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10. Acute Aortic Dissection Type A in Younger Patients (< 60 Years Old) — Does Full Arch Replacement Provide Benefits Compared to Limited Approach?

Author

Natanov, Ruslan, primary, Shrestha, Malakh Lal, additional, Martens, Andreas, additional, Beckmann, Erik, additional, Krueger, Heike, additional, Arar, Morsi, additional, Rudolph, Linda, additional, Ruemke, Stefan, additional, Poyanmehr, Reza, additional, Korte, Wilhelm, additional, Schilling, Tobias, additional, Haverich, Axel, additional, and Kaufeld, Tim, additional

Published
2024
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13. Impact of preoperative malperfusion on postoperative outcomes in type A aortic dissection - importance of serum lactate estimation in ongoing malperfusion.

Author

Kaufeld, Tim, Beckmann, Erik, Rudolph, Linda, Krüger, Heike, Natanov, Ruslan, Arar, Morsi, Korte, Wilhelm, Kaufeld, Jessica, Schilling, Tobias, Haverich, Axel, Shrestha, Malakh, and Martens, Andreas

Subjects
*PREOPERATIVE period, *STATISTICAL correlation, *POSTOPERATIVE care, *ISCHEMIA, *SURGERY, *PATIENTS, *EXTRACORPOREAL membrane oxygenation, *AORTIC dissection, *BLOOD vessels, *COMPUTED tomography, *FISHER exact test, *TREATMENT effectiveness, *RESUSCITATION, *RETROSPECTIVE studies, *MAGNETIC resonance imaging, *DESCRIPTIVE statistics, *SURGICAL therapeutics, *MANN Whitney U Test, *HEMODYNAMICS, *CARDIOPULMONARY bypass, *LONGITUDINAL method, *KAPLAN-Meier estimator, *LOG-rank test, *LACTATES, *CARDIOVASCULAR surgery, *RESEARCH, *REOPERATION, *POSTOPERATIVE period, *COMPARATIVE studies, *STROKE, *DATA analysis software, *CEREBRAL ischemia, *BIOMARKERS, *PERIOPERATIVE care, *DISEASE incidence, *DISEASE complications
Abstract

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. [ABSTRACT FROM AUTHOR]

Published
2024
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16. B-21 | Coronary Angiography Within 30 days from Coronary Artery Bypass Graft Surgery: Indications, Findings and Outcomes

Author

Rynders, Beatrice D., primary, Simsek, Bahadir, additional, Okeson, Brynn, additional, Rangan, Bavana V., additional, Rempakos, Athanasios, additional, Kostantinis, Spyridon, additional, Karacsonyi, Judit, additional, Page, Elizabeth, additional, Cahnbley, Melina, additional, Stanberry, Larissa, additional, Mastrodemos, Olga C., additional, Allana, Salman S., additional, Palmer, Sarah, additional, Steffen, Robert, additional, Lodewyks, Carly, additional, Beckmann, Erik, additional, Sun, Benjamin, additional, Bapat, Vinayak, additional, Sandoval, Yader B., additional, Burke, M. Nicholas, additional, and Brilakis, Emmanouil S., additional

Published
2023
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20. Impact of preoperative malperfusion on postoperative outcomes in type A aortic dissection - importance of serum lactate estimation in ongoing malperfusion

Author

Kaufeld, Tim, primary, Beckmann, Erik, additional, Rudolph, Linda, additional, Krüger, Heike, additional, Natanov, Ruslan, additional, Arar, Morsi, additional, Korte, Wilhelm, additional, Kaufeld, Jessica, additional, Schilling, Tobias, additional, Haverich, Axel, additional, Shrestha, Malakh, additional, and Martens, Andreas, additional

Published
2023
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48. Train early and with deliberate practice: simple coronary surgery simulation platform results in fast increase in technical surgical skills in residents and students

Author

Korte, Wilhelm, primary, Merz, Constanze, primary, Kirchhoff, Felix, primary, Heimeshoff, Jan, primary, Goecke, Tobias, primary, Beckmann, Erik, primary, Kaufeld, Tim, primary, Fleissner, Felix, primary, Arar, Morsi, primary, Schilling, Tobias, primary, Haverich, Axel, primary, Shrestha, Malakh, primary, and Martens, Andreas, primary

Published
2020
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50. Aortic Valve–Sparing Root Replacement (David I Procedure) in Adolescents: Long-Term Outcome.

Author

Beckmann, Erik, Martens, Andreas, Krueger, Heike, Korte, Wilhelm, Kaufeld, Tim, Haverich, Axel, and Shrestha, Malakh Lal

Subjects
*AORTA, *AORTIC dissection, *MARFAN syndrome, *HEART valve prosthesis implantation, *CONNECTIVE tissue diseases, *TEENAGERS, *EARLY death
Abstract

Introduction Aortic valve-sparing root replacement (David's procedure) is an especially appealing treatment option for young patients. Here, we present the short-, mid, and long-term outcomes of this operation in adolescent patients. Methods Between September 1994 and March 2014, 29 patients aged 6 to 21 years underwent the David-I procedure at our center. We conducted a retrospective study with follow-up. Results The mean age was 16.8 ± 3.4 years and 90% (n = 26) were male. Marfan's syndrome was present in 86% (n = 25) of cases. Ninety-seven percent (n = 28) of cases were performed electively, and one case (3%) was performed emergently for acute aortic dissection type A. There were no early perioperative deaths (0%). Follow-up, which was completed on 100% of patients, comprised a total of 394 patient years and a mean follow-up time of 13.6 ± 5.4 years. The estimates for survival at 1, 5, and 10 years after initial surgery were 100, 97, and 93%, respectively. During follow-up, there were four (14%) late deaths and five (17%) aortic valve-related reoperations. The 1-, 5-, and 10-year estimates for freedom from valve-related reoperation were 100, 86, and 83%, respectively. The perioperative mortality for these five reoperations was 0%. Discussion Aortic valve–sparing root replacement can be performed in adolescents with a very low perioperative risk. Long-term survival seems to be affected by connective tissue diseases. [ABSTRACT FROM AUTHOR]

Published
2021
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