Top

Journal of Cardiothoracic Surgery

Published in:

Open Access 01-12-2024 | Aortic Dissection | Research

Delayed surgery for acute type A aortic dissection: a retrospective review of an alternative surgical strategy in the COVID-19 era

Authors: Rin Itokawa, Ryosuke Kowatari, Yuki Imamura, Hanae Sasaki, Norihiro Kondo, Kazuyuki Daitoku, Masahito Minakawa

Published in: Journal of Cardiothoracic Surgery | Issue 1/2024

Abstract

Background

During the coronavirus disease (COVID-19) pandemic, medical resources have often been limited to emergency surgeries. This study aimed to evaluate our experience with delayed surgery for acute type A aortic dissections (ATAADs).

Methods

A retrospective study was conducted on 33 patients who underwent surgery for ATAADs between January 2020 and December 2021. The patients were divided into two groups: patients treated within 12 h of arrival (E group; N = 21) and those treated > 12 h after arrival (D group; N = 12) with strict antihypertensive therapy until surgery.

Results

The plasma fibrinogen levels on arrival were lower in the D group than in the E group (174.3 ± 109.1 vs 293.4 ± 165.4, p = 0.038). The time to surgery from symptom onset was longer in the D group than in the E group (4 ± 1 h vs. 86 ± 108 h, p < 0.001). There was one case (3%) of mortality and seven cases (21%) of cerebral infarctions in the E group. There was no significant difference in the intraoperative data and quantity of blood transfused between the two groups.

Conclusion

Thus, delayed surgery for ATAAD with appropriate preoperative management may be an alternative surgical strategy in the COVID-19 era.

Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Shimizu H, Okada M, Toh Y, Doki Y, Endo S, et al. Thoracic and cardiovascular surgeries in Japan during 2018: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2021;69:179–212. https://doi.org/10.1007/s11748-020-01460-w.CrossRef

Sabe AA, Percy ED, Kaneko T, Plichta RP, Hughes GC. When to consider deferral of surgery in acute type A aortic dissection: a review. Ann Thorac Surg. 2021;111:1754–62. https://doi.org/10.1016/j.athoracsur.2020.08.002.CrossRefPubMed

Haft JW, Atluri P, Ailawadi G, Engelman DT, Grant MC, Hassan A, et al. Adult cardiac surgery during the COVID-19 pandemic: a tiered patient triage guidance statement. Ann Thorac Surg. 2020;110:697–700. https://doi.org/10.1016/j.athoracsur.2020.04.003.CrossRefPubMedPubMedCentral

Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol. 2015;66:350–8. https://doi.org/10.1016/j.jacc.2015.05.029.CrossRefPubMed

Malaisrie SC, Szeto WY, Halas M, Girardi LN, Coselli JS, Sundt TM, et al. 2021 The American Association for Thoracic Surgery expert consensus document: surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2021;162:735–758.e2. https://doi.org/10.1016/j.jtcvs.2021.04.053.CrossRefPubMed

Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283:897–903. https://doi.org/10.1001/jama.283.7.897.CrossRefPubMed

Fukuda I, Imazuru T. Intentional delay of surgery for acute type A dissection with stroke. J Thorac Cardiovasc Surg. 2003;126:290–1. https://doi.org/10.1016/s0022-5223(03)00358-1.CrossRefPubMed

Deeb GM, Williams DM, Bolling SF, Quint LE, Monaghan H, Sievers J, et al. Surgical delay for acute type A dissection with malperfusion. Ann Thorac Surg. 1997;64:1669–75. https://doi.org/10.1016/s0003-4975(97)01100-4. discussion 1675.CrossRefPubMed

Hamad R, Amr G, Demers P. Delayed surgery in patients with acute type A aortic dissection who are receiving novel oral anticoagulants. J Thorac Cardiovasc Surg. 2018;155:e1–4. https://doi.org/10.1016/j.jtcvs.2017.08.021.CrossRefPubMed

10.

Paparella D, Rotunno C, Guida P, Malvindi PG, Scrascia G, De Palo M, et al. Hemostasis alterations in patients with acute aortic dissection. Ann Thorac Surg. 2011;91:1364–9. https://doi.org/10.1016/j.athoracsur.2011.01.058.CrossRefPubMed

11.

Guan X, Li J, Gong M, Lan F, Zhang H. The hemostatic disturbance in patients with acute aortic dissection: a prospective observational study. Medicine. 2016;95: e4710. https://doi.org/10.1097/MD.0000000000004710.CrossRefPubMedPubMedCentral

12.

Bavaria JE, Pochettino A, Brinster DR, Gorman RC, McGarvey ML, Gorman JH, et al. New paradigms and improved results for the surgical treatment of acute type A dissection. Ann Surg. 2001;234:336–42. https://doi.org/10.1097/00000658-200109000-00007. discussion 342.CrossRefPubMedPubMedCentral

13.

Sun L, Qi R, Zhu J, Liu Y, Chang Q, Zheng J. Repair of acute type A dissection: our experiences and results. Ann Thorac Surg. 2011;91:1147–52. https://doi.org/10.1016/j.athoracsur.2010.12.005.CrossRefPubMed

14.

Andersen ND, Ganapathi AM, Hanna JM, Williams JB, Gaca JG, Hughes GC. Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program. J Am Coll Cardiol. 2014;63:1796–803. https://doi.org/10.1016/j.jacc.2013.10.085.CrossRefPubMedPubMedCentral

15.

Shander A, Goobie SM, Warner MA, Aapro M, Bisbe E, Perez-Calatayud AA, et al. Essential role of patient blood management in a pandemic: a call for action. Anesth Analg. 2020;131:74–85. https://doi.org/10.1213/ANE.0000000000004844.CrossRefPubMed

16.

Raturi M. The journey of blood. Transfus Clin Biol. 2020;27:3. https://doi.org/10.1016/j.tracli.2020.01.004.CrossRefPubMed

Title: Delayed surgery for acute type A aortic dissection: a retrospective review of an alternative surgical strategy in the COVID-19 era
Authors: Rin Itokawa
Ryosuke Kowatari
Yuki Imamura
Hanae Sasaki
Norihiro Kondo
Kazuyuki Daitoku
Masahito Minakawa
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Aortic Dissection
COVID-19
Published in: Journal of Cardiothoracic Surgery / Issue 1/2024
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-024-02682-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Delayed surgery for acute type A aortic dissection: a retrospective review of an alternative surgical strategy in the COVID-19 era

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Safety and efficacy of Cox‐Maze procedure for atrial fibrillation during mitral valve surgery: a meta-analysis of randomized controlled trials

Surgical aortic valve replacement etiologies, hemodynamics, and outcomes in 1346 patients from the Malaysian heart centre

Risk factors for postoperative delirium in elderly patients undergoing heart valve surgery with cardiopulmonary bypass

No cupid, just an arrow: a penetrating injury into the interventricular septum

Simple and secure thrombectomy without circulatory arrest for acute pulmonary embolism

Pleural epithelioid hemangioendothelioma in a 39-Year-old female: a case report