Analysis of Ascending and Transverse Aortic Arch Repair in Octogenarians

Shah, Pallav; Estrera, Anthony L.; Miller, Charles C.; Lee, Taek Yeon; Irani, Adel D.; Meada, Riad; Safi, Hazim J.

doi:10.1016/j.athoracsur.2008.05.020

Cited by 43 publications

(27 citation statements)

References 21 publications

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“…In contrast, survival and hospital discharge rates of 41% have been reported in some medically treated patients (39). Such reports and the significant mortality and neurological event risk evident even within younger patients has prompted a debate with Subtypes and Complications of Aortic Dissection regard to the appropriateness of surgery in octogenarians (70,(72)(73)(74)(75)(76)(77)(78)(79). The data are conflicting.…”

Section: Ataad Outcomes With and Without Surgerymentioning

confidence: 75%

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Bonser

Ranasinghe

Loubani

et al. 2011

Journal of the American College of Cardiology

215

175

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Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.

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Section: Ataad Outcomes With and Without Surgerymentioning

confidence: 75%

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Bonser

Ranasinghe

Loubani

et al. 2011

Journal of the American College of Cardiology

215

175

View full text Add to dashboard Cite

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“…It has previously been identified as a risk factor for mortality. 8,20) Shah and colleagues 3) demonstrated that the mortality increased exponentially with a decreasing glomerular filtration rate after the transverse aortic arch had been repaired.…”

Section: )mentioning

confidence: 99%

“…repair, [1][2][3] there appears to be a benefit in the application of selective cerebral perfusion (SCP) among those patients in whom prolonged episodes of circulatory arrest are required to perform a total arch replacement (TAR). [4][5][6][7] For more complex arch repairs or extensive aortic arch disease, superior cerebral protective technique is of crucial importance.…”

mentioning

confidence: 99%

Factors Influencing Permanent Neurologic Dysfunction and Mortality after Total Arch Replacement with Separate Arch Vessel Grafting Using Selective Cerebral Perfusion

Nakamura

Yano

et al. 2011

ATCS

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Objectives: The present study was undertaken to identify risk factors for permanent neurological dysfunction (PND) and in-hospital mortality after total aortic arch replacement (TAR) with separate arch vessel grafting using selective cerebral perfusion (SCP) and hypothermic circulatory arrest. Methods: Between 1998 and 2008, we preformed a TAR on 143 consecutive patients in two centers by identical methods. Of these, 19 (13.3%) were emergency operations, and 46 (32.2%) were open stent-graft placements. Statistical analysis was performed to determine risk factors for PND and mortality, and furthermore, the survival rate was analyzed. Results: The in-hospital mortality rate was 4.9%, with chronic renal failure (p = 0.0013, odds ratio 10.0) as a significant risk factor. Nine patients (6.3%) had PND, with significant risk factors identified as (1) the presence of an old cerebral or silent lacunar infarction on preoperative imaging methods ( p = 0.0458, odds ratio 8.0) and (2) duration of SCP ( p = 0.0026, odds ratio 1.036). Long-term survival was the same in patients with or without PND. Conclusion: The enhanced vulnerability of the brain in patients with a pre-existing old cerebral infarction or silent lacunar infarction is reflected by a high incidence of PND. Chronic renal failure had an impact on in-hospital mortality.

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“…The stroke risk increases significantly when the duration of the deep hypothermic circulatory arrest exceeds 40 min [10]. Moreover, in addition to the negative side effects of deep hypothermia on various organ systems, the duration of CPB had also been identified as an independent risk factor for an adverse outcome [11,12]. Consequentially, there are three potential goals to improve the results in a surgery necessitating circulatory arrest: extension of a safe period of cerebral protection, omitting the deep hypothermia and shortening the time of CPB.…”

Section: Discussionmentioning

confidence: 99%