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General Thoracic and Cardiovascular Surgery

Published in:

01-06-2019 | Original Article

Surgical outcomes of acute type A aortic dissection in dialysis patients

Authors: Kei Akiyoshi, Naoyuki Kimura, Kei Aizawa, Daijiro Hori, Homare Okamura, Hideki Morita, Koichi Adachi, Koichi Yuri, Koji Kawahito, Atsushi Yamaguchi

Published in: General Thoracic and Cardiovascular Surgery | Issue 6/2019

Abstract

Background

Acute type A aortic dissection (ATAAD) is relatively uncommon in dialysis patients, and characteristics and repair outcomes are not fully understood.

Patients and methods

Patients with ATAAD (n = 960) were divided into a dialysis group (n = 19) and non-dialysis group (n = 941), depending on whether they required dialysis for preoperative end-stage renal disease (ESRD). Hospital charts and imaging data were reviewed, and characteristics and outcomes were compared between the groups. Segmental aortic wall or intima/media flap calcification in the thoracic and abdominal aorta was assessed in the dialysis patients.

Results

The leading primary causes of ESRD were polycystic kidney disease (n = 5) and chronic glomerulonephritis (n = 5). There were no significant differences (dialysis group vs. non-dialysis group) in age (60.5 vs. 64.5 years), preoperative hemodynamics, or organ ischemia. Dialysis patients were more likely to have an entry tear in the aortic arch (42% vs. 15%, p = 0.003). These patients showed moderate-to-severe calcification (multiple focal or single focal calcification > 10 mm) in the ascending aorta (17%), aortic arch (61%), descending aorta (67%), and abdominal aorta (83%). Arch replacement was common in this group (37% vs. 18%, p = 0.030). Although in-hospital mortality was increased in this group (21% vs. 7%, p = 0.059), morbidities did not differ significantly. Six-year survival was 60.3 ± 13.4% and 78.8 ± 1.6%, respectively (p = 0.01).

Conclusions

Dialysis patients tend to have aortic calcification and a primary tear in the aortic arch. Outcomes are acceptable.

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Title: Surgical outcomes of acute type A aortic dissection in dialysis patients
Authors: Kei Akiyoshi
Naoyuki Kimura
Kei Aizawa
Daijiro Hori
Homare Okamura
Hideki Morita
Koichi Adachi
Koichi Yuri
Koji Kawahito
Atsushi Yamaguchi
Publication date: 01-06-2019
Publisher: Springer Singapore
Published in: General Thoracic and Cardiovascular Surgery / Issue 6/2019
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-018-1051-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical outcomes of acute type A aortic dissection in dialysis patients

Abstract

Background

Patients and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusions

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