Hybrid operating room concept for combined diagnostics, intervention and surgery in acute type A dissection

Tsagakis, Konstantinos; Konorza, Thomas; Dohle, Daniel-Sebastian; Kottenberg, Eva; Buck, Thomas; Thielmann, Matthias; Erbel, Raimund; Jakob, Heinz

doi:10.1093/ejcts/ezs287

Cited by 112 publications

(103 citation statements)

References 21 publications

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“…The safety and benefits of coronary angiography have repeatedly been shown in selected patients with spontaneous AAD, and with postcardiac surgery acute AAD, as well. 18,25,38,39 Operative management of CAD is fundamentally different when the coronary status is known. 18,25,38 The consequences of missing significant native CAD and occluded bypass grafts must therefore be weighted against the presumed risk of a slight delay.…”

Section: Discussionmentioning

confidence: 99%

“…11,18,25 As a future concept currently gaining popularity, the hybrid operating room enables the exact diagnosis of coronary status and aortic pathologies without time delay. 39 Furthermore, electron beam CT and multislice spiral CT allow simultaneous diagnosis of aortic dissection and CAD as an alternative to intracoronary modalities. 40 This study shares the limitations associated with all post hoc analyses.…”

Section: Discussionmentioning

confidence: 99%

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Type A Aortic Dissection After Nonaortic Cardiac Surgery

et al. 2013

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A cute type A aortic dissections (AADs) are life-threatening conditions that are conventionally treated with emergency operations. Population-based studies suggest an incidence of ≈20 to 30 cases per million people per year which roughly translates to an estimated >6000 new AAD cases annually in the United States and >14 000 in Europe. [1][2][3][4][5] The clinical presentation, natural history, management, and outcome of spontaneous AADs are well described.2,5-7 Despite improvements in imaging, surgical techniques, and management, the overall in-hospital mortality of patients with spontaneous acute AAD remains high with a range of 15% to 32%, 7-10 with early death resulting mainly from rupture and tamponade. Editorial see p 1593 Clinical Perspective on p 1611AAD can complicate routine cardiac surgery unexpectedly at any time, either intraoperatively and early or late afterward, suddenly converting a low-risk elective procedure into a highrisk situation with excessive operative mortality.11,12 Previous reports suggest that AAD occurs in 0.12% to 0.16% of patients Background-Cardiac surgery with cardiopulmonary bypass is associated with mechanical manipulation of the ascending aorta that occasionally leads to type A aortic dissection (AAD). Methods and Results-One hundred three patients with surgical repair for AAD following nonaortic cardiac surgery were identified. With the use of logistic regression modeling, coronary artery bypass surgery (CABG), either isolated or combined with another procedure in the initial operation, was associated with significantly higher operative mortality in comparison with patients with non-CABG procedures at the time of AAD repair both for all patients (odds ratio, 2.90; 95% confidence interval, 1.09-7.72; P=0.033) and for patients with acute and chronic AAD ≥30 days after the initial operation (odds ratio, 3.62; 95% confidence interval, 1.13-11.54; P=0.03). In patients who developed AAD late after the initial operation, operative mortality was highest in patients without preoperative coronary angiography and appropriate management of their native coronary artery disease and graft disease (odds ratio, 5.36; 95% confidence interval, 1.68-17.0; P=0.002). Nearly all the intimal dissection tears were located at sites of previous surgical trauma. Most of the ascending aortas that had dissected initially had a diameter ≥40 mm with histological evidence of medial degeneration in resected tissue samples. Conclusions-In patients who have undergone previous cardiac surgery, preexisting aortic wall pathology contributes to AAD with typical intimal damage at sites of mechanical trauma. The operative mortality was the highest in patients with previous CABG in comparison with patients with non-CABG procedures. Preoperative coronary angiography and operative management of native coronary and graft disease were significantly associated with outcome in patients with previous CABG. (Circulation. 2013;128:1602-1611.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Type A Aortic Dissection After Nonaortic Cardiac Surgery

et al. 2013

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“…Therefore, different strategies to resolve malperfusion have been developed (4), but only limited data exist regarding the impact of malperfusion on outcomes.…”

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confidence: 99%

The Impact of Pre-Operative Malperfusion on Outcome in Acute Type A Aortic Dissection

Czerny

Schoenhoff

Etz

et al. 2015

Journal of the American College of Cardiology

319

262

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Malperfusion remains a severe clinical condition with strong potential for adverse outcomes in patients undergoing surgery for acute type A aortic dissection. The GERAADA registry suggests that the impact of the number of organs involved and the type of malperfusion on outcome differs substantially. Introducing an appropriate classification system, such as "complicated" and uncomplicated" acute type A aortic dissection, might help predict individual risk as well as select a surgical strategy that may quickly resolve malperfusion.

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“…Recently, several groups reported encouraging results using this approach, and showed how FET techniques (which are often associated with secondary endovascular procedures to optimize final results) can result in superior outcomes for this high-risk group of malperfused patients when appropriately employed in hybrid operative rooms by a multidisciplinary team (34,35).…”

Section: Distal Malperfusionmentioning

confidence: 99%

Descending endograft for DeBakey type 1 aortic dissection: pro

Berretta¹,

Eusanio²

2016

Ann. Cardiothorac. Surg.

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The surgical management of patients with DeBakey type 1 acute aortic dissection (DBT1-AAD) represents a major challenge for aortic surgeons. It has been demonstrated that the distal false lumen remains patent in about 70% to 80% of patients undergoing DBT1-AAD surgery and that a patent false lumen worsens the prognosis. In order to improve long term outcomes and reduce the frequency of late aneurysm formation and reoperation, a more aggressive primary operation involving total arch replacement (TAR) and concomitant antegrade stenting of the descending thoracic aorta (DTA) with a frozen elephant trunk (FET) has been introduced. Such extensive operations, however, remain controversial due to their increased technical complexity and perceived higher operative mortality and morbidity. This perspective article will overview the rationale behind, and the potential advantages and current evidence for, FET surgery in acute aortic dissection.

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Hybrid operating room concept for combined diagnostics, intervention and surgery in acute type A dissection

Cited by 112 publications

References 21 publications

Type A Aortic Dissection After Nonaortic Cardiac Surgery

Type A Aortic Dissection After Nonaortic Cardiac Surgery

The Impact of Pre-Operative Malperfusion on Outcome in Acute Type A Aortic Dissection

Descending endograft for DeBakey type 1 aortic dissection: pro

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