Intraoperative neurophysiologic monitoring during aortic arch surgery

Journal of Cardiac Surgery

Zhu

et al. 2022

Self Cite

Background While prior data have suggested worse outcomes in women after acute type A aortic dissection (ATAAD) repair when compared to men, results have been inconsistent across studies over time. This study sought to evaluate the impact of sex on short‐ and long‐term outcomes after ATAAD repair. Methods This was a retrospective study utilizing an institutional database of ATAAD repairs from 2007 to 2021. Patients were stratified according to sex. Kaplan–Meier survival estimation and multivariable Cox regression were performed. Supplementary analysis using propensity score matching was also performed. Results Of the 601 patients who underwent ATAAD repair, 361 were males (60.1%) and 240 (39.9%) were females. Females were significantly older, more likely to have hypertension, and more likely to have chronic lung disease. Females were also significantly more likely than males to undergo hemiarch replacement, while males were significantly more likely than females to undergo total arch replacement and frozen elephant trunk. Operative mortality was 9.4% among males and 13.8% among females, though this was not a statistically significant difference (p = .098). Postoperative complications were comparable between groups. Kaplan–Meier survival estimates were similar for men and women, and, on multivariable Cox regression, sex was not significantly associated with long‐term survival (hazard ratio: 1.00, 95% confidence interval: 0.73, 1.37, p = .986). Outcomes remained comparable after supplementary propensity score matched analysis. Conclusion ATAAD repair can be performed with comparable short‐term and long‐term outcomes in both men and women.

Section: Methodsmentioning

confidence: 99%

Section: Operative Techniquementioning

confidence: 99%

Sex‐based outcomes after surgery for acute type A aortic dissection

Yousef

Journal of Cardiac Surgery

Zhu

et al. 2022

Self Cite

“…Finally, routine neurocerebral monitoring was employed during all hemiarch and all TAR via electroencephalography and somatosensoryevoked potentials. 20,21 While symmetric IONM changes during cooling are expected, asymmetric changes while rewarming may be a symptom of neurologic malperfusion. The typical first response is to increase perfusion pressure to mitigate effects of hypoperfusion.…”

Section: Operative Proceedingsmentioning

confidence: 99%

The long‐term impact of acute renal failure after aortic arch replacement for acute type A aortic dissection

Brown

Serna‐Gallegos

Journal of Cardiac Surgery

et al. 2022

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Objective: To determine the long-term impact of developing acute renal failure (ARF) on survival after open aortic arch reconstruction for acute type A aortic dissection (ATAAD). Methods:This was an observational study of consecutive aortic surgeries from 2007 to 2021. Patients with ATAAD were identified via a prospectively maintained institutional database and were stratified by the presence or absence of postoperative ARF (by RIFLE criteria). Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed.Results: A total of 601 patients undergoing open surgery for ATAAD were identified, of which 516 (85.9%) did not develop postoperative ARF, while 85 (14.1%) developed ARF, with a median follow-up time of 4.6 years (1.6, 7.9). Baseline characteristics were similar across each group, except for higher rates of branch vessel malperfusion and lower preoperative ejection fraction in the ARF group.Patients with ARF underwent more total arch replacement and elephant trunk procedures, with longer cardiopulmonary bypass and circulatory arrest times than patients without ARF. ARF was associated with worse short-term outcomes, including increased in-hospital mortality, prolonged mechanical ventilation, higher rates of sepsis, more blood transfusions, and longer length of hospital stay.Unadjusted Kaplan-Meier survival estimates were significantly lower in the ARF group, compared to the group without ARF (p < .001, log-rank test). After multivariable adjustment, the development of postoperative ARF was significantly associated with an increased hazard of death over the study's follow-up time-period (hazard ratio: 2.74, 95% confidence interval: 1.95, 3.86, p < .001).Conclusions: ARF is a highly morbid postoperative event that may adversely impact long-term survival after aortic surgery.

“…When peripheral cannulation was required, right subclavian artery cannulation through a silo graft was preferred over femoral cannulation. Hypothermic circulatory arrest was employed routinely, and patients were cooled to electroencephalogram (EEG) silence [9]. The default repair strategy involved hemiarch replacement with retrograde cerebral perfusion (RCP).…”

Section: Operative Techniquementioning

confidence: 99%

Sex-based Outcomes after Surgery for Acute Type A Aortic Dissection

Yousef

Zhu³

et al. 2022

Preprint

Self Cite

Background: While prior data have suggested worse outcomes in women after acute type A aortic dissection (ATAAD) repair when compared to men, results have been inconsistent across studies over time. This study sought to evaluate the impact of sex on short- and long-term outcomes after ATAAD repair. Methods: This was a retrospective study utilizing an institutional database of ATAAD repairs from 2007 to 2021. Patients were stratified according to sex. Kaplan-Meier survival estimation and multivariable Cox regression were performed. Supplementary analysis using propensity score matching was also performed. Results: Of the 601 patients who underwent ATAAD repair, 361 were males (60.1%) and 240 (39.9%) were females. Females were significantly older, more likely to have hypertension, and more likely to have chronic lung disease. Females were also significantly more likely than males to undergo hemiarch replacement, while males were significantly more likely than females to undergo total arch replacement and frozen elephant trunk. Operative mortality was 9.4% among males and 13.8% among females, though this was not a statistically significant difference (p=0.098). Postoperative complications were comparable between groups. Kaplan-Meier survival estimates were similar for men and women, and, on multivariable Cox regression, sex was not significantly associated with long-term survival (HR 1.00, 95% CI: 0.73, 1.37, p=0.986). Outcomes remained comparable after supplementary propensity score matched analysis. Conclusion: ATAAD repair can be performed with comparable short-term and long-term outcomes in both men and women.