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1.
J Card Surg ; 36(4): 1320-1327, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33533117

RESUMO

OBJECTIVE: Severe acute kidney injury (AKI) and hyperbilirubinemia increase the morbidity and mortality risk in patients undergoing emergency surgery for acute type A aortic dissection (AAAD). Our purpose was to investigate the risk factors of mortality in AAAD surgery patients who had severe postoperative hyperbilirubinemia and AKI receiving continuous renal replacement therapy (CRRT). METHODS: Patients who had severe hyperbilirubinemia and received CRRT after AAAD surgery in our center between January 2015 and December 2018 were retrospectively screened. Univariate and multivariate analyses were performed to identify the risk factors of in-hospital mortality. Kaplan-Meier curves were employed to evaluate the accumulated patient survival proportion. RESULTS: After screening, 50 patients were included in our present study. The in-hospital mortality was 84%. The univariate logistic analysis showed that preoperative MAP (p = .017) and peak total bilirubin concentration (p < .001) were associated with in-hospital mortality in AAAD surgery patients who had severe postoperative hyperbilirubinemia and received CRRT. Multivariate logistic regression analysis revealed that the peak bilirubin concentration (odds ratio, 1.050; 95% confidence interval, 1.002-1.101; p = .041) after surgery was the only independent risk factor for in-hospital mortality. The optimal cutoff value of peak bilirubin for predicting in-hospital mortality was 134.4 µmol/L. CONCLUSIONS: AAAD surgery patients with severe hyperbilirubinemia and AKI requiring CRRT had a poor prognosis. Increased postoperative peak bilirubin concentration strongly increased the risk of patient in-hospital mortality. Therefore, these patients should be closely monitored and treated aggressively when possible.


Assuntos
Lesão Renal Aguda , Aneurisma Dissecante , Terapia de Substituição Renal Contínua , Hiperbilirrubinemia , Lesão Renal Aguda/terapia , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/cirurgia , Mortalidade Hospitalar , Humanos , Hiperbilirrubinemia/etiologia , Terapia de Substituição Renal , Estudos Retrospectivos , Fatores de Risco
2.
Vasc Endovascular Surg ; 55(4): 355-360, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33535904

RESUMO

BACKGROUND: Adequate seal for thoracic endovascular aortic repair (TEVAR) commonly requires landing in zone 2, but can prove to be challenging due to the tortuous and angulated anatomy of the region. OBJECTIVES: Our objective was to determine the proximal landing accuracy of zone 2-targeted TEVARs following carotid-subclavian revascularization (CSR) and its impact on clinical outcomes. METHODS: Retrospective review of patients that underwent CSR for zone 2 endograft delivery at a tertiary institute between January 2008 and March 2018 was conducted. Technical outcomes were assessed by examining the incidence of intraoperative corrective maneuvers, 1a endoleaks and reinterventions. Distance to target and incidence of LSA stump filling were examined as radiographic markers of landing accuracy. RESULTS: Zone 2-targeted TEVAR with CSR was performed in 53 patients for treatment of dissections (49%), aneurysms (30%) or trauma (21%). Nine (17%) cases required intraoperative corrective procedures: 5 (9%) proximal cuffs due to type 1a endoleak and 4 (8%) left common carotid artery (LCCA) stenting due to inadvertent coverage. Cases performed using higher resolution hybrid fluoroscopy machine compared to mobile C-arm were associated with increased proximal cuff use (OR 8.8; 95% CI 1.2-62.4). Average distance between the proximal edge of the covered graft to LCCA was 8 ± 1 mm and larger distances were not associated with higher rates of 1a endoleak. Twenty-eight (53%) cases of antegrade LSA stump filling were noted on follow-up imaging, but were not associated with higher rates of reinterventions (OR 0.8, 95% CI [0.2-4.6]). Three (6%) patients had a stroke within 30 days and 4 (8%) patients expired within 1 month. Intraoperative corrective maneuvers, post-operative 1a endoleak and reinterventions were not associated with higher rates of stroke or mortality. CONCLUSION: Using current endografts and imaging modalities, zone 2-targeted TEVARs have suboptimal technical accuracy.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Artérias Carótidas/cirurgia , Procedimentos Endovasculares , Artéria Subclávia/cirurgia , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/fisiopatologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Endoleak/etiologia , Endoleak/mortalidade , Endoleak/terapia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Stents , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
3.
J Thorac Cardiovasc Surg ; 161(3): 873-884.e2, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33451835

RESUMO

OBJECTIVE: The study objective was to determine if hemiarch replacement is an adequate arch management strategy for patients with acute type A aortic dissection and arch branch vessel dissection but no cerebral malperfusion. METHODS: From January 2008 to August 2019, 479 patients underwent open acute type A aortic dissection repair. After excluding those with aggressive arch replacement (n = 168), cerebral malperfusion syndrome (n = 34), and indeterminable arch branch vessel dissection (n = 1), 276 patients with an acute type A aortic dissection without cerebral malperfusion syndrome who underwent hemiarch replacement comprised this study. Patients were then divided into those with arch branch vessel dissection (n = 133) and those with no arch branch vessel dissection (n = 143). RESULTS: The median age of the entire cohort was 62 years, with the arch branch vessel dissection group being younger (60 vs 62 years, P = .048). Both groups had similar aortic arch and descending thoracic aortic diameters, with significantly more DeBakey type I dissections (100% vs 80%) in the arch branch vessel dissection group. The arch branch vessel dissection group had more aortic root replacement (36% vs 27%, P = .0035) and longer aortic crossclamp times (153 vs 128 minutes, P = .007). Postoperative outcomes were similar between the arch branch vessel dissection and no arch branch vessel dissection groups, including stroke (10% vs 5%, P = .12) and operative morality (7% vs 5%, P = .51). The arch branch vessel dissection group had a significantly greater cumulative incidence of reoperation (8-year: 19% vs 4%, P = .04) with a hazard ratio of 2.89 (95% confidence interval, 1.01-8.27; P = .048), which was similar between groups among only DeBakey type I dissections (8-year: 19% vs 5%, P = .11). The 8-year survival was similar between the arch branch vessel dissection and no arch branch vessel dissection groups (76% vs 74%, P = .30). CONCLUSIONS: Hemiarch replacement was adequate for patients with acute type A aortic dissection with arch branch vessel dissection without cerebral malperfusion syndrome, but carried a higher risk of late reoperation.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Doença Aguda , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/fisiopatologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Circulação Cerebrovascular , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
Vasc Endovascular Surg ; 55(4): 332-341, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33371807

RESUMO

OBJECTIVE/BACKGROUND: This study examined the 10-year hospitalization characteristics, economic patterns and early clinical outcomes of type B aortic dissection (TBAD) patients that underwent thoracic endovascular aortic repair (TEVAR) in one high-volume hospital in China. METHODS: We performed a population-based retrospective analysis based on electronic medical record system data provided by Zhongshan Hospital Fudan University from 2009 to 2018. RESULTS: We identified 1,367 cases of TBAD patients with TEVAR over the past decade. The total incidence of in-hospital complications was 7.6% (104 of 1,367), among which acute kidney injury (AKI) had the highest incidence (3.1%, 42 of 1,367). Aortic-related reintervention was performed in 7 patients (0.5%). The overall aortic-related in-hospital mortality rate was 2.7% (37 of 1,367) and had no significant time-varying trend (P = 0.2). Among these, 27% of in-hospital deaths were caused by retrograde type A dissection (RTAD). Chronic TBAD had a higher risk of in-hospital death versus acute TBAD, with a risk ratio of 2.69 (95% confidence interval [CI]: 1.19-6.09). Patients with hypertension (risk ratio 4.63, 95% CI: 1.38, 15.54) also had a higher in-hospital death risk. These 2 factors were also the predictive factors for the composite endpoint of in-hospital adverse events (risk ratio 2.17, 95% CI: 1.43, 3.29 and risk ratio 4.83, 95% CI: 1.90, 12.28, respectively), in addition to Marfan syndrome (risk ratio 4.05, 95% CI: 1.61, 10.19). The average length of hospitalization significantly declined during the past decade (annual percentage change -6.3%, 95% CI -8.2 to -4.3), and the stent-grafts (SGs) cost was the main expenditure of the total hospitalization costs. CONCLUSION: Our study showed a favorable early outcome of TEVAR over the past decade. Greater attention should be paid to certain risk factors in order to reduce the in-hospital adverse events. SG expenditure is still the primary economic burden on Chinese TBAD patients.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/economia , Aneurisma Dissecante/mortalidade , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/economia , Aneurisma da Aorta Torácica/mortalidade , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/economia , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , China/epidemiologia , Registros Eletrônicos de Saúde , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/economia , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Custos Hospitalares , Mortalidade Hospitalar , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(45): e23008, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157946

RESUMO

Type A acute aortic dissection (TAAAD) carries a high mortality rate in the absence of surgical treatment. This study sought to determine whether combining the assessment of clinical and computed tomography (CT) findings can be used to predict the long-term all-cause mortality rate of patients with TAAAD.Eighty-five consecutive patients with TAAAD who had undergone CT imaging and surgery were retrospectively reviewed. For the clinical and CT findings, univariate testing followed by multivariate logistic regression analysis was conducted to identify independent predictors of death. Then, the area under the receiver operating characteristic curve of the combined prediction model was calculated.The long-term mortality rate was 34.1% in our cohort (a median follow-up period of 60 months). Multivariate logistic regression analysis identified the following presenting variables as predictors of death: male sex (odds ratio [OR]: 6.67; 95% confidence interval [CI]: 1.67-25.0; P = .007), kidney malperfusion (OR: 2.18; 95% CI: 1.16-4.1; P = .02), and descending aorta size (OR: 1.12; 95% CI: 1.00-1.25; P = .05). Receiver operating characteristic curve analysis revealed an area under the receiver operating characteristic curve of 0.84 when using the combined model for prediction of long-term all-cause mortality (P ≤ .01).The combined assessment of clinical and CT findings can reasonably predict the long-term prognosis of TAAAD with surgery.


Assuntos
Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/mortalidade , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Feminino , Seguimentos , Humanos , Rim/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores Sexuais , Tomografia Computadorizada por Raios X
6.
PLoS One ; 15(9): e0239801, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970774

RESUMO

While hospital admissions for myocardial infarction (MI) and pulmonary embolism (PE) are decreased during the COVID-19 pandemic, controversy remains about respective complication and mortality rates. This study evaluated admission rates, complications, and intrahospital mortality for selected life-threatening cardiovascular emergencies (MI, PE, and acute aortic dissection (AAD)) during COVID-19-associated restrictive social measures (RM) in Styria, Austria. By screening a patient information system for International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis codes covering more than 85% of acute hospital admissions in the state of Styria (~1.24 million inhabitants), we retrospectively identified patients with admission diagnoses for MI (I21, I22), PE (I26), and AAD (I71). Rates of complications such as cardiogenic shock and cardiopulmonary resuscitation, treatment escalations (thrombolysis for PE), and mortality were analyzed by patient chart review during 6 weeks following onset of COVID-19 associated RM, and during respective time frames in the years 2016 to 2019. 1,668 patients were included. Cumulative admissions for MI, PE and AAD decreased (RR 0.77; p<0.001) during RM compared to previous years. In contrast, intrahospital mortality increased by 65% (RR 1.65; p = 0.041), mainly driven by mortality following MI (RR 1.80; p = 0.042). PE patients received more frequently thrombolysis treatment (RR 3.63; p = 0.006), while rates of cardiogenic shock and cardiopulmonary resuscitation remained unchanged. Of 226 patients hospitalized during RM, 81 patients with suspected COVID-19 disease were screened for SARS-CoV-2 infection with only 5 testing positive. Thus, cumulative hospital admissions for cardiovascular emergencies decreased during COVID-19 associated RM while intrahospital mortality increased.


Assuntos
Aneurisma Dissecante/mortalidade , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Pneumonia Viral/epidemiologia , Embolia Pulmonar/mortalidade , Idoso , Idoso de 80 Anos ou mais , Áustria , Betacoronavirus , Serviço Hospitalar de Emergência/tendências , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos
7.
Asian Cardiovasc Thorac Ann ; 28(9): 577-582, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32819152

RESUMO

BACKGROUND: Decision-making regarding the operability of thoracic aortic disease in nonagenarian patients remains controversial because outcomes of open surgical repair of the thoracic aorta are unclear. We investigated the surgical and nonsurgical outcomes of acute thoracic aortic syndrome treatment in nonagenarians. METHODS: After evaluating data in our institute from April 2016 to March 2020, we included 10 nonagenarians who needed surgical intervention on the thoracic aorta via a median sternotomy for acute thoracic aortic syndrome. The mean age of the cohort was 91.9 ± 2.1 years. Five patients underwent open surgical repair of the thoracic aorta (surgical group), and 5 refused surgery (nonsurgical group). All patients in the surgical group performed activities of daily living independently, with a mean clinical frailty scale of 3.2 ± 0.4. The surgical group included 4 patients with type A aortic dissection and one with a ruptured thoracic aortic aneurysm. Hemiarch replacement was performed in 3 patients and total arch replacement in 2. The mean follow-up period was 17.8 ± 5.1 months. RESULTS: Hospital mortality rates were 0% in the surgical and 80% in the nonsurgical group. The mean length of hospitalization was 28.4 ± 6.7 days in the surgical group. The 1-year survival rates were 100% in the surgical group and 20% in the nonsurgical group. CONCLUSION: Open surgical repair for acute thoracic aortic syndrome via median sternotomy is a reasonable treatment option even in nonagenarians. Involvement of family members is important for decision-making to devise the optimal treatment strategy (surgical vs. medical).


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Esternotomia , Fatores Etários , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Tomada de Decisão Clínica , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Seleção de Pacientes , Complicações Cognitivas Pós-Operatórias/mortalidade , Medição de Risco , Fatores de Risco , Esternotomia/efeitos adversos , Esternotomia/mortalidade , Síndrome , Fatores de Tempo , Resultado do Tratamento
8.
Am J Emerg Med ; 38(9): 1820-1824, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32738476

RESUMO

BACKGROUND: Evidence regarding the characteristics and prognosis in acute type A aortic dissection (AAD) patients with negative D-dimer result is limited. We aimed to investigate the characteristics and prognosis in AAD patients with negative D-dimer result. METHODS AND RESULTS: 370 AAD patients within 24 h of symptom onset were enrolled in a hospital in China from January 2014 to December 2018. Nine (2.43%) and 361 (97.57%) exhibited negative and positive D-dimer results, respectively. The average age of nine negative D-dimer result participants was 47.67 ± 10.95 years old, and about seven (77.78%) of them were male. The negative group showed a significantly lower blood pressure, white blood cell, hemoglobin, activated partial thromboplastin, ejection fraction and symptom with pain than the positive group. Multivariate analysis showed white blood cell (×109/L) (P = 0.008; odds ratio, 0.566) and symptom with pain (P < 0.001; odds ratio, 0.013) were significantly related to a negative result. The result of the fully-adjusted model showed negative D-dimer result was negatively associated with in-hospital mortality compared with positive group in AAD patients after adjusting confounders (OR = 0.34, 95%CI 0.01 to 10.82). CONCLUSIONS: Negative D-dimer result is strongly influenced by white blood cell and symptom with pain. Negative D-dimer result was negatively associated with in-hospital mortality compared with positive group in AAD patients.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/sangue , Aneurisma Aórtico/mortalidade , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Biomarcadores/sangue , China/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Resultados Negativos , Prognóstico , Estudos Retrospectivos , Fatores de Risco
9.
Vasc Endovascular Surg ; 54(8): 676-680, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32729398

RESUMO

OBJECTIVES: Thoracic endovascular aortic repair (TEVAR) remains controversial in patients with connective tissue disorders given the concern for durability. We report on the largest series to date on outcomes of patients with thoracic aortic disease and connective tissue disorders treated with TEVAR. METHODS: The Vascular Quality Initiative registry identified 12 207 patients treated with TEVAR from January 2010 to December 2018, including 102 with Marfans, Ehlers-Danlos, or Loey-Dietz syndrome. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. RESULTS: Median age was 50.6 years (interquartile range: 57.0-75.0), and 62 (60.7%) were male. Eighty-eight (86.3%) patients had Marfan, 9 (8.8%) had Ehlers-Danlos, and 5 (4.9%) had Loey-Dietz syndrome. Twenty-six (25.5%) patients were treated for degenerative aneurysmal disease and 76 (74.5%) patients for type B dissections (33 acute, 31 chronic). Most common indications for interventions in patients with type B dissection were pain (n = 41), aneurysmal degeneration (n = 16), and malperfusion (n = 8), with 3 patients who presented ruptured. There was no significant difference in perioperative complications between acute/chronic dissections and aneurysms (P = .14). Percutaneous access was utilized in 61.7% of patients, with a 2.9% rate of arterial injury requiring reintervention. Follow-up data were available for 75 (73.3%) patients at a mean follow-up of 15.6 months. Overall mortality was 5.3%. There were 30 patients with follow-up endoleak data, and 8 (26.7%) endoleaks were identified. All endoleaks were in patients treated for acute type B dissection, and all resolved after a mean of 2.1 reinterventions. Three patients treated for acute Type B Aortic Dissection (TBAD) had retrograde dissections requiring intervention. DISCUSSION: Thoracic endovascular aortic repair for patients with connective tissue disorders can be performed with low perioperative mortality, spinal cord ischemia, or Cerebrovascular Accident (CVA). On follow-up, acute type B aortic dissections represent a higher risk subgroup with increased rates of endoleak and retrograde dissection. Closer follow-up for these patients and early reintervention may be beneficial.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Síndrome de Ehlers-Danlos/complicações , Procedimentos Endovasculares , Síndrome de Loeys-Dietz/complicações , Síndrome de Marfan/complicações , Adulto , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/mortalidade , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Ruptura Aórtica/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Síndrome de Loeys-Dietz/diagnóstico , Síndrome de Loeys-Dietz/mortalidade , Masculino , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/mortalidade , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
J Card Surg ; 35(10): 2663-2671, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32678967

RESUMO

BACKGROUND: We report our experience in aortic arch repair with the E-vita Open hybrid prosthesis and describe the changes in our technique over time. METHODS: Between October 2013 and December 2019, 56 patients underwent a total aortic arch replacement with the E-vita Open hybrid prosthesis. The main indications were thoracic aorta aneurysm (n = 27) and acute type A aortic dissection (n = 18). We analyze the technique and results in the overall series, and compare both between our early (group I, 25 patients) and late experience (group II, 31 patients). RESULTS: Overall in-hospital mortality was 7.1% (n = 4), and permanent stroke and spinal cord injury were 3.6% and 1.8%, respectively. Fifteen patients (26.8%) underwent a planned second procedure on the distal aorta: 13 endovascular, 1 open, and 1 hybrid. Survival at 1 and 3 years was 90.7% and 80.7%, respectively. Group II included more patients with acute dissection (45.2% vs 16%, P = .02), higher rates of bilateral cerebral perfusion (100% vs 64%, P < .001), left subclavian artery perfusion during lower body circulatory arrest (87.1% vs 0%, P < .001), early reperfusion (96.8% vs 40%, P < .001), and zone 0 to 2 distal anastomosis (100% vs 72%, P = .02). In-hospital mortality (3.2% vs 12%) and permanent stroke (0% vs 8%) tended to be lower in group II. CONCLUSIONS: Total arch replacement with E-vita Open hybrid prosthesis in complex thoracic aorta disease is safe. One-stage treatment is feasible when pathology does not extend beyond the proximal descending thoracic aorta. In any case, it facilitates subsequent procedures on distal aorta if needed.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Idoso , Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/mortalidade , Estudos de Viabilidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Segurança , Resultado do Tratamento
12.
Surgery ; 168(1): 185-192, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32507629

RESUMO

BACKGROUND: Acute type A aortic dissection is a cardiovascular emergency requiring operative intervention. Despite advancements in operative technique and increased specialization of cardiovascular care, operative mortality, and morbidity after repair of type A aortic dissection remain high. Our aim was to assess national trends in outcomes of type A aortic dissection repair and the impact of institutional thoracic aortic repair volume on clinical outcomes and resource use in the United States. METHODS: Using the procedural and diagnostic codes of the International Classification of Diseases, Ninth Revision, we identified type A aortic dissection repairs from the 2005 to 2014 database of the National Inpatient Sample. Hospitals were classified into low-, medium- and high-volume tertiles based on annual incidence of thoracic aortic operations. Patient demographics and hospital characteristics, as well as outcomes including mortality, cost, and duration of stay, were evaluated using parametric tests for trends and the volume-outcome relationship. We used a multivariable-adjusted logistic regression model to identify factors associated with mortality. RESULTS: An estimated 25,231 patients received type A aortic dissection repair with an increasing temporal trend in volume and concomitant decrease in mortality. When stratified by hospital volume, 10,115 (40.1%), 8,194 (32.4%), and 6,920 (27.4%) underwent type A aortic dissection at low-volume, medium-volume, and high-volume, respectively. The unadjusted mortality rate in high-volume was the least (21.5% vs 16.8% vs 11.6% for low-volume, medium-volume, and high-volume, respectively; P < .001). Multivariable analysis revealed older age, lesser household incomes and comorbidities, including congestive heart failure (adjusted odds ratio 1.44; P < .001) and coagulopathy (adjusted odds ratio 1.33; P = .01) as statistically significant predictors of mortality; however, the risk-adjusted duration of stay (adjusted odds ratio 0.88; P = .06) was not different between low-volume and high-volume hospitals. After adjusting for patient and hospital characteristics, type A aortic dissection repair at low-volume hospitals was associated with increased likelihood of mortality compared with high-volume hospitals (adjusted odds ratio 2.10; P < .001). Patients undergoing type A aortic dissection repair at low-volume hospitals had increased odds of all complications including stroke, and respiratory complications compared than those at high-volume hospitals (P = .02, P < .001, and P < .001, respectively). CONCLUSION: The volume of open surgical repair for type A aortic dissection in the United States has increased over the past decade, while mortality has decreased. Hospital aortic operative volume is strongly associated with outcomes for type A aortic dissection repair. Protocols for expeditious transfer of patients to high volume aortic centers may serve to further decrease the acute mortality and complications of this procedure.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/patologia , Aorta/patologia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/mortalidade , Aneurisma Aórtico/patologia , Feminino , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia
13.
Ann Vasc Surg ; 69: 62-73, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32561245

RESUMO

BACKGROUND: The aim of the study was to analyze aortic-related outcomes after diagnosis of aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) from a population-based approach. METHODS: Retrospective review of an incident cohort of AD, IMH, and PAU patients in Olmsted County, Minnesota from 1995 to 2015. Primary end point was aortic death. Secondary end points were subsequent aortic events (aortic intervention, new dissection, or rupture not present at presentation) and first-time diagnosis of an aortic aneurysm. Outcomes were compared with randomly selected population referents matched for age and sex in a 3:1 ratio using Cox proportional hazards regression adjusting for comorbidities. RESULTS: Among 133 patients (77 AD, 21 IMH, and 35 PAU), 57% were males, and mean age was 71.8 years (standard deviation, 14). Median follow-up was 10 years. Of 73 deaths among AD/IMH/PAU patients, 23 (32%) were aortic-related. Estimated freedom from aortic death was 84%, 80%, and 77% at 5, 10, and 15 years. There were no aortic deaths among population referents (adjusted hazard ratio [HR] for aortic death in AD/IMH/PAU, 184.7; 95% confidence interval [95% CI], 10.3-3,299.2; P < 0.001). Fifty (38%) AD/IMH/PAU patients had a subsequent aortic event (aortic intervention, new dissection, or rupture), whereas there were 8 (2%) aortic events among population referents (all elective aneurysm repairs; adjusted HR for any aortic event and aortic intervention in AD/IMH/PAU patients, 33.3; 95% CI, 15.3-72.0; P < 0.001 and 31.5; 95% CI, 14.5-68.4; P < 0.001, respectively). After excluding aortic events/interventions ≤14 days of diagnosis, AD/IMH/PAU patients remained at increased risk of any aortic event (adjusted HR, 10.8; 95% CI, 3.9-29.8; P < 0.001) and aortic intervention (adjusted HR, 9.6; 95% CI, 3.4-26.8; P < 0.001). Among those subjects with available follow-up imaging, the risk of first-time diagnosis of aortic aneurysm was significantly increased for AD/IMH/PAU patients when compared with population referents (adjusted HR, 10.9; 95% CI, 5.4-21.7; P < 0.001 and 8.3; 95% CI, 4.1-16.7; P < 0.001 for thoracic and abdominal aneurysms, respectively) and remained increased when excluding aneurysms that formed within 14 days of AD/IMH/PAU (adjusted HR, 6.2; 95% CI, 1.8-21.1; P = 0.004 and 2.8; 95% CI, 1.0-7.6; P = 0.040 for thoracic and abdominal aneurysms, respectively). CONCLUSIONS: AD/IMH/PAU patients have a substantial risk of aortic death, any aortic event, aortic intervention, and first-time diagnosis of aortic aneurysm that persists even when the acute phase (≤14 days after diagnosis) is uncomplicated. Advances in postdiagnosis treatment are necessary to improve the prognosis in these patients.


Assuntos
Aneurisma Dissecante/epidemiologia , Aneurisma Aórtico/epidemiologia , Doenças da Aorta/epidemiologia , Hematoma/epidemiologia , Úlcera/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/mortalidade , Aneurisma Aórtico/terapia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/mortalidade , Doenças da Aorta/terapia , Progressão da Doença , Feminino , Hematoma/diagnóstico por imagem , Hematoma/mortalidade , Hematoma/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Úlcera/diagnóstico por imagem , Úlcera/mortalidade , Úlcera/terapia
14.
J Cardiothorac Surg ; 15(1): 145, 2020 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-32552706

RESUMO

BACKGROUND: Although gender-related disparities in cardiovascular surgery have been investigated extensively in the past decades, knowledge about the impact of gender on outcomes after surgery for acute aortic dissection type A (AADA) is sparse. This study investigated the impact of gender on early morbidity and mortality and follow-up outcome in patients after surgery for AADA and to analyze gender-related risk factors for 30-day mortality. METHODS: This retrospective study included 368 consecutive patients (male 65.8% vs. female 34.2%) undergoing surgery for AADA between 2001 and 2016 at our department. Survival was estimated by Kaplan-Meier curves. Risk factors for 30-day mortality were assessed by multivariable logistic regression and interaction analysis. RESULTS: Women were older (70.7 years vs. 60.6 years; p <  0.001) and showed a higher logistic EuroSCORE I (31.0% vs. 19.7%, p <  0.001). In the male group, a higher portion of smokers (27.6% vs. 16.0%, p = 0.015) and intraoperatively, more complex procedures and longer cardiopulmonary bypass (CPB) (171 min vs. 149 min, p = 0.001) and cross-clamping times (94 min vs. 85 min, p = 0.018) occurred. 30-day mortality was 19.0% in the female and 16.5% in the male group (p = 0.545). Predictive for 30-day mortality in both genders was intraoperative blood transfusion, while in the female group chronic obstructive pulmonary disease (COPD), peripheral arterial disease and preoperative intubation were predictive. Preoperative cardiopulmonary resuscitation and duration of CPB time were predictors only in males. Averaged follow-up time was 5.2 years and survival did not differ between genders, even if it was stratified by age over 70 years. CONCLUSIONS: This analysis demonstrated a similar and satisfactory survival in both genders after surgical treatment of AADA. Women and men differed significantly in age, unadjusted and adjusted risk factors and complexity of surgical treatment, but gender itself was no risk factor for mortality. These results suggest that the decision-making for surgical treatment should not depend on gender, but that accounting for sex-specific risk factors rather than common risk factors may help to improve the outcome in both genders.


Assuntos
Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/cirurgia , Procedimentos Cirúrgicos Cardíacos , Fatores Sexuais , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , Ponte Cardiopulmonar , Reanimação Cardiopulmonar , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Doença Arterial Periférica/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Estudos Retrospectivos , Fatores de Risco , Fumar , Resultado do Tratamento
15.
Ann Vasc Surg ; 69: 17-26, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32505683

RESUMO

BACKGROUND: The aim of our study is to examine the perioperative outcomes of carotid-subclavian bypass or transposition (CS-BpTp) versus endovascular techniques (ETs) for left subclavian artery (LSA) revascularization during nontraumatic zone 2 thoracic endovascular aortic repair (TEVAR). METHODS: We used prospectively collected data from the Society for Vascular Surgery Vascular Quality Initiative (VQI) to identify patients who had undergone TEVAR at participating centers (2013-2018). Patients were eligible for inclusion if they had undergone nontraumatic zone 2 TEVAR and concomitant LSA revascularization. Our main exposure of interest was LSA revascularization technique, CS-BpTp, or any ET. If a patient underwent multiple TEVAR procedures during the study period, the first case involving zone 2 was used for analysis. Preoperative patient characteristics were reviewed between treatment groups. The primary outcomes were mortality, transient ischemic attack (TIA)/stroke, and spinal cord ischemia (SCI). All outcomes were assessed up to 30 days postoperatively. RESULTS: A total of 837 patients were included in the study. The pathologies most frequently treated were aneurysm in 248 (34%) and dissection in 326 (45%). Overall, 721 subjects (86%) underwent CS-BpTp while 116 subjects (16%) underwent ETs. The latter included the following techniques: 23 chimney grafts, 3 scallops, 15 fenestrated grafts, and 75 branched grafts. Mortality was equal at 3% for both groups (P = 0.67). The rate of TIA/stroke was not significantly different in both groups (5.5% vs. 5%, P = 0.78). Similarly, the rate of SCI was 3% in the entire cohort without significant differences seen between treatment groups (P = 1). Multivariate logistic regression could not identify either CS-BpTp or ETs as independent predictors for death or TIA/stroke. CONCLUSIONS: Within VQI, LSA revascularization during nontraumatic zone 2 TEVAR is safely and effectively achieved with either CS-BpTp or ETs across all nontraumatic thoracic aortic diseases. These techniques appear to be associated with similar perioperative outcomes in selected patients with low rates of mortality and major neurologic morbidity. Although no differences were seen in the proportion of early type I or III endoleaks, further prospective studies are warranted to elucidate the long-term durability of ETs compared with CS-BpTp.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Artérias Carótidas/cirurgia , Procedimentos Endovasculares , Artéria Subclávia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Canadá , Artérias Carótidas/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Isquemia do Cordão Espinal/etiologia , Acidente Vascular Cerebral/etiologia , Artéria Subclávia/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
16.
Vasc Endovascular Surg ; 54(6): 510-518, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32436464

RESUMO

PURPOSE: Patients who have survived an acute aortic dissection remain at risk for postdissection thoracoabdominal aortic aneurysms (PD-TAAAs). Fenestrated/branched endovascular repair for PD-TAAA is increasingly used in some high-volume centers, but outcomes are still limited because of the additional challenges compared to atherosclerotic thoracoabdominal aneurysms. This study was performed to evaluate the literature on fenestrated/branched endovascular repair for PD-TAAAs. METHODS: PubMed, Embase, and the Cochrane Database were searched for relevant studies published until September 2019. Outcome data were extracted to evaluate the technical success, 30-day mortality, later survival, major complications, endoleaks, target vessel patency, and reintervention. Studies were analyzed in a pooled proportion meta-analysis. RESULTS: In total, 143 patients from 4 studies were identified for the pooled data analysis. The pooled technical success rate was 98% (95% CI: 86%-100%). After the treatment, the overall estimated 30-day mortality rate was 3% (95% CI: 1%-8%), early spinal cord ischemia rate was 10% (95% CI: 4%-21%), early renal injury rate was 5% (95% CI: 1%-19%), endoleak rate was 33% (95% CI: 22%-47%), reintervention rate at a median follow-up of 22.5 months was 34% (95% CI: 27%-42%), and all-cause mortality rate was 12% (95% CI: 6%-24%). CONCLUSIONS: The use of fenestrated/branched stent grafts for the treatment of PD-TAAA appears generally feasible based on the limited literature, but endoleaks and reinterventions are frequent.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Reoperação , Fatores de Risco , Resultado do Tratamento
17.
Vascular ; 28(6): 675-682, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32396495

RESUMO

OBJECTIVES: Open repair is still the first choice for thoraco-abdominal and para-renal aortic aneurysms, but surgical treatment is burdened by significant morbidity and mortality, especially in urgent setting. Endovascular treatment by fenestrated or branched endografts is feasible and safe; but in urgent/emergent settings, custom-made endografts are hardly available in due time, and the repair with standard multibranched devices is still debated in cases with complex anatomy. Parallel grafting, on the other hand, which exploits covered stents to preserve patency of the visceral vessels, has been shown as a valuable option and can be performed in urgency, though some concerns still remain regarding its durability and complications. The purpose of this case series is to review the outcomes of all consecutive cases of complex aortic diseases treated with this technique in emergent/urgent setting. MATERIALS AND METHODS: All cases of endovascular aortic repair of thoraco-abdominal and para-thoraco-abdominal performed in urgency or emergency from 2016 to June 2019 were retrospectively reviewed, recording clinical records, operative technique, primary technical success, and long-term outcomes. Each patient was followed-up by computed tomography angiography three months after the procedure and yearly thereafter. RESULTS: Twenty consecutive patients (median age: 68, range: 47-89, male/female ratio: 16:4) affected by para-thoraco-abdominal (12) or thoraco-abdominal (8) were treated in urgent or emergent setting by chimney and/or periscope technique. A total number of 37 visceral vessels were stented (29 renal arteries, 1 polar artery of the kidney, 3 superior mesenteric arteries, and 4 coeliac trunks). Primary technical success was 100%, with one perioperative death. One patient died on post-operative month III for unrelated cause. Two type II endoleaks were detected at the first post-operative imaging studies and were managed conservatively. One type IB endoleak was treated by endovascular repair with a custom-made endograft (overall re-intervention rate: 5%). Over a median 22 months follow-up (range: 4-40, interquartile range: 12 months), all stentgrafts were patent. CONCLUSION: Parallel graft is a feasible and safe option that should be considered in urgent and emergent treatment of para-thoraco-abdominal and thoraco-abdominal, when fenestrated and branched endografts cannot be used.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Endoleak/etiologia , Endoleak/terapia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
J Cardiothorac Surg ; 15(1): 100, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32414388

RESUMO

OBJECTIVE: The study objective was to investigate the incidence and risk factors of continuous renal replacement therapy (CRRT) in patients undergoing emergency surgery for type A acute aortic dissection (TA-AAD) and evaluate the perioperative and long-term outcomes. METHODS: From January 2014 to December 2018, 712 consecutive patients were enrolled in the study. These patients were divided into two groups according to whether or not needed postoperative CRRT: the CRRT group vs the control group. Univariate analysis and binary logistic regression analysis were used to analyze the risk factors of CRRT. To avoid the selection bias and confounders, baseline characteristics were matched for propensity scores. Kaplan-Meier curves were generated to provide survival estimates at postoperative points in time. RESULTS: Before propensity score matching, univariate analysis showed that there were significant differences in age, preoperative hypertension, pericardial effusion, preoperative serum creatinine (sCr), intraoperative need for combined coronary artery bypass grafting (CABG) or mitral valve or tricuspid valve surgery, cardiopulmonary bypass (CPB) time, extracorporeal circulation assistant time, aortic cross-clamp time, drainage volume 24 h after surgery and ventilator time between two groups. All were higher in the CRRT group (P < 0.05). These risk factors were included in binary logistic regression. It showed that preoperative sCr and CPB time were independent risk factors for CRRT patients undergoing surgery for TA-AAD. And there were significant differences regarding 30-day mortality (P < 0.001) and long-term overall cumulative survival (P < 0.001) with up to a 6-year follow-up. After propensity scoring, 29 pairs (58 patients) were successfully matched. Among these patients, the analysis showed that CPB time was still significantly longer in the CRRT group (P = 0.004), and the 30-day mortality rate was also higher in this group (44.8% vs 10.3%; P = 0.003). CONCLUSION: CRRT after TA-AAD is common and worsened short- and long- term mortality. The preoperative sCr and CPB time are independent risk factors for postoperative CRRT patients. Shorten the CPB time as much as possible is recommended to reduce the risk of CRRT after the operation.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Valva Mitral/cirurgia , Terapia de Substituição Renal/efeitos adversos , Adulto , Idoso , Aneurisma Dissecante/mortalidade , Procedimentos Cirúrgicos Cardíacos/mortalidade , Ponte de Artéria Coronária/mortalidade , Creatinina/sangue , Tratamento de Emergência/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Pontuação de Propensão , Terapia de Substituição Renal/mortalidade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
19.
Vasc Endovascular Surg ; 54(4): 333-340, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32270757

RESUMO

PURPOSE: This study was performed to investigate the long-term effect of chimney technique using balloon-expandable bare-metal stents (BMSs) to preserve the supra-arch branches in type B aortic dissection (TBAD). METHODS: Fifty patients with TBAD treated by thoracic endovascular aortic repair with the chimney technique (chTEVAR) using balloon-expandable BMSs from July 2009 to December 2013 were retrospectively assessed. Follow-up computed tomography angiography was performed to assess the postoperative outcomes. The primary end point was a persistent type Ia endoleak (ELIa). The secondary endpoints were chimney stent (CS)-based complications (stenosis, occlusion, fracture, or transposition), all-cause mortality, reintervention, and stroke. RESULTS: Fifty supra-arch branches (left common carotid artery, n = 11; left subclavian artery, n = 39) were preserved via the chimney technique with 50 balloon-expandable BMSs. The technical success rate was 100%. An immediate ELIa was discovered in 9 (18%) patients. The median survival duration during follow-up was 77.3 months. Five (10%) patients had a persistent ELIa; 3 of these patients had an immediate ELIa. Asymptomatic CS-based complications were found in 3 (6%) patients. The all-cause mortality rate was 8% (4/50); 2 deaths were aortic-related deaths. Five (10%) patients underwent a reintervention. During the estimated 36-month survival period, the survival rate, the rate of freedom from persistent ELIa, and the rate of freedom from reintervention were 93.87%, 89.48%, and 95.56%, respectively. CONCLUSIONS: The long-term outcomes showed that chTEVAR using balloon-expandable BMSs was safe and feasible for preservation of the supra-arch branches. Evaluation of more patients with a longer follow-up period is needed.


Assuntos
Aneurisma Dissecante/cirurgia , Angioplastia com Balão/instrumentação , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Metais , Stents , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/mortalidade , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Intervalo Livre de Progressão , Desenho de Prótese , Retratamento , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
20.
J Card Surg ; 35(7): 1425-1430, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32340068

RESUMO

BACKGROUND AND AIM: Acute type A aortic dissection (AAAD) is a life-threatening condition. The emergency operation usually results in 20% perioperative mortality. If preoperative cardiopulmonary resuscitation (CPR) is necessary, there is an increase in the rate of mortality. The aim of the present study was to report the outcomes of AAAD surgery in patients requiring preoperative CPR in a high-volume center. METHODS: A retrospective analysis of preoperative, intraoperative, postoperative, and follow-up data in patients requiring preoperative CPR in the setting of AAAD surgery was performed. RESULTS: Between January 2006 and December 2018, 637 patients underwent emergency surgery for AAAD. In total, 26 (4%) patients received CPR; the mean age was 63 ± 13 years; and 18 were male (69%). The reason for CPR was acute tamponade (N = 14, 54%), pulseless electrical activity (N = 5, 19%), asystole or ventricular fibrillation (N = 7, 27%), and four (15%) patients were not operated due to prolonged CPR and severe initial neurological impairment. There was no intraoperative mortality. The in-hospital mortality rate was 50% (N = 11), due to severe cerebral damage confirmed by computed tomography, and six patients (55%) were older than 70 years. The median follow-up was 35 months (7-149), which was 100% complete; two patients had permanent hemiplegia, one had anterior spinal syndrome, and other two died during the follow-up. The overall survival rate was 41% (n = 9). CONCLUSION: Surgery outcomes were still reasonable in AAAD patients requiring preoperative CPR in a high-volume center.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Reanimação Cardiopulmonar/estatística & dados numéricos , Cuidados Pré-Operatórios/estatística & dados numéricos , Doença Aguda , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/complicações , Aneurisma Aórtico/mortalidade , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/terapia , Seguimentos , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia
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