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Long-term Outcomes After Controlled Pericardial Drainage for Acute Type A Aortic Dissection.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2020 Oct; Vol. 110 (4), pp. 1357-1363. Date of Electronic Publication: 2020 Mar 07. - Publication Year :
- 2020
-
Abstract
- Background: Cardiac tamponade with acute aortic dissection type A can cause fatal outcomes. We previously reported excellent outcomes using percutaneous pericardial drainage with controlled volumes of aspirated pericardial effusion (controlled pericardial drainage [CPD]) to stabilize patients with critical cardiac tamponade. This study evaluates the early and late outcomes using this approach.<br />Methods: Between September 2003 and July 2018, 308 patients with acute aortic dissection type A were treated surgically, including 76 patients who presented with cardiac tamponade on hospital arrival. Forty-nine patients who did not respond to intravenous volume resuscitation underwent CPD in the emergency room, including 14 patients (28.6%) who presented with cardiopulmonary arrest. After CPD 39 patients (79.6%) were transferred to the operating room to undergo immediate aortic repair. The remaining 10 patients (20.4%) received medical treatment on arrival, followed by aortic repair within several days.<br />Results: In 49 patients the mean systolic blood pressure before CPD was 64.4 ± 10.3 mm Hg. Blood pressure rose significantly in all patients after CPD. The total volume of aspirated pericardial effusion was 46.8 ± 56.2 mL, and 30 of 49 patients (61%) required only 30 mL or less of aspiration to improve their blood pressure. All patients underwent successful aortic repair. Early hospital mortality was 16%. However there was no mortality related to CPD. The mean follow-up period was 52.9 ± 54.3 months. The cumulative survival rate was 63.4% after 5 years.<br />Conclusions: CPD for critical cardiac tamponade with acute type A aortic dissection produced satisfactory early and late outcomes.<br /> (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aortic Dissection complications
Aortic Dissection mortality
Aortic Aneurysm complications
Aortic Aneurysm mortality
Cardiac Tamponade diagnostic imaging
Cardiac Tamponade etiology
Female
Humans
Male
Middle Aged
Pericardial Effusion diagnostic imaging
Pericardial Effusion etiology
Retrospective Studies
Survival Rate
Time Factors
Treatment Outcome
Aortic Dissection surgery
Aortic Aneurysm surgery
Cardiac Tamponade surgery
Drainage
Pericardial Effusion surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 110
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 32151579
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2020.01.078