Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications, Cardiovascular/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Dissection/diagnostic imaging , Pregnancy Complications, Cardiovascular/surgery , Tomography, X-Ray Computed , Ultrasonography , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Marfan Syndrome/complicationsSubject(s)
Humans , Male , Middle Aged , Aortic Valve Insufficiency/pathology , Aortic Aneurysm, Abdominal/pathology , Heart Failure/psychology , Hypertension/pathology , Aortic Dissection/pathology , Aortic Valve Insufficiency/diagnostic imaging , Aortography , Radiography, Thoracic , Aortic Aneurysm, Abdominal/diagnostic imaging , Fatal Outcome , Electrocardiography , Pulmonary Infarction , Aortic Dissection/diagnostic imagingABSTRACT
Abstract Introduction: Hypothermic circulatory arrest is widely used for correction of acute type A aortic dissection pathology. We present our experience of 45 consecutive patients operated in our unit with bilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest. Methods: Between January 2011 and April 2015, 45 consecutive patients were admitted for acute type A aortic dissection and operated emergently under moderate hypothermic circulatory arrest and bilateral antegrade cerebral perfusion. Results: Mean age was 58±11.4 years old. Median circulatory arrest time was 41.5 (30-54) minutes while the 30-day mortality and postoperative permanent neurological deficits rates were 6.7% and 13.3%, respectively. Unadjusted analysis revealed that the factors associated with 30-day mortality were: preoperative hemodynamic instability (OR: 14.8, 95% CI: 2.41, 90.6, P=0.004); and postoperative requirement for open sternum management (OR: 5.0, 95% CI: 1.041, 24.02, P=0.044) while preoperative hemodynamic instability (OR: 8.8, 95% CI: 1.41, 54.9, P=0.02) and postoperative sepsis or multiple organ dysfunction (OR: 13.6, 95% CI: 2.1, 89.9, P=0.007) were correlated with neurological dysfunction. By multivariable logistic regression analysis, postoperative sepsis and multiple organ dysfunction independently predicted (OR: 15.9, 95% CI: 1.05, 96.4, P=0.045) the incidence of severe postoperative neurological complication. During median follow-up of 6 (2-12) months, the survival rate was 86.7%. Conclusion: Bilateral antegrade cerebral perfusion and direct carotid perfusion for cardiopulmonary bypass, in the surgical treatment for correction of acute aortic dissection type A, is a valuable technique with low 30-day mortality rate. However, postoperative severe neurological dysfunctions remain an issue that warrants further research.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aortic Aneurysm/surgery , Brain/blood supply , Cardiopulmonary Bypass/methods , Reperfusion/methods , Circulatory Arrest, Deep Hypothermia Induced/methods , Aortic Dissection/surgery , Aortic Aneurysm/mortality , Postoperative Complications , Time Factors , Cardiopulmonary Bypass/adverse effects , Cardiopulmonary Bypass/mortality , Reperfusion/adverse effects , Reperfusion/mortality , Logistic Models , Acute Disease , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , Circulatory Arrest, Deep Hypothermia Induced/adverse effects , Circulatory Arrest, Deep Hypothermia Induced/mortality , Hemodynamics , Aortic Dissection/mortality , Nervous System Diseases/etiologyABSTRACT
Objective To investigate the risk factors for neurological complications after deep hypothermic ciculatory arrest (DHCA) operation.Methods From January 2009 to October 2013, 70 patients who were diagnosed as aortic dissection or aortic an-eurysm underwent aortic operations under DHCA .According to the occurrence of neurological complications after surgery , patients were divided into neurological complication group (26 patients) and normal group (44 patients).Risk factors of neurological complications after surgery were evaluated by univariate analysis and multivariate logistic regression analysis .Results Central neurological compli-cations occurred in 26 patients (37.14%) , including 18 patients with temporary neurological dysfunction and 7 patients with perma-nent neurological dysfunction , 1 patient with paraplegia , 1 patient died of cerebral infarction .Univariate analysis showed that hyperten-sion disease( P =0.001), emergency surgery within 72 hours( P =0.009),cardiopulmonary bypass time ( P =0.015),antegrade se-lective cerebral perfusion ( ASCP) ( P =0.005 ) , hemodilution degree ( P =0.001 ) , erythrocyte ( P =0.033 ) and plasma ( P =0.034 ) transfusion volume in the perioperative period , oxygen index <200 mmHg in 4 hours postoperatively ( P =0.043 ) , arterial blood pressure instability ( P =0.037 ) and hypernatremia in 24 hours postoperatively ( P =0.001 ) , and the Acute Physiology And Chronic Health Evaluation II (APACHE II) score are the risk factors for central neurological complication .Hypertension disease( P =0.017 ) , emergency surgery within 72 hours ( P =0.048 ) , ASCP ( P =0.015 ) , hypernatremia in 24 hours postoperatively ( P =0.008 ) were independent determinats for central neurological complication .Conclusions A series of procedure including evaluating patients condition correctly before operation , controlling hypertension effectively in the perioperative period , applying the ASCP and the suitable hemodilution degree in operation , maintaining electrolyte balance , and correcting hypernatremia timely in the postoperative pe-riod maybe reduce the incidence of neurological complications after DHCA operation .
ABSTRACT
Objective To explore the misunderstanding and comprehension of hybrid operation for treating aortic dissection involving aortic arch.Methods From March 2009 to November 2013,13 patients received hybrid operation for aortic dissection involving aortic arch in the People's Hospital of Xinjiang Urgur Autonomous Region were enrolled,including male 11 and female 2,and aged 36 ～ 60 years old with a mean age (44 ± 6.8) years old.All patients were type-B aortic dissection.All of them were not suitable to be treated with endovascular exclusion monotherapy.The ascending aorta-brachiocephalic artery bypass and left carotid artery bypass was established with median sternotomy approach and neck incision in 13 patients,and 2 patients did left subclavian artery bypass additionally,then retrograde endovascular stent graft implantation was used.Computed tomography angiography (CTA) scanning at 3-month,9-month,1-year and every-year after operation showed no stent grafts translocation and bypass graft obstruction.Results The surgical operation and stent grafts implantation were completely successful.Angiography showed 1 case had end leakage and other cases no obvious displacement or end leakage of stent grafts in operation.Blood flow in true lumen of aortic dissection was recovered and all of bypass grafts were unobstructed.No death and severe complications occurred.All patients were followed-up with 3 to 56 months [(29.0 ± 10.2) months],and all patients resumed normal life.Enhanced CT scanning after operation showed 1 case had endoleak and other cases no endoleak,stent grafts translocation and bypass graft obstmction.No signs of brain and limb ischemia were observed.Conclusions To summarize misunderstanding and experience by continuous explore feature of hybrid operation for treating disease involving aortic arch,we developed a more reasonable surgical treatment options that can improve the success rate of complex aortic dissection surgery,and ultimately achieve better surgical results.