Surgical Results and Quality of Life in Stanford Type A Aortic Dissection / 日本心臓血管外科学会雑誌

From April 1990 to August 1995, 44 consecutive patients (25 males and 19 females; mean age, 63 years) who underwent surgery for Stanford type A aortic dissection, were studied to examine surgical results and postoperative quality of life (QOL). Ascending aortic replacement was performed in 22 patients and simultaneous replacement of the ascending aorta and the aortic arch in 22. The postoperative 30-day survival rate was 84% (37/44). Univariate analysis revealed that operation time (<i>p</i><0.01), postoperative cardiac failure (<i>p</i><0.02), respiratory failure (<i>p</i><0.01), severe brain damage (<i>p</i><0.01), and intestinal ischemia (<i>p</i><0.02) were significant factors in increased operative mortality risk. Additional operative procedure was also a significant factor (<i>p</i><0.05) all 3 patients with coronary artery bypass grafting died, while all 5 patients with the Bentall or Cabrol procedure lived. The factors which influenced postoperative QOL were preoperative renal damage (<i>p</i><0.05), history of cerebral vascular disease (<i>p</i><0.02), shock (<i>p</i><0.02), postoperative renal failure (<i>p</i><0.02), paraplegia (<i>p</i><0.02), and residual dissection (<i>p</i><0.02). The operation method, which was replacement of the ascending aorta or simultaneous replacement of the ascending aorta and the aortic arch, had no influence on postoperative QOL. Five of 22 patients receiving ascending aorta replacement had dissection only in the ascending aorta (localized type). The other 17 patients receiving ascending aorta replacement had dissections extending to the arch or descending aorta. The incidence of complications due to residual dissection was 5/17 (29%) in cases of replacement of the ascending aorta for type A aortic dissection, while it was 1/22 (5%) in cases of replacement of the ascending aorta and the aortic arch (<i>p</i>=0.0684). Simultaneous replacement of the ascending aorta and the aortic arch did not negatively affect the surgical results and postoperative QOL more than replacement of the ascending aorta, and there was lower incidence of postoperative complications due to residual dissection. If Stanford type A aortic dissection extends to the arch, simultaneous replacement of the ascending aorta and the aortic arch is recommended.

Renal Function after Cardiopulmonary Bypass and Effect of Urinastatin on Renal Function / 日本心臓血管外科学会雑誌

To evaluate the renal function after cardiopulmonary bypass (CPB) and the effect of Urinastatin on renal function, the tubular and glomerular damage were studied in patients underwent cardiac operations, dividing following two groups; Group U with Urinastain and Group C without Urinastatin. Of indexes of glomerular function, changes in serum creatinine and urine nitrogen, and creatinine clearance did not show remarkably after CPB. Serum β₂-microglobulin indicating glomerular function after CPB demonstrated significantly higher levels than that before operation in Group C, but did not in Group U. N-acetyl-β3-D-glucosaminidase and γ-glutamyl-transpeptidase in urine as markers of tubular function rose significantly after CPB in both groups, but they showed significantly lower level in Group U than in Group C. After CPB, even in patients without clinical renal failure, glomerular and tubular dysfunction were placed. Urinastatin was considered to be effective in protection of glomerular and tubular function.