Health-related quality of life of patients after surgery for acute Type A aortic dissection.

OBJECTIVES: Acute Type A aortic dissection (ATAAD) and the ensuing surgical therapy may be experienced as a traumatic event by patients. This study aimed at analysing the prevalence of post-traumatic stress disorder (PTSD) and the physical and mental well-being of survivors of surgically treated ATAAD. METHODS: A total of 393 survivors were contacted and asked to fill in various health questionnaires. RESULTS: Two hundred and ten (53%) patients returned the questionnaires. The mean follow-up was 51 ± 27.8 months. The results showed that 67.6% had high blood pressure, 12.9% had pre-existing diseases of the aorta and 31.5% or 27% of these groups were at risk for PTSD according to the health questionnaires. Duration of intensive care unit or hospital stay had no effect on the risk for PTSD. According to the questionnaire, Short Form 12, physical and mental well-being was significantly reduced in the patients compared to a large German norm sample, even after adjustment for differences in age between the 2 cohorts. Physical activity prior to the event was associated with improved physical and mental well-being but did not reduce the risk for PTSD. CONCLUSIONS: Emergency surgery for ATAAD is associated with high risk for PTSD, which seems to negatively affect physical and mental well-being. More efforts should be directed at prevention and early diagnosis and therapy of PTSD. This study has evaluated 8-year trends in the presentation, diagnosis and outcomes such as physical and mental measures and prevalence rates of PTSD in patients who have undergone an emergency operation for ATAAD.

Asanguineous priming of miniaturized paediatric cardiopulmonary bypass circuits for congenital heart surgery: independent predictors associated with transfusion requirements and effects on postoperative morbidity.

OBJECTIVES: In paediatric cardiac surgery, body weight-adjusted miniaturized cardiopulmonary bypass (CPB) circuits within a comprehensive blood-sparing approach can reduce transfusion requirements. Haemodilution resulting from mixing the patient's blood with a CPB crystalloid solution may be reduced to the extent that asanguineous priming becomes possible. Therefore, we adopted asanguineous priming in our clinical routine. Our goal was to report the effects of asanguineous priming on transfusion requirements, clinical features associated with transfusion and effects on in-hospital morbidity. METHODS: Data of all paediatric patients with body weights up to 15 kg treated within a 2-year period between May 2013 and May 2015 were retrospectively analysed. The incidence of transfusions was analysed and periprocedural haemoglobin concentrations were evaluated. Predictors associated with transfusion requirements, duration of ventilation or length of stay in the intensive care unit were evaluated by multivariable analyses. RESULTS: Data from 579 patients with body weights up to 15 kg were analysed. The ability to avoid transfusion depended on body weight: in patients <3 kg, the rate (95% confidence interval) of transfusion during CPB was 0.53 (0.37-0.69), and in patients >8 kg, the rate was 0.14 (0.10-0.19). The respective rates of transfusions throughout the hospital stay were 1.00 (0.90-1.00) and 0.67 (0.60-0.73). Body weight, preoperative haemoglobin concentration, duration of CPB and palliative surgery were independently associated with transfusion during CPB. Transfusion, particularly transfusion during CPB, was independently associated with longer mechanical ventilation time (hazard ratio 3.52, confidence interval 2.66-4.65) and length of stay in the intensive care unit (hazard ratio 2.52, confidence interval 1.91-3.32). CONCLUSIONS: Asanguineous priming is feasible using miniaturized CPB circuits. It may help to avoid blood transfusions in patients on CPB and reduce transfusion requirements and transfusion-related morbidity.