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Purpose: To investigate the impact of direct aortic cannulation (DAC) versus femoral arterial cannulation (FAC) on clinical outcomes of surgery for acute type A aortic dissection. Methods: PubMed/MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials were searched until August 25, 2023, to conduct a meta-analysis. Primary endpoints of the study were operative mortality and postoperative stroke. Secondary endpoints were cardiopulmonary bypass time, myocardial ischemic time, hypothermic circulatory arrest time, temporary neurological dysfunction (TND), combined stroke and TND, re-exploration for bleeding, and need for renal replacement therapy. A random-effect model was used to estimate the pooled effect size, and a leave-one-out method was used for the primary endpoints for sensitivity analysis. Results: 15 studies met our eligibility criteria, including a total of 7941 samples. Operative mortality was significantly lower in the DAC group with a pooled odds ratio (OR) of 0.72 [95% confidence interval (CI): 0.61–0.85)]. Incidence of postoperative stroke was also lower in the DAC group with a pooled OR of 0.79 (95% CI: 0.66–0.94). However, after excluding one study with the greatest weight, the difference became nonsignificant. DAC was also associated with a lower incidence of postoperative TND, and re-exploration for bleeding with a pooled OR of 0.52 (95% CI: 0.37–0.73), and 0.60 (95% CI: 0.47–0.77), respectively. Conclusions: This meta-analysis showed that patients who underwent ATAAD repair with DAC had a lower incidence of operative mortality, postoperative stroke, TND, and re-exploration for bleeding compared to those who underwent FAC. [ABSTRACT FROM AUTHOR]

Aim: Aimed to evaluate the relationship of serum biochemical and blood parameters with aortic rupture and dissection types according to the DeBakey classification. Methods: Forty-three patients, who were admitted to the emergency department between 01.01.2011 and 01.01.2019 with the diagnosis of aortic dissection, were retrospectively evaluated. Gender, age, symptoms at presentation, vital parameters, creatinine and, troponin levels, and hemogram parameters were recorded after blood tests. Neutrophil-tolymphocyte ratio and monocyte-to-platelet ratio were obtained from these values. These results were compared with the presence of aortic rupture and the DeBakey classification. Results: Of the 43 patients included in the study, 30 were male (69.8%), and 13 were female (30.2%). Aortic rupture was seen in two of the 30 male patients (6.7%) and none of the females (p=1.000). There was a significant difference only in blood urine nitrogen and monocyte-to-platelet ratio between patients with and without aortic rupture (p=0.035 and p=0.015, respectively). Conclusion: Most of the routinely evaluated blood and biochemical parameters in aortic dissection cases did not yield significant results in comparison to the DeBakey classification and the presence of rupture. Only blood urea nitrogen and monocyte-to-platelet ratio values were lower in patients with aortic rupture. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The DeBakey classification was used to discriminate the extent of acute aortic dissection (AD) and was correlated to long-term outcome and re-intervention rate. A slight modification of type II subgroup definition was applied by incorporating the aortic arch, when full resectability of the dissection process was given. Methods: Between January 2001 and March 2010, 118 patients (64% male, mean age 59 years) underwent surgery for acute AD. As many as 74 were operated on for type I and 44 for type II AD. Complete resection of all entry sites was performed, including antegrade stent grafting for proximal descending lesions. Results: Patients were comparable with respect to demographics and preoperative hemodynamic status. They underwent isolated ascending replacement, hemiarch, or total arch replacement in 7%, 26%, and 67% in type I, versus 27%, 37%, and 36% in type II, respectively. Additional descending stent grafting was performed in 33/74 (45%) type I patients. In-hospital mortality was 14%, 16% (12/74) in type I versus 9% (4/44, type II), p =0.405. After 5 years, the estimated survival rate was 63% in type I versus 80% in type II, p =0.135. In type II, no distal aortic re-intervention was required. In type I, the freedom of distal re-interventions was 82% in patients with additional stent grafting versus 53% in patients without, p =0.022. Conclusions: The slightly modified DeBakey classification exactly reflects late outcome and aortic re-intervention probability. Thus, in type II patients, the aorta seems to be healed without any probability of later re-operation or re-intervention. [Copyright &y& Elsevier]

Summary: Recent advances in the management of acute Stanford type A dissection have highlighted the clinical importance of clinical presentation and extent of dissection. The Penn classification of type A clinical presentations is based on ischemic profiles that not only determine mortality but also influence management options. The extent of type A dissection as summarized by the DeBakey classification significantly determines the role of endovascular intervention in this important disease. We propose an integration of these three classifications of acute type A dissection as a framework for future advances in diagnosis, intervention and prognosis. [ABSTRACT FROM AUTHOR]

Abstract: To analyze the characteristics of aortic dissection in the elderly, we reviewed 168 cases from January 1999 to September 2005 in a medical center in Taiwan. Fifty-six cases were suitable for enrollment in our study. Of these, 44 (79%) were male and 12 (21%) were female; ages ranged from 29 to 92 years, with a mean of 61 ± 11.75 years. We defined elderly as age ≥ 65 years. There was no obvious discrepancy between age and types of aortic dissections involved (p = 0.726). The elderly had the lower mean systolic blood pressure (166.4 mm Hg) upon arrival at the Emergency Department (p = 0.002). Presentation to the Emergency Department with chest pain or chest tightness was more commonly seen in the elderly (66.7%) (p = 0.042). The mean hospital stay was 12.6 ± 0.5 days, and it was longer in the elderly group (12.96 days) (p = 0.009). Otherwise, the mortality rate was 6.7% ± 3.6%. We found a lower mortality rate in the elderly than in the younger group (4% vs. 9%, respectively; p = 0.008). [Copyright &y& Elsevier]

Background: The DeBakey classification divides Stanford acute type A aortic dissection (ATAAD) into DeBakey type I (D1) and type II (D2) according to the extent of acute aortic dissection (AAD). This retrospective study aimed to compare the early and late outcomes of D1-AAD and D2-AAD through a propensity score-matched analysis.Methods: Between January 2009 and April 2020, 599 consecutive patients underwent ATAAD repair at our institution, and were dichotomized into D1 (n = 543; 90.7%) and D2 (n = 56; 9.3%) groups. Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 56 patients per group. The clinical features, postoperative complications, 5-year cumulative survival and freedom from reoperation rates were compared.Results: In the overall cohort, the D1 group had a lower rate of preoperative shock and more aortic arch replacement with longer cardiopulmonary bypass time. The D1 group had a higher in-hospital mortality rate than the D2 group in overall (15.8% vs 5.4%; P = 0.036) and matched cohorts (19.6% vs 5.4%; P = 0.022). For patients that survived to discharge, the D1 and D2 groups demonstrated similar 5-year survival rates in overall (77.0% vs 85.2%; P = 0.378) and matched cohorts (79.1% vs 85.2%; P = 0.425). The 5-year freedom from reoperation rates for D1 and D2 groups were 80.0% and 97.1% in overall cohort (P = 0.011), and 93.6% and 97.1% in matched cohort (P = 0.474), respectively.Conclusions: Patients with D1-AAD had a higher risk of in-hospital mortality than those with D2-AAD. However, for patients who survived to discharge, the 5-year survival rates were comparable between both groups. [ABSTRACT FROM AUTHOR]

The author reflects on the advancement in surgery related to acute type A arotic dissection in heart.

A response from the authors of an article that demonstrates the success of dissecting the aortic wall in the previous issue is presented.