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OBJECTIVES: Preventing loss of life in patients with type A acute aortic dissection (AAD) who present with cardiopulmonary arrest (CPA) can be extremely difficult. Thus, we investigated the early outcomes in these patients. METHODS: Patients with type A AAD who were transported to hospitals belonging to the Tokyo Acute Aortic Super-network between January 2015 and December 2019 were considered for this study. We assessed the early mortality of these patients presenting with CPA and also investigated the differences in outcomes between patients with out-of-hospital and in-hospital CPA. RESULTS: A total of 3307 patients with type A AAD were transported, 434 (13.1%) of whom presented with CPA. The overall mortality of patients presenting with CPA was 88.2% (383/434), of which 94.5% (240/254) experienced out-of-hospital CPA and 79.4% (143/180) experienced in-hospital CPA (P < 0.001). Multivariable analysis revealed that aortic surgery [odds ratio (OR), 0.022; 95% confidence interval (CI), 0.008–0.060; P < 0.001] and patient age over 80 years (OR, 2.946; 95% CI, 1.012–8.572; P = 0.047) were related with mortality in patients with type A AAD and CPA. Between in-hospital and out-of-hospital CPA, the proportions of DeBakey type 1 (OR, 2.32; 95% CI, 1.065–5.054; P = 0.034), cerebral malperfusion (OR, 0.188; 95% CI, 0.056–0.629; P = 0.007), aortic surgery (OR, 0.111; 95% CI, 0.045–0.271; P = 0.001), age (OR, 0.969; 95% CI, 0.940–0.998; P = 0.039) and the time from symptom onset to hospital admission (OR, 1.122; 95% CI, 1.025–1.228; P = 0.012) were significantly different. CONCLUSIONS: Patients with type A AAD presenting with CPA exhibited extremely high rates of death. Patient outcomes following in-hospital CPA tended to be better than those following out-of-hospital CPA; however, this difference was not significantly different. To prevent deaths, aortic surgery, when possible, should be considered in patients with type A AAD who sustained CPA. We previously reported a risk analysis for early death in emergency Stanford type A acute aortic dissection (AAD) surgery using the Tokyo Acute Aortic Super (TAAS)-network Registry. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES We investigated the various pre- and postoperative complications related to early (30-day) mortality after open surgery for acute type A aortic dissection. METHODS Data from the Tokyo Acute Aortic Super-network database spanning January 2015 to December 2017 were retrospectively reviewed. Pre- and postoperative factors related to early postoperative mortality were assessed in 1504 of 2058 (73.0%) consecutive patients [age: 66.6 (SD: 13.5) years, male: 52.9%] who underwent acute type A aortic dissection repair. RESULTS The early mortality rate following surgical repair was 8.9%. According to multivariable analysis, male sex [odds ratio (OR) 1.670, 95% confidence interval (CI) 1.063–2.624, P  = 0.026], use of percutaneous circulatory assist devices (n  = 116, 7.7%) including extracorporeal membrane oxygenators or intra-aortic balloon pumps (OR 4.857, 95% CI 2.867–8.228, P  < 0.001), shock (n  = 162, 10.8%) (OR 3.06, 95% CI 1.741–5.387, P  < 0.001), cardiopulmonary arrest (n  = 41, 2.7%) (OR 7.534, 95% CI 3.407–16.661, P  < 0.001), coronary ischaemia (n  = 36, 2.3%) (OR 2.583, 95% CI 1.042–6.404, P  = 0.041) and cerebral ischaemia (n  = 59, 3.9%) (OR 2.904, 95% CI 1.347–6.261, P  = 0.007) were independent preoperative risk factors for early mortality, while cardiac tamponade (n  = 34, 2.3%) (OR 10.282, 95% CI 4.640–22.785, P  < 0.001), cerebral ischaemia (n  = 80, 5.3%) (OR 2.409, 95% CI 1.179–4.923, P  = 0.016) and mesenteric ischaemia (n  = 15, 1.0%) (OR 44.763, 95% CI 13.027–153.808, P  < 0.001) were independent postoperative risk factors. CONCLUSIONS Not only critical preoperative conditions but also postoperative cardiac tamponade and vital organ ischaemia are risk factors for early mortality after acute type A aortic dissection repair. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the association between accessibility to cardiovascular emergency centers and cardiovascular mortality in Japan.Design: A semi-ecological study.Setting: Three databases were generated: accessibility to emergency cardiovascular centers, population records and death records.Main Outcome Measures: The standardized mortality ratio (SMR) for cardiovascular disease was adjusted by age and sex. Accessibility was represented by transfer time, number of cardiovascular emergency hospitals, and the proportion of habitable areas. Combinations of the three were divided into Categories 1-8 from the worst to the best, and the association with SMR was analyzed.Results: There were 1998 cardiovascular emergency hospitals. The median of crude mortality was 0.16%. The median SMR of the reference Category 8 (transfer time <30 min and habitable area ≥50% with cardiovascular emergency hospitals) was 0.96, but that of the low accessibility Category 1 (transfer time ≥30 min and habitable area <50% without cardiovascular emergency hospitals) was 1.10. The SMR of accessibility Category 1 : Category 8 was 1.18 (95% confidence interval: 1.14-1.21).Conclusions: Decreased accessibility to cardiovascular emergency hospitals was associated with increased SMR. Areas with less accessibility and higher cardiovascular mortality were characterized by geographical variability in Japan. [ABSTRACT FROM AUTHOR]

Objectives Amlodipine, a calcium channel blocker (CCB), is one of the most common antihypertensive medicines in Japan. We evaluated whether the calcium channel blocker confers cardiac protection through the renin-angiotensin-aldosterone system in male stroke-prone spontaneously hypertensive rats (SHR-SP). Methods Fifteen week-old rats were divided into 2 groups: amlodipine group (3 mg/kg/day, n = 5) and control group ( n = 5). Key findings The CCB lowered systolic blood pressure significantly ( P < 0.05). Plasma aldosterone concentration in the amlodipine group was remarkably lower than in the control group ( P < 0.05), but plasma renin activity and plasma angiotensin II concentration were not different between the two groups. The CCB also suppressed the mRNA expression of brain natriuretic peptide, transforminggrowth factor- β1, and fibronectin extracted from the left ventricle. Conclusions These results suggest that amlodipine attenuates cardiac damage by lowering plasma aldosterone concentration in hypertensive rats with developing arteriosclerosis. [ABSTRACT FROM AUTHOR]