, Norihiko; Saiki, Yoshikatsu; Kawaharada, Nobuyoshi; Nakai, Michikazu; Iba, Yutaka; Minatoya, Kenji; Ogino, Hitoshi

doi:10.1016/j.athoracsur.2019.12.051

Cited by 53 publications

(58 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Indeed, Wang et al 26 reported that a critical preoperative state and malperfusion syndrome were independent predictors of operative and long‐term mortality. Inoue et al, 28 who reported Japanese experience in AAAD, highlighted that shock vital status on arrival, cardiopulmonary resuscitation, and disturbance of consciousness were risk factors for in‐hospital mortality. In addition, Zindovic et al 29 demonstrated that malperfusion had a significant influence on early and late outcomes in AAAD surgery.…”

Section: Resultsmentioning

confidence: 99%

Aortic root remodeling with external annuloplasty for acute type A aortic dissection: Midterm results

et al. 2020

View full text Add to dashboard Cite

Background To evaluate the role of aortic root remodeling with external aortic annuloplasty (ARREAA) in acute type A aortic dissection (AAAD). Methods From May 2011 to May 2020, 59 patients out of 240 with AAAD underwent ARREAA. Data were retrospectively collected and analyzed. Results The mean age was 61.4 ± 8.6 years and 43 patients were males (73%). Hemiarch and total arch replacement were performed in 37 (62.7%) and 14 (23.7%) patients. An aortic valvuloplasty was performed in seven patients (11.8%). Five patients (8.5%) required coronary artery bypass graft. Re‐exploration for bleeding was required in six patients (10.1%). The 30‐day mortality rate was 18.6%. Preoperative hemodynamic instability (odds ratio [OR] = 8.57, 95% confidence interval [CI] = 1.57–46.71; p = 0.013), consciousness disorder (OR = 19.18, 95% CI = 3.02–121.72]; p = 0.002) or myocardial ischemia (OR = 6.28, 95% CI = 1.27–31.10; p = 0.013) were significantly associated with postoperative mortality. No patient was reoperated for aortic valve during the postoperative period. One patient suffered a stroke postoperatively with partial recovery. Kidney failure requiring temporary dialysis occurred in 12 patients (20.3%). At discharge, a transthoracic echocardiogram showed moderate aortic regurgitation (AR; grade 2) in two patients. During follow‐up (mean = 58.4 ± 32.4 months), three patients died. The rate of mortality was 6.2%. Actuarial survival at 5 years was 76.3%. No patient required reoperation on the proximal aorta or aortic valve. At 4 years, freedom from any aortic valve or root reintervention and AR > 2 were both 100%. Conclusion In a center with expertise in valve‐sparing procedures, ARREAA is a reasonable option in the surgical management of AAAD in selected patients. This technique stabilizes the aortic annulus and preserves root anatomy for durable outcomes.

show abstract

Section: Resultsmentioning

confidence: 99%

Aortic root remodeling with external annuloplasty for acute type A aortic dissection: Midterm results

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Data from German Registry for Acute Aortic Dissection Type A (GERAADA) [ 3 ] showed that 30% were 70 years or older in the population of 2137 patients. Almost one-third of patients were > 70 years of age in International Registry of Acute Aortic Dissection (IRAD) [ 1 ] and 19.8% were aged 80 years old or older in Japan registry of aortic dissection (JRAD) [ 8 ]. Compared with IRAD, the patients with AAD were significantly younger in Chinese registry (Sino-RAD) [ 9 ], of which 6.5% were over 70 years old and 25.4% were over 60 years old.…”

Section: Discussionmentioning

confidence: 99%

Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?-insights from single center experience

Qin

et al. 2020

J Cardiothorac Surg

View full text Add to dashboard Cite

Background This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes. Methods From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n = 41) and total arch replacement + stent elephant trunk implantation (TAR+SET, n = 62). Results There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR+SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality ( P = 0.04). The overall survival rates at 5-year follow-up were 82.5 ± 6.0% in LAR group and 75.2 ± 5.6% in TAR+SET group, but with no difference ( p = 0.151). The freedom from adverse aortic events at 5-year was 84.3 ± 6.5% in LAR group versus 97.9 ± 2.1% in TAR+SET group, with a statistical difference ( p = 0.03). Conclusion These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.

show abstract

“…Data from German Registry for Acute Aortic Dissection Type A (GERAADA) [3] showed that 30% were 70 years or older in the population of 2,137 patients. Almost one-third of patients were >70 years of age in International Registry of Acute Aortic Dissection (IRAD) [1] and 19.8% were aged 80 years old or older in Japan registry of aortic dissection (JRAD) [8]. Compared with IRAD, the patients with AAD were signi cantly younger in Chinese registry (Sino-RAD) [9], of which 6.5% were over 70 years old and 25.4% were over 60 years old.…”

Section: Discussionmentioning

confidence: 99%

Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?

Qin

Su²,

Li³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes.Methods: From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n=41) and total arch replacement + stent elephant trunk implantation (TAR+SET, n=62). Results: There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR+SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality (P=0.04). The overall survival rates at 5-year follow-up were 82.5±6.0% in LAR group and 75.2±5.6% in TAR+SET group, but with no difference (p=0.151). The freedom from adverse aortic events at 5-year was 84.3±6.5% in LAR group versus 97.9±2.1% in TAR+SET group, with a statistical difference (p=0.03). Conclusion: These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.

show abstract

Analysis of Acute Type A Aortic Dissection in Japan Registry of Aortic Dissection (JRAD)

Cited by 53 publications

References 21 publications

Aortic root remodeling with external annuloplasty for acute type A aortic dissection: Midterm results

Aortic root remodeling with external annuloplasty for acute type A aortic dissection: Midterm results

Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?-insights from single center experience

Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?

Contact Info

Product

Resources

About