Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database

Autor:	Paramita S. Chaudhuri, Gorav Ailawadi, Vinod H. Thourani, Teng C. Lee, Zachary Kon, J. Matthew Brennan, G. Chad Hughes, Brian R. Englum, James S. Gammie, Matthew L. Williams, Maria V. Grau-Sepulveda, Sunghee Kim, Faisal H. Cheema, Lars G. Svensson
Rok vydání:	2018
Předmět:	Male Pulmonary and Respiratory Medicine medicine.medical_specialty Resuscitation 030204 cardiovascular system & hematology law.invention Cohort Studies 03 medical and health sciences Postoperative Complications Sex Factors 0302 clinical medicine Hypothermia Induced law Catheterization Peripheral medicine Humans Cerebral perfusion pressure Stroke Aged Aortic dissection business.industry Cardiovascular Surgical Procedures Cardiogenic shock Age Factors Length of Stay Middle Aged medicine.disease Intensive care unit Aortic Aneurysm Cardiac surgery Aortic Dissection Treatment Outcome Databases as Topic 030228 respiratory system Anesthesia Acute Disease North America Cohort Female Surgery Morbidity Cardiology and Cardiovascular Medicine business
Zdroj:	Journal of Cardiac Surgery. 33:7-18
ISSN:	0886-0440
DOI:	10.1111/jocs.13511
Popis:	Purpose Management of acute type A aortic dissection (AAAD) is challenging and operative strategies are varied. We used the STS Adult Cardiac Surgery Database (STS ACSD) to describe contemporary surgical strategies and outcomes for AAAD. Methods Between July 2011 and September 2012, 2982 patients with AAAD underwent operations at 640 centers in North America. Results In this cohort, median age was 60 years old, 66% were male, and 80% had hypertension. The most common arterial cannulation strategies included femoral (36%), axillary (27%), and direct aortic (19%). The median perfusion and cross-clamp times were 181 and 102 min, respectively. The lowest temperature on bypass showed significant variation. Hypothermic circulatory arrest (HCA) was used in 78% of cases. Among those undergoing HCA, brain protection strategies included antegrade cerebral perfusion (31%), retrograde cerebral perfusion (25%), both (4%), and none (40%). Median HCA plus cerebral perfusion time was 40 min. Major complications included prolonged ventilation (53%), reoperation (19%), renal failure (18%), permanent stroke (11%), and paralysis (3%). Operative mortality was 17%. The median intensive care unit and hospital length of stays were 4.7 and 9.0 days, respectively. Among 640 centers, the median number of cases performed during the study period was three. Resuscitation, unresponsive state, cardiogenic shock, inotrope use, age >70, diabetes, and female sex were found to be independent predictors of mortality. Conclusions These data describe contemporary patient characteristics, operative strategies, and outcomes for AAAD in North America. Mortality and morbidity for AAAD remain high.
Databáze:	OpenAIRE
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