Tomonobu Abe1, Hiroyuki Yamamoto2, Hiroaki Miyata3, Noboru Motomura4, Yoshiyuki Tokuda5, Kazuo Tanemoto6, Akihiro Usui5, Shinichi Takamoto3. 1. Division of Cardiovascular Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan. 2. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 3. Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan. 4. Division of Cardiovascular Surgery, Department of Surgery, Toho University Sakura Medical Center, Sakura, Japan. 5. Department of Cardiac Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan. 6. Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan.
Abstract
OBJECTIVES: To evaluate the background trends and surgical outcomes for more than 10 000 patients with acute type A dissection in Japan in a recent 8-year period. METHODS: Data on replacement of the ascending aorta and/or aortic arch for acute type A dissection were collected from the Japan Cardiovascular Surgery Database from 2008 to 2015. Linear-by-linear association tests or Cuzick's test for trend was used to evaluate group trends over time. The results were calculated for ascending or hemiarch replacement and arch replacement. A multivariable logistic regression model was used to calculate the risk-adjusted operative mortality rate. RESULTS: A total of 11 843 patients were included. The overall 30-day mortality and operative mortality rates were 7.6% and 9.5%, respectively. The number of surgically treated cases increased from 2436 patients in 2008-2009 to 3533 in 2014-2015, a 45.0% increase. A trend analysis revealed significant changes in patient characteristics with time, including increasing age and rate of preoperative renal failure. Despite worsening risk factors, the unadjusted operative mortality rate with arch replacement showed a significant downward trend (P = 0.01; test of trend). The risk-adjusted mortality rate showed a downward trend both in ascending aorta or hemiarch replacement and arch replacement, although the trend was not statistically significant (P > 0.05). CONCLUSIONS: Unadjusted and adjusted operative deaths have shown a decreasing trend, although patients undergoing surgery for acute type A dissection have demonstrated worsening of risk factors, such as age and renal failure. The number of surgeries performed for acute type A dissection significantly increased throughout the study period in Japan.
OBJECTIVES: To evaluate the background trends and surgical outcomes for more than 10 000 patients with acute type A dissection in Japan in a recent 8-year period. METHODS: Data on replacement of the ascending aorta and/or aortic arch for acute type A dissection were collected from the Japan Cardiovascular Surgery Database from 2008 to 2015. Linear-by-linear association tests or Cuzick's test for trend was used to evaluate group trends over time. The results were calculated for ascending or hemiarch replacement and arch replacement. A multivariable logistic regression model was used to calculate the risk-adjusted operative mortality rate. RESULTS: A total of 11 843 patients were included. The overall 30-day mortality and operative mortality rates were 7.6% and 9.5%, respectively. The number of surgically treated cases increased from 2436 patients in 2008-2009 to 3533 in 2014-2015, a 45.0% increase. A trend analysis revealed significant changes in patient characteristics with time, including increasing age and rate of preoperative renal failure. Despite worsening risk factors, the unadjusted operative mortality rate with arch replacement showed a significant downward trend (P = 0.01; test of trend). The risk-adjusted mortality rate showed a downward trend both in ascending aorta or hemiarch replacement and arch replacement, although the trend was not statistically significant (P > 0.05). CONCLUSIONS: Unadjusted and adjusted operative deaths have shown a decreasing trend, although patients undergoing surgery for acute type A dissection have demonstrated worsening of risk factors, such as age and renal failure. The number of surgeries performed for acute type A dissection significantly increased throughout the study period in Japan.
Authors: Panagiotis T Tasoudis; Dimitrios E Magouliotis; Dimitrios N Varvoglis; Ioannis A Ziogas; Mohammad Yousuf Salmasi; Konstantinos Spanos; Antonios Kourliouros; Miltiadis Matsagkas; Athanasios Giannoukas; Thanos Athanasiou Journal: Gen Thorac Cardiovasc Surg Date: 2022-02-26
Authors: Jun Ho Lee; Yongil Cho; Yang Hyun Cho; Hyunggoo Kang; Tae Ho Lim; Hyo Jun Jang; Sun Kyun Ro; Hyuck Kim Journal: J Korean Med Sci Date: 2020-10-19 Impact factor: 2.153