Document Detail


Type A aortic dissection: has surgical outcome improved with time?
MedLine Citation:
PMID:  19026799     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The study objective was to determine whether developments in surgical, anesthetic, and perfusion techniques in the treatment of type A aortic dissection have resulted in improved clinical outcome. METHODS: A consecutive series of 165 patients undergoing surgical repair of type A aortic dissection performed between April of 1992 and March of 2006 in a single center were analyzed. Operations were grouped in 2 time frames of equal length (before April of 1999 vs from April of 1999 onward). RESULTS: There were 30 in-hospital deaths (18.2%), and the death rate was similar in the 2 time periods. Patients who underwent operation in the recent era compared with the earlier era were older (median 62 years [interquartile range 51-68] vs 59 years [45-68], P = .18), with a significantly higher incidence of concomitant coronary artery disease (13 [18%] vs 5 [7%], P = .03]) and significantly worse (moderate to poor) left ventricular function (33 [40%] vs 13 [18%], P = .002). The duration of circulatory arrest was shorter in the recent era (median 31 minutes [interquartile range 26.5-39] vs 37.5 minutes [31-45], P = .009), with a higher incidence of concomitant procedures (19 [21%] vs 10 [14%], P = .22). Except for total hospital stay, which increased over time, there were no significant differences in postoperative outcome. CONCLUSION: Despite the adoption of techniques to improve outcome for patients with type A dissection, mortality remains unchanged. A deteriorating risk profile and factors relating to the disease process itself may explain this observation.
Authors:
Pradeep Narayan; Chris A Rogers; Ian Davies; Gianni D Angelini; Alan J Bryan
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-09-06
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  136     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-11-25     Completed Date:  2008-12-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1172-7     Citation Subset:  AIM; IM    
Affiliation:
Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aneurysm, Dissecting / physiopathology,  surgery*
Aortic Aneurysm / surgery*
Cardiovascular Surgical Procedures / methods
Coronary Disease / complications
Female
Humans
Length of Stay
Male
Middle Aged
Tomography, X-Ray Computed
Treatment Outcome
Ventricular Function, Left / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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