Increased hospital volume is associated with reduced mortality after thoracoabdominal aortic aneurysm repair

Polanco, Antonio; d'Angelo, Alex; Shea, Nicholas; Allen, Philip M.; Takayama, Hiroo; Patel, Virendra I.

doi:10.1016/j.jvs.2020.05.027

Cited by 32 publications

(22 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Meta-analysis indicated that the total pooled in-hospital mortality rate was 11.26% among all studies including all Crawford types, and was 10.32% for Crawford types II ( 12 ). The overall in-hospital mortality of TAAA repair was reported to be more than 19% in the United States ( 13 – 15 ). The high incidence of severe adverse events including spinal cord ischemia, respiratory complications, permanent postoperative renal dialysis, stroke rate, and cardiac events also affect the clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Meta-regression evidenced that the mortality had a statistically significant inverse association with the volume of the TAAA center ( 12 ). The patients who accepted TAAA repair in high-volume centers have reported excellent results: lower rate of in-hospital mortality and postoperative complications ( 6 , 8 , 15 ). Moreover, the rate of cardiac complications and gastrointestinal complications, as well as blood transfusion rates were also lower for patients operated on at high-volume centers ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The application of modular multifunctional left heart bypass circuit system integrated with ultrafiltration in thoracoabdominal aortic aneurysm repair

Huang

Chen

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Open thoracoabdominal aortic aneurysm (TAAA) repair is a complex and challenging operation with a high incidence of serious complications, and high perioperative mortality and morbidity. Left heart bypass (LHB) is a circulatory support system used to perfuse the distal aorta during TAAA operation, and the advantages of LHB include guaranteeing distal perfusion, reducing the use of heparin, and diminishing the risk of bleeding and postoperative neurological deficits. In China, the circuit for TAAA repair is deficient, and far from the perfusion requirements. We designed a modular multifunctional LHB circuit for TAAA repair. The modular circuit consisted of cannulation pipelines, functional consumables connection pipelines, and accessory pipelines. The accessory pipelines make up lines for selective visceral perfusion and kidney perfusion, suckers and rapid infusion. The circuit can be assembled according to surgical requirements. The ultrafilter and heat exchanger are integrated into the circuit to fulfill the basic demands of LHB. The LHB circuit also has pipelines for selective visceral perfusion to the celiac artery and superior mesenteric artery and renal perfusion pipelines. Meanwhile, the reserved pipelines facilitate the quick switch from LHB to conventional cardiopulmonary bypass (CPB). The reserved pipelines reduce the time of reassembling the CPB circuit. Moreover, the rapid infusion was integrated into the LHB circuit, which can rapid infusion when massive hemorrhage during the open procedures such as exposure and reconstruction of the aorta. The ultrafiltration can diminish the consequent hemodilution of hemorrhage and rapid infusion. A hemoperfusion cartridge also can be added to reduce the systemic inflammatory during operation. The circuit can meet the needs of LHB and quickly switch to conventional CPB. No oxygenator was required during LHB, which reduce the use of heparin and reduce the risk of bleeding. The heat exchanger contributes to temperature regulation; ultrafiltration, arterial filter, and rapid-infusion facilitated the blood volume management and are useful to maintain hemodynamic stability. This circuit made the assembly of the LHB circuit more easily, and more efficient, which may contribute to the TAAA repair operation performed in lower volume centers easily. 26 patients who received TAAA repair under the modular multifunctional LHB from January 2018-March 2022 were analyzed, and we achieved acceptable clinical outcomes. The in-hospital mortality and 30-day postoperative mortality were 15.4%, and the postoperative incidences of paraparesis (4%), stroke (4%), and AKI need hemodialysis (12%) were not particularly high, based on the limited patients sample size in short research period duration.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The application of modular multifunctional left heart bypass circuit system integrated with ultrafiltration in thoracoabdominal aortic aneurysm repair

Huang

Chen

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…These studies emphasized the need for these high-risk surgeries to be concentrated in high-volume aortic centers with careful patient selection. 9,11 Open TAAA repairs are durable, with a low rate of reintervention, 14 and likely will remain the preferred approach for younger patients, especially those with connective tissue-associated disease, 15 and selected older patients with anatomy not amenable to endovascular repair.…”

Section: Open Repairmentioning

confidence: 99%

Spinal Cord Protection for Thoracoabdominal Aortic Surgery

Miller

Patel

Wagener

2022

Journal of Cardiothoracic and Vascular Anesthesia

Self Cite

View full text Add to dashboard Cite

“…Open thoracoabdominal aortic aneurysm (TAAA) repair is a technically complex operation associated with a number of anatomic and mechanical complications. 1 Notably, aortoesophageal fistula and diaphragmatic hernia represent examples of delayed anatomic complications after open TAAA repair. 2 , 3 To facilitate exposure of the distal aortic arch for the proximal extent of repair, it is not uncommon to resect a posterior segment of rib four, five or six.…”

mentioning

confidence: 99%

Commentary: Mechanical aortic graft injury after thoracoabdominal aortic aneurysm repair: A reminder that even the little details matter

2021

View full text Add to dashboard Cite

Increased hospital volume is associated with reduced mortality after thoracoabdominal aortic aneurysm repair

Cited by 32 publications

References 19 publications

The application of modular multifunctional left heart bypass circuit system integrated with ultrafiltration in thoracoabdominal aortic aneurysm repair

The application of modular multifunctional left heart bypass circuit system integrated with ultrafiltration in thoracoabdominal aortic aneurysm repair

Spinal Cord Protection for Thoracoabdominal Aortic Surgery

Commentary: Mechanical aortic graft injury after thoracoabdominal aortic aneurysm repair: A reminder that even the little details matter

Contact Info

Product

Resources

About