Long-term outcome and quality of life following emergency surgery for acute aortic dissection type A: a comparison between young and elderly adults.

Objectives: Innovations in surgical techniques and perioperative management have continuously improved survival rates for acute aortic dissection type A (AADA). The aim of our study was to evaluate long-term outcome and quality of life (QoL) after surgery for AADA in elderly patients compared with younger patients. Methods: We retrospectively evaluated 242 consecutive patients, who underwent surgery for AADA between January 2004 and April 2014. Patients were divided into two groups: those aged 70 years and older (elderly group; n = 78, mean age, 76 ± 4 years) and those younger than 70 years (younger group; n = 164, mean age, 56 ± 10 years). QoL was assessed with the Short Form Health Survey Questionnaire (SF-36) 1 year after surgery. Results: The questionnaire return rate was 91.0%. There were already significant differences noted between the two groups with regard to preoperative risk factors on admission. The clinical presentation with a cardiac tamponade was higher in the elderly group (62.8% vs 47.6%; P = 0.03). Intraoperatively, complex procedures were more common in the younger group (21.3% vs 5.2%; P = 0.001). Accordingly, cardiopulmonary bypass and cross-clamping times were significantly longer in the younger group. The operative mortality was similar in both groups (3.8% vs 1.2%; P = 0.33). In the elderly population, 30-day mortality was higher (21.8% vs 7.9%; P = 0.003). One-year (72% vs 85%), 3-year (68% vs 84%) and 5-year (63% vs 79%) survival rates were satisfactory for the elderly group, but significantly lower compared with the younger group ( P = 0.008). The physical component summary score also was similar between the groups (39.14 ± 11.12 vs 39.12 ± 12.02; P = 0.99). However, the mental component summary score might be slightly higher in the elderly group but not statistically significant (51.61 ± 10.73 vs 48.63 ± 11.25; P = 0.12). Conclusions: Satisfactory long-term outcome and the general perception of well-being encourage surgery in selected elderly patients with AADA.

Outcome after surgery for acute aortic dissection type A in the elderly: a single-center experience.

OBJECTIVES: Despite improvements in surgical and perfusion techniques, surgery for acute aortic dissection type A (AADA) remains associated with high mortality rates. The aim of this study was to evaluate outcome after surgery for AADA in elderly in comparison with the outcome in younger patients. METHODS: Between January 2004 and December 2012, 204 patients underwent operation for AADA. Of these, 65 patients were aged 70 years and older (elderly group; range, 70-85 years) and 139 were younger than 70 years (younger group; range, 18-69 years). RESULTS: No significant differences were detected between the groups with regard to preoperative risk factors on admission. Significantly more number of elderly patients than younger underwent supracoronary replacement of the ascending aorta (93.8% versus 80.6%, p = 0.013). In comparison to the elderly patients, younger patients more frequently received complex surgery (Bentall and David operation). The mean extracorporeal circulation time (183 ± 62 minutes versus 158 ± 3 minutes; p = 0.003) and the mean aortic cross-clamp time (100 ± 45 minute versus 82 ± 30 minute; p = 0.006) were significantly higher for younger patients. No significant differences in postoperative complications and major morbidity were observed. The operative mortality (elderly group 4.6% versus younger group 1.4%; p = 0.33) and 30-day mortality (elderly group 18.5% versus younger group 8.6%; p = 0.06) were without statistical significance between the groups. CONCLUSION: Surgery for AADA in the elderly resulted in acceptable mortality. Satisfactory outcomes should encourage the offering of surgery in these patients.

Erythropoietin plus methylprednisolone or methylprednisolone in the treatment of acute spinal cord injury: a preliminary report.

Recent studies in animal models indicate that recombinant human erythropoietin (rhEPO) is very effective in enhancing neurological recovery after spinal cord injury (SCI). We aimed to evaluate the effect of rhEPO plus methylprednisolone sodium succinate (MPSS) compared to MPSS alone to improve neurological function of patients after SCI in a randomized clinical trial. During a 15-month period 30 patients presenting to emergency departments of two university affiliated hospitals within less than 6 hours after acute SCI were randomized to two groups. Both groups received MPSS 30 mg/kg initially and 5.4 mg/kg every hour till 23 hours if admitted within 3 hours and till 47 hours if recruited within 3-6 hours after injury. Group EPO also received 500 unit/kg rhEPO on admission and another 500 unit/kg 24 hours later instead of placebo in group MPSS. Neurologic evaluation was performed on admission, 24, 48, 72 hours and one and 6 months later. Range of patients' age was 18-65 years. There was no significant difference between patients receiving two types of treatment in neurological exam on admission (P=0.125), 24 hours after admission (P=0.108) and 48 hours after admission (P=0.085). However, one week (P=0.046), one month (P=0.021) and six months (P=0.018) after admission these differences were significant. MPSS plus rhEPO started within 6 hours after acute spinal injury may be more effective than MPSS plus placebo in improvement of neurologic dysfunction. More studies with larger sample sizes are warranted.

The pericardium-reinforced technique of amputation of the left atrial appendage: quick, safe, and simple.

Ligation or amputation of the left atrial appendage is indicated in several surgical procedures but has been shown ineffective in many cases, depending on the method used. The only 100% effective means of excluding the left atrial appendage from the circulation is by complete resection. Complicating complete resection or amputation is the thin, fragile, delicate left atrial tissue, with a certain incidence of bleeding occurring. To handle this tissue adequately, we developed a safe and easy method for amputation of the left atrial appendage using autologous pericardium as reinforcement.

Alternative technique of the right atrial anastomosis (cavo-atrial) in orthotopic heart transplantation.

An alternative technique of the right atrial anastomosis in heart transplantation, which allows a more anatomical reconstruction of the right atrium and is easier in handling than bi-caval anastomoses is described.

Stent-graft repair versus open surgery for the descending aorta: a case-control study.

PURPOSE: To compare the clinical outcomes of open surgery versus endovascular repair in patients with pathologies of the descending thoracic aorta (DTA). METHODS: This retrospective study included 44 patients (28 men; mean age 68+/-12 years, range 37-86) treated for DTA pathologies between 1995 and 2003. Twenty-two patients (15 men; mean age 68+/-13 years, range 37-86) undergoing stent-graft implantation were matched for sex, age, emergency operation, and comorbidities (coronary artery disease, chronic obstructive pulmonary disease) with a 22-patient contemporaneous surgical cohort (13 men; mean age 69+/-11 years, range 41-80). RESULTS: Thirty-day mortality was 5% in the stent-graft group and 27% in the open surgery group (p=0.047). The incidences of postoperative stroke and paraplegia were both 5% in the stent-graft group and 9%, respectively, in the open surgery cohort. One patient required a second stent-graft due to an endoleak during the same hospital stay, and 2 reoperations were performed in the standard operation group (p = NS). Lengths of stay in the intensive care unit (ICU) and hospital were 4.3+/-5.4 and 11.9+/-15.0 days, respectively, in the stent-graft group and 10.0+/-7.4 and 21.5+/-17.4 days, respectively, in the open surgery group (p<0.006). CONCLUSIONS: Stent-graft repair was associated with lower 30-day mortality and comparable complication rates in older patients with significant comorbidities and a high percentage of emergency operations compared to open surgery. Stent-graft implantation shortens ICU and hospital stays significantly. In the future, subgroups of patients who may experience the greatest benefit from stent-graft repair in the long term should be defined.