Arar, Morsi

Objective Acute aortic dissection type A (AADA) is a condition that affects both genders and requires urgent surgical intervention as non-operative treatment is often associated with a poor prognosis. Studies have proven that less aggressive surgical treatments influence the outcome for female patients in the fields of several diseases. The purpose of this study was to report and analyze our results in the selective cohort of female patients with AADA to detect differences in the treatment of this group of patients. Methods Between January 2000 and July 2018, 141 adult female patients with acute aortic dissection (AAD) underwent repair of the aorta in our department. A total of 75 patients received a proximal arch. replacement (group A), and 66 patients received a subtotal (replacement of the brachiocephalic trunk) and/or total arch. replacement with elephant trunk or frozen elephant trunk (group B). Results The median age in group A was 70.7 years (range 60.7–74.7 years) and in group B 66.3 years (range 55.6–71.3 years). Operation times were significantly longer in group B (total operation time: A = 286.9 min (range 225.0–341.0 min), B = 341 min (range 266.0–392 min), p = .003; cardiopulmonary bypass time: A = 189.0 min (range 139.0–138 min), B = 238 min (range 176.8–300.5 min), p < .001; circulatory arrest time: A = 27.0 min (range 21.0–37.0 min), B = 42.0 min (range 32.0–56.3 min), p < .001). There were no significant differences between the groups regarding 30-day mortality (A = 24% ( n = 18), B = 19.7% ( n = 13), p = .538) and rate of reoperation (A = 13.3% ( n = 10), B = 15.2% ( n = 10), p = .757) or the preoperative characteristics. Conclusion Our study showed no significant difference in mortality rate depending on the type of operation. Based on these results, a proximal arch. replacement should be considered as the first line of operation technique if the individual situation allows. For inexperienced clinics and surgeons in particular, we recommend limited aortic repair in patients with AADA. Finally, location of the intimal tear remains the essential factor for the evaluation of the surgical treat.

Introduction Acute type A aortic dissection (ATAAD) is one of the most critical emergencies in cardiovascular surgery. Additional complications such as organ malperfusion can significantly decrease the chances of survival. Despite promptly performed surgical treatment, impaired organ perfusion may persist, thus close postoperative monitoring is recommended. But, is there a surgical consequence due to the existence of a preoperatively known malperfusion and is there a correlation between pre-, peri- and postoperative levels of serum lactate and proven malperfusion? Methods Between 2011 and 2018, 200 patients (66% male; median age: 62.5 years; interquartile range: +/−12.4 years) that received surgical treatment at our institution for an acute dissection DeBakey type I were enrolled in this study. The cohort was divided into two groups according to the preoperative existence of malperfusion and non-malperfusion. At least one kind of malperfusion occurred in 74 patients (Group A: 37%), while 126 patients (Group B: 63%) showed no evidence of malperfusion. Furthermore, lactate levels of both cohorts were differentiated into four periods: preoperative, intraoperative, 24 hours after surgery, and 2–4 days after surgery. Results The patients’ status differed significantly prior to surgery. Group A (malperfusion) showed an elevated requirement for mechanical resuscitation (A: 10.8%; B: 5.6%; p: 0.173), were significantly more often admitted in an intubated state (A: 14.9%; B: 2.4%; p: 0.001) and showed higher incidences of stroke (A: 18.9% ( n = 149); B: 3.2% ( n = 4); p: 0.001). Levels of serum lactate from the preoperative period until days 2–4 were significantly increased in the malperfusion cohort at all times. Conclusions Preexisting malperfusion due to ATAAD may significantly increase the chance of early mortality in patients with ATAAD. Serum lactate levels were a reliable marker for inadequate perfusion from admission until day 4 after surgery. Despite this, early intervention survival in this cohort remains limited.