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

Publication ,  Journal Article
Lee, TC; Kon, Z; Cheema, FH; Grau-Sepulveda, MV; Englum, B; Kim, S; Chaudhuri, PS; Thourani, VH; Ailawadi, G; Hughes, GC; Williams, ML ...
Published in: J Card Surg
January 2018

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.

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Published In

J Card Surg

DOI

EISSN

1540-8191

Publication Date

January 2018

Volume

33

Issue

1

Start / End Page

7 / 18

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Sex Factors
  • Postoperative Complications
  • North America
  • Morbidity
  • Middle Aged
  • Male
  • Length of Stay
  • Hypothermia, Induced
  • Humans
 

Citation

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MLA
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Lee, T. C., Kon, Z., Cheema, F. H., Grau-Sepulveda, M. V., Englum, B., Kim, S., … Gammie, J. S. (2018). Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database. J Card Surg, 33(1), 7–18. https://doi.org/10.1111/jocs.13511
Lee, Teng C., Zachary Kon, Faisal H. Cheema, Maria V. Grau-Sepulveda, Brian Englum, Sunghee Kim, Paramita S. Chaudhuri, et al. “Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database.J Card Surg 33, no. 1 (January 2018): 7–18. https://doi.org/10.1111/jocs.13511.
Lee TC, Kon Z, Cheema FH, Grau-Sepulveda MV, Englum B, Kim S, et al. Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database. J Card Surg. 2018 Jan;33(1):7–18.
Lee, Teng C., et al. “Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database.J Card Surg, vol. 33, no. 1, Jan. 2018, pp. 7–18. Pubmed, doi:10.1111/jocs.13511.
Lee TC, Kon Z, Cheema FH, Grau-Sepulveda MV, Englum B, Kim S, Chaudhuri PS, Thourani VH, Ailawadi G, Hughes GC, Williams ML, Brennan JM, Svensson L, Gammie JS. Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database. J Card Surg. 2018 Jan;33(1):7–18.
Journal cover image

Published In

J Card Surg

DOI

EISSN

1540-8191

Publication Date

January 2018

Volume

33

Issue

1

Start / End Page

7 / 18

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Sex Factors
  • Postoperative Complications
  • North America
  • Morbidity
  • Middle Aged
  • Male
  • Length of Stay
  • Hypothermia, Induced
  • Humans