Short-term outcomes of a novel modified Bentall procedure in acute type A aortic dissection.

BACKGROUND: The Bentall procedure is a common surgical treatment for aortic root replacement in acute type A aortic dissection (ATAAD) with some complications which affect postoperative efficacy. We innovatively modified the Bentall procedure and investigated its short-term efficacy. METHODS: From March 2017 to March 2019, 77 cases with ATAAD in our department underwent total arch replacement and frozen elephant trunk technique following prior Bentall procedure. They were divided into three groups. In modified-Bentall group, 20 patients underwent a modified Bentall surgery. In Bentall-inclusion group, coronary ostia inclusion anastomosis and Cabrol shunt were performed in 32 patients. In Bentall-button group, coronary ostia button anastomosis was used to 25 cases. RESULTS: No intraoperative deaths occurred in three groups. Operation time, CPB time, and aortic cross-clamp time in modified-Bentall group was longer than those in Bentall-inclusion group (P<0.05), but the number of RBC transfusion and postoperative drainage volume decreased compared with Bentall-button group (P<0.05). One patient with mesenteric malperfusion syndrome died after surgery in modified-Bentall group, 2 patients died in Bentall-inclusion group, and 1 patient died in Bentall-button group. No coronary anastomotic leak and vena cava-right atrium shunt signal occurred in modified-Bentall group, and there was no contrast extravasation and no pseudoaneurysm formation in the aortic root. The cardiac function of patients was grade I-II. CONCLUSIONS: This novel modified procedure is feasible and can significantly reduce postoperative complications with satisfactory short-term efficacy in ATAAD.

Early outcomes of Stanford type A aortic dissection under the coronavirus disease 2019 (COVID-19) pandemic: a multicentre study from Hubei province.

OBJECTIVES: Our goal was to compare the short-term outcomes of Stanford type A aortic dissection (TAAD), during the coronavirus disease 2019 (COVID-19) pandemic with those during normal times and summarize our perioperative management experience of patients with TAAD in the context of COVID-19. METHODS: From 17 January 2020 to 8 March 2020, a total of 27 patients with TAAD were operated on in 8 cardiovascular surgery centres in Hubei Province (COVID-19 group). The data from 91 patients with TAAD from the same centres during the same period last year were extracted from the Hubei Cardiac Surgery Registration System (control group). A propensity score matched subgroup of 26 pairs (1:2) was identified. Perioperative data and short-term outcomes were assessed. RESULTS: Nine patients in the COVID-19 group were categorized as suspicious for the disease (9/27, 33.3%), and others were excluded (18/27, 66.7%). No one was laboratory confirmed preoperatively. The average waiting, cross-clamp and circulatory arrest times were longer in the COVID-19 group (22.9 ± 8.3 vs 9.7 ± 4.0 h, P < 0.001; 135 ± 36 vs 103 ± 45 min, P = 0.003; 24 ± 9 vs 17 ± 8 min, P < 0.001, respectively). The 30-day or in-hospital deaths were 3.8% in both groups (P = 1.0). The COVID-19 group was associated with longer ventilation and intensive care unit times (81 ± 71 vs 45 ± 19 h, P < 0.001; 7.4 ± 3.8 vs 4.5 ± 2.7 days; P < 0.001, respectively). There were no statistical differences between the 2 groups in the incidence of complications such as stroke, neurological deficit, acute kidney injury, pulmonary infection and reoperation. Serum antibody tests for those patients showed 7 out of 9 suspected cases were Immunoglobulin G positive. No cross-infection occurred in other patients or associated medical staff. CONCLUSIONS: With adequate preparation and appropriate protection, satisfactory early outcomes can be achieved after emergency operations for patients with TAAD during the COVID-19 pandemic.