Simplified surgical approach to improve surgical outcomes in the center with a small volume of acute type A aortic dissection surgery

Choi, Jong Bum; Kim, Tae Youn; Kim, Kyung Hwa; Kuh, Ja Hong

doi:10.3233/thc-171169

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Nevertheless, improvements in surgical technique, as well as implementation of multidisciplinary programmes, 50 have led to improved mortality outcomes in acute TAAD surgery, even in low volume centres, and even among the elderly, who may be at increased risk of surgery. 51,52 Hitherto, the role of surgical intervention for patients with type A IMH remains controversial. Some investigators have demonstrated that aggressive medical treatment led to complete resorption of the thrombosed false lumen, with a low mortality risk, 46,53 whereas others have reported poorer outcomes associated with medical treatment alone, 37,54 which corroborates findings of a previous meta-analysis of 143 patients.…”

Section: Discussionmentioning

confidence: 99%

Non-operative Management of Type A Acute Aortic Syndromes: A Systematic Review and Meta-Analysis

Wee

Varughese

Syn

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS This review assembles and analyses contemporary evidence regarding the medical management of patients with type A acute aortic syndrome. For patients with type A aortic dissection, surgery remains superior to medical intervention. However, there may be a role for medical therapy of type A intramural haematoma. This warrants further investigation and research. Objective: For type A acute aortic syndrome (TAAAS), the only alternative for patients who are contraindicated for open surgery or endovascular interventions is medical therapy. The objective of this study was to assess the impact of conservative treatment in patients suffering TAAAS. Methods: This systematic review and meta-analysis was performed according to the PRISMA guidelines. A systematic search was conducted on MEDLINE, Embase, and the Cochrane Library for relevant studies. Pairwise meta-analysis was conducted to compare surgical with medical intervention. Included studies were subjected to risk of bias assessment using the NewcastleeOttawa scale. Results: Twenty-nine studies comprising 6894 patients were included. For patients with type A aortic dissection (TAAD), the pooled proportions of all cause in hospital mortality and all cause 30 day mortality were 39.1% (95% confidence interval [CI] 29.8e48.9%; I 2 ¼ 90.1%), and 31.1% (95% CI 8.8e59.1%; I 2 ¼ 95.9%), respectively. There was a significant proportion of patients who converted from medical to surgical treatment (20.7%, 95% CI 0.0e 61.7%; I 2 ¼ 93.4%). In patients with type A intramural haematoma (IMH), the pooled proportions of all cause in hospital mortality and all cause 30 day mortality were 7.2% (95% CI 2.6e13.4%; I 2 ¼ 76.5%) and 15.3% (95% CI 1.1e37.9%; I 2 ¼ 64.1%). A significant proportion of patients converted from medical to surgical treatment (26.3%, 95% CI 12.1e43.4%; I 2 ¼ 90.5%). Conclusion: Mortality remains high for conservatively treated patients with TAAD. For patients with IMH, heterogeneity in the types of conservative treatment prohibit any firm conclusion regarding its safety and efficacy.

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Section: Discussionmentioning

confidence: 99%

Non-operative Management of Type A Acute Aortic Syndromes: A Systematic Review and Meta-Analysis

Wee

Varughese

Syn

et al. 2019

European Journal of Vascular and Endovascular Surgery

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“…The importance of patient-specific characteristics cannot be overstated. Preexisting conditions, such as ankylosing spondylitis and hypertension, can impact the decision to catheterize [37,38].…”

Section: Frequently Neglected Factors In Cannulation Decision-makingmentioning

confidence: 99%

“…However, novel techniques, such as direct true lumen cannulation and dual arterial cannulation, are garnering attention for their potential to address difficulties associated with conventional methods. In addition to ensuring optimal perfusion, these techniques seek to minimize the risk of complications and malperfusion [38].…”

Section: Introduction To Innovative and Emergent Cannulation Techniquesmentioning

confidence: 99%

Cannulation Strategies in Type A Aortic Dissection: Overlooked Details and Novel Approaches

Yadav,

Saifullah,

Mandal

et al. 2023

Cureus

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Aortic dissection type A is a life-threatening condition that frequently necessitates surgical intervention. This review focuses on central aortic cannulation, arch branch vessel (ABV) cannulation, and proximal arch cannulation as key techniques during aortic surgery. It discusses innovative solutions for addressing these challenges. The review synthesizes findings from recent studies and emphasizes the significance of meticulous planning and execution of cannulation in aortic dissection repair. This review aims to contribute to the advancement of surgical practices and the enhancement of patient outcomes in the management of type A aortic dissection (AAD) by addressing these frequently overlooked details.

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“…Môže to vyriešiť dodatočná anuloplastika, kde sa pomocou anulárnych ringov alebo sutúr posilňuje samotný anulus. (19,20,21).…”

Section: Popis Pacientovunclassified

Dissection of ascending aorta, a diagnosis needs to remember about it

Jankovičová¹,

Belicová²,

Ochodnický³

et al. 2020

Vnitř Lék

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I. interná klinika, Univerzitná nemocnica a JLF UK v Martine Akútna disekcia aorty typu A je život ohrozujúci stav a významnou príčinou morbidity a mortality. Jej typickým symptómom je náhle vzniknutá bolesť na hrudníku, ktorá sa vyskytuje u viac ako 85% pacientov. Akútna bolesť na hrudníku vedie k podozreniu na akútny koronárny syndróm a ak zmeny na elektrokardiograme naznačujú možnú ischémiu, pacientom je podaná antitrombotická liečba. U niektorých pacientov bolesť na hrudníku nemusí byť prítomná, môže byť prítomný ložiskový neurologický deficit, ktorý sa objavuje ako jedna z komplikácií šírenia dissekcie na veľké artérie. Autori v práci popisujú troch pacientov s akútnou disekciou aorty typu A. Dvaja z nich nemali akútne bolesti na hrudniku, dominoval u nich ložiskový neurologický deficit. Tretí pacient mal typické akútne bolesti na hrudníku, na elektrokardiograme suspektné ischemické zmeny, čo viedlo k podozreniu na akútny koronárny syndróm. Autori prezentujú, že akútna disekcia aorty typu A môže byť ľahko prehliadnutá, preto je potrebné na túto diagnózu myslieť, aby sa včas diagnostikovala a bola zahájená okamžitá adekvátna liečba.Kľúčové slová: aorta, akútny koronárny syndróm, cievna mozgová príhoda, disekcia aorty typu A. Dissection of ascending aorta, a diagnosis needs to remember about itAcute type A aortic dissection is a life-threating condition, and is associated with significant morbidity and mortality. Patients typically present with the acute onset of chest pain, which occurs in up to 85% of cases. Acute chest pain may lead to the suspicion of acute coronary syndrome, and as the electrocardiogram may indicate ischaemia, patients are given anti-thrombotic treatment. Some patients can present without chest pain, but with focal neurological deficits, which can occur with involvement of the great vessel. The authors described three patients with acute type A aortic dissection. Two of them did not present with the acute onset of chest pain, but with focal neurological deficits. Third patient presented with the acute onset of chest pain and the electrocardiogram indicated suspected ischaemia, which led to the suspicion of acute coronary syndrome. The authors presented, that diagnosis of acute type A aortic dissection can be easily overlooked and a high index of suspicion is needed to obtain a timely diagnosis such that appropriate initial therapy can be instituted promptly.

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Simplified surgical approach to improve surgical outcomes in the center with a small volume of acute type A aortic dissection surgery

Cited by 6 publications

References 24 publications

Non-operative Management of Type A Acute Aortic Syndromes: A Systematic Review and Meta-Analysis

Non-operative Management of Type A Acute Aortic Syndromes: A Systematic Review and Meta-Analysis

Cannulation Strategies in Type A Aortic Dissection: Overlooked Details and Novel Approaches

Dissection of ascending aorta, a diagnosis needs to remember about it

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