A systematic approach to improve the outcomes of type A aortic dissection

Hidefumi Nishida, Minoru Tabata, Toshihiro Fukui, Yasunori Sato, Hajime Kin, Shuichiro Takanashi

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives The aims of this study are to evaluate the outcomes and trends of contemporary emergency surgery for acute type A aortic dissection on the basis of a systematic approach and to assess the impact of temporary aortic crossclamping during systemic cooling on early and late outcomes. Methods We retrospectively reviewed 702 consecutive patients who underwent emergency surgery for acute type A aortic dissection between March 2004 and May 2015. Our clinical protocol includes rapid transfer to the operating room, quick establishment of cardiopulmonary bypass, temporary aortic crossclamping during cooling, primary entry resection, and open distal anastomosis. We analyzed the perioperative data, survival, freedom from aortic reinterventions, and impact of aortic crossclamping on early and late outcomes. Results The median time from hospital arrival to cardiopulmonary bypass establishment was 115 minutes and has decreased over the last decade (trend test P <.001). We perfused the femoral artery in 615 patients (87.6%), placed aortic crossclamping in 616 patients (87.7%), and performed open distal anastomosis in all patients. The operative mortality was 5.4% (38/702), and the incidence of stroke was 10.8% (76/702). The 7-year overall survival and freedom from aortic reinterventions were 80.4% and 87.5%, respectively. Compared with the nonclamping group, the crossclamping group had a shorter operation time, similar operative mortality, incidence of stroke, and freedom from aortic reinterventions. Conclusions Emergency surgery for acute type A aortic dissection based on our systematic approach demonstrated excellent early and late outcomes. The temporary aortic crossclamping during cooling decreased the operation time without increasing early and late adverse events.

Original languageEnglish
Pages (from-to)89-96.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume154
Issue number1
DOIs
Publication statusPublished - 2017 Jul 1
Externally publishedYes

Fingerprint

Dissection
Emergencies
Cardiopulmonary Bypass
Stroke
Survival
Mortality
Incidence
Femoral Artery
Operating Rooms
Operative Time
Clinical Protocols

Keywords

  • acute type A aortic dissection
  • aortic crossclamping
  • femoral artery cannulation
  • open distal anastomosis

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

A systematic approach to improve the outcomes of type A aortic dissection. / Nishida, Hidefumi; Tabata, Minoru; Fukui, Toshihiro; Sato, Yasunori; Kin, Hajime; Takanashi, Shuichiro.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 154, No. 1, 01.07.2017, p. 89-96.e1.

Research output: Contribution to journalArticle

Nishida, Hidefumi ; Tabata, Minoru ; Fukui, Toshihiro ; Sato, Yasunori ; Kin, Hajime ; Takanashi, Shuichiro. / A systematic approach to improve the outcomes of type A aortic dissection. In: Journal of Thoracic and Cardiovascular Surgery. 2017 ; Vol. 154, No. 1. pp. 89-96.e1.
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abstract = "Objectives The aims of this study are to evaluate the outcomes and trends of contemporary emergency surgery for acute type A aortic dissection on the basis of a systematic approach and to assess the impact of temporary aortic crossclamping during systemic cooling on early and late outcomes. Methods We retrospectively reviewed 702 consecutive patients who underwent emergency surgery for acute type A aortic dissection between March 2004 and May 2015. Our clinical protocol includes rapid transfer to the operating room, quick establishment of cardiopulmonary bypass, temporary aortic crossclamping during cooling, primary entry resection, and open distal anastomosis. We analyzed the perioperative data, survival, freedom from aortic reinterventions, and impact of aortic crossclamping on early and late outcomes. Results The median time from hospital arrival to cardiopulmonary bypass establishment was 115 minutes and has decreased over the last decade (trend test P <.001). We perfused the femoral artery in 615 patients (87.6{\%}), placed aortic crossclamping in 616 patients (87.7{\%}), and performed open distal anastomosis in all patients. The operative mortality was 5.4{\%} (38/702), and the incidence of stroke was 10.8{\%} (76/702). The 7-year overall survival and freedom from aortic reinterventions were 80.4{\%} and 87.5{\%}, respectively. Compared with the nonclamping group, the crossclamping group had a shorter operation time, similar operative mortality, incidence of stroke, and freedom from aortic reinterventions. Conclusions Emergency surgery for acute type A aortic dissection based on our systematic approach demonstrated excellent early and late outcomes. The temporary aortic crossclamping during cooling decreased the operation time without increasing early and late adverse events.",
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