BACKGROUND: Patients with acute type A aortic dissection with a previous cardiac surgery (PCS) and malperfusion syndrome (MPS) are extremely difficult to manage and have poor outcomes. METHODS: From 1996 to 2018, 668 patients underwent emergent open aortic repair or endovascular fenestration/stenting for MPS for an acute type A aortic dissection, including those with PCS (PCS, n = 64) and those without PCS (No-PCS, n = 604). The groups were further divided into PCS+MPS, PCS+No-MPS, No-PCS+MPS, and No-PCS+No-MPS. RESULTS: Compared with the No-PCS group, the PCS group had significantly more coronary artery disease, acute renal failure, and mesenteric and renal MPS. Forty-two percent of patients with PCS underwent upfront endovascular fenestration/stenting for endovascular-amendable MPS. The in-hospital mortality was significantly higher in patients with PCS+MPS (40%) compared with PCS+No-MPS (5.9%), No-PCS+MPS (30%), and No-PCS+No-MPS (6.7%). Multivariable logistic regression showed cardiogenic shock (odds ratio, 7.3) and MPS (odds ratio, 6.6) were risk factors for in-hospital mortality (P < .001). After recovering from MPS the PCS group (n = 54) had similar rates of postoperative complications, including 30-day mortality (7.4% vs 6.3%, P = .77), compared with the No-PCS group (n = 557). The 5-year survival was significantly lower in the PCS group compared with the No-PCS group (60% vs 72%, P = .004) and was lowest in those with PCS+MPS (46%). PCS was not a significant risk factor for in-hospital (odds ratio, 1.2; P = .63) or late (hazard ratio, 1.3; P = .27) mortality. CONCLUSIONS: Because of severe preoperative comorbidities and the complexity of open aortic repair, in acute type A aortic dissection patients with PCS and MPS, endovascular fenestration and stenting first with delayed redo sternotomy and central aortic repair was a valid approach.
BACKGROUND: Patients with acute type A aortic dissection with a previous cardiac surgery (PCS) and malperfusion syndrome (MPS) are extremely difficult to manage and have poor outcomes. METHODS: From 1996 to 2018, 668 patients underwent emergent open aortic repair or endovascular fenestration/stenting for MPS for an acute type A aortic dissection, including those with PCS (PCS, n = 64) and those without PCS (No-PCS, n = 604). The groups were further divided into PCS+MPS, PCS+No-MPS, No-PCS+MPS, and No-PCS+No-MPS. RESULTS: Compared with the No-PCS group, the PCS group had significantly more coronary artery disease, acute renal failure, and mesenteric and renal MPS. Forty-two percent of patients with PCS underwent upfront endovascular fenestration/stenting for endovascular-amendable MPS. The in-hospital mortality was significantly higher in patients with PCS+MPS (40%) compared with PCS+No-MPS (5.9%), No-PCS+MPS (30%), and No-PCS+No-MPS (6.7%). Multivariable logistic regression showed cardiogenic shock (odds ratio, 7.3) and MPS (odds ratio, 6.6) were risk factors for in-hospital mortality (P < .001). After recovering from MPS the PCS group (n = 54) had similar rates of postoperative complications, including 30-day mortality (7.4% vs 6.3%, P = .77), compared with the No-PCS group (n = 557). The 5-year survival was significantly lower in the PCS group compared with the No-PCS group (60% vs 72%, P = .004) and was lowest in those with PCS+MPS (46%). PCS was not a significant risk factor for in-hospital (odds ratio, 1.2; P = .63) or late (hazard ratio, 1.3; P = .27) mortality. CONCLUSIONS: Because of severe preoperative comorbidities and the complexity of open aortic repair, in acute type A aortic dissection patients with PCS and MPS, endovascular fenestration and stenting first with delayed redo sternotomy and central aortic repair was a valid approach.
Authors: Bo Yang; Elizabeth L Norton; Reilly Hobbs; Linda Farhat; Xiaoting Wu; Whitney E Hornsby; Karen M Kim; Himanshu J Patel; G Michael Deeb Journal: J Thorac Cardiovasc Surg Date: 2018-12-21 Impact factor: 5.209
Authors: Bo Yang; Himanshu J Patel; Claire Sorek; Whitney E Hornsby; Xiaoting Wu; Sarah Ward; Marc Thomas; Anisa Driscoll; Victoria A Waidley; Elizabeth L Norton; Donald S Likosky; G Michael Deeb Journal: Ann Thorac Surg Date: 2017-12-16 Impact factor: 4.330
Authors: Bo Yang; Elizabeth L Norton; Terry Shih; Linda Farhat; Xiaoting Wu; Whitney E Hornsby; Karen M Kim; Himanshu J Patel; G Michael Deeb Journal: J Thorac Cardiovasc Surg Date: 2018-11-14 Impact factor: 5.209
Authors: Harleen K Sandhu; Akiko Tanaka; Syed Taha Zaidi; Alexa Perlick; Charles C Miller; Hazim J Safi; Anthony L Estrera Journal: J Thorac Cardiovasc Surg Date: 2019-05-17 Impact factor: 5.209
Authors: Elizabeth D Krebs; J Hunter Mehaffey; Robert B Hawkins; Jared P Beller; Clifford E Fonner; Andy C Kiser; Mark Joseph; Mohammed A Quader; John A Kern; Leora T Yarboro; Nicholas R Teman; Gorav Ailawadi Journal: Ann Thorac Surg Date: 2019-04-02 Impact factor: 4.330
Authors: Bo Yang; Aroosa Malik; Victoria Waidley; Kellianne C Kleeman; Xiaoting Wu; Elizabeth L Norton; David M Williams; Minhaj S Khaja; Whitney E Hornsby Journal: J Thorac Cardiovasc Surg Date: 2017-12-16 Impact factor: 5.209