Long-term Result of Acute Type B Aortic Dissection Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Hyogo Brain and Heart.

Slides:

Advertisements

Similar presentations

Management of acute type b aortic dissection

Advertisements

KAREN L. WALKER MS JONATHAN J. SHUSTER PHD THOMAS M. BEAVER MD, MPH DIVISION OF THORACIC AND CARDIOVASCULAR SURGERY DIVISION OF BIOSTATISTICS UNIVERSITY.

Background (1) ・ In 1998, we developed a modified elephant trunk (ET) technique using a single four-branched arch graft with a sewing “collar” and “long.

Optimal Graft Diameter and Location Reduces Postoperative Complications Following Total Arch Replacement with a Long Elephant Trunk K. Taniguchi K.Toda.

Antegrade Stent Grafting of Descending Thoracic Aorta During Acute Debakey I Dissection: Early and Midterm Outcomes Prashanth Vallabhajosyula MD, Joseph.

Division of Cardiovascular Surgery Xijing Hospital, Xi’an, China

Conventional and frozen elephant trunk surgery for extensive aneurysmal disease of the thoracic aorta: a retrospective comparative study Marco Di Eusanio.

Aortic Root Conservative Repair in Acute Type A Aortic Dissection Involving Aortic Root: Fate of Aortic Root & Aortic Valve Function Joon Bum Kim, Su Kyung.

Aortic Aneurysms & Dissection Robbins Aneurysm-localized dilation of a blood vessel True aneurysm: bounded by generally complete but often atentuated.

Blood Pressure Reduction Among Acute Stroke Patients A Randomized Controlled Clinical Trial Jiang He, Yonghong Zhang, Tan Xu, Weijun Tong, Shaoyan Zhang,

Evidence That D-dimer Levels Predict Subsequent Thromboembolic and Cardiovascular Events in Patients with Atrial Fibrillation during Oral Anticoagulant.

Open Repair of Ruptured Descending Thoracic and Thoracoabdominal Aortic Aneurysms in 100 Consecutive Cases Mario F. Gaudino, Christopher Lau, Monica Munjal,

Stent Assisted Balloon Induced Intimal Disruption and Relamination in Aortic Dissection Repair: The STABILISE Concept Sophie C. Hofferberth 1, Andrew E.

Aortic Aneurysm Dr.mehdi hadadzadeh Cardiovascular surgeon IN THE NAME OF GOD.

Number of Entry Tears Is Associated With Aortic Growth in Type B Dissections Ann Thorac Surg March 28, 2013 Thoracic Aortic Research Center, University.

P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?

The assessment of the new hybrid procedure for extensive aortic aneurysms compared with the conventional open surgery Department of Cardiovascular surgery,

Sakakibara Heart Institute Minoru Tabata, MD, MPH, Akihito Matsushita, MD, Toshihiro Fukui, MD, Shigefumi Matsuyama, MD, Tomoki Shimokawa, MD, Shuichiro.

Randomized Trial of Ea rly S urgery Versus Conventional Treatment for Infective E ndocarditis (EASE) Duk-Hyun Kang, MD, PhD on behalf of The EASE Trial.

Usefulness of fenestrated stent graft for thoracic aortic aneurysms

Osaka University Department of Cardiovascular Surgery Osaka University Department of Cardiovascular Surgery The efficacy of debranching TEVAR for arch.

Aneurysms of the innominate artery: surgical treatment of 27 patients. John D. Symbas, M.D., Michael E. Joseph B. Whitehead Department of Surgery, Division.

Surgery for Aortic Dissection Adrian E. Manapat, M.D.

ASCVTS 2011 Shaggy aorta & TEVAR 1 “Shaggy aorta” is a highly dangerous sign of TEVAR for aortic arch aneurysm “Shaggy aorta” is a highly dangerous sign.

One-stage repair for Stanford Type B Aortic Dissection concomitant with cardiac diseases Open stented elephant trunk technique combined with cardiac operation.

Does Operative Technique of Performing Distal Anastomosis in Acute type A Dissection Affect Early And Late Clinical Outcomes? Sotiris C. Stamou, MD, Ph.D,

Aneurysm. It is a blood sac that communicates with the lumen of an artery They are classified according to –Etiology congenital Acquired –pathological,

Aortic Symposium New York 2012 „Pseudoaneurysm After Endovascular Stent Graft Placement for Treatment of Type B Aortic Dissection“ R.A. Jánosi, M. Bettin,

AAA Repair Justin Brown 4 September yo W transfer from OSH with ruptured Abdominal Aortic Aneurysm – Presented with acute onset of abdominal.

PREDICTORS FOR IN HOSPITAL MORTALITY IN PATIENTS WITH TYPE A AORTIC DISSECTION FROM A TWO CENTRE EXPERIENCE S Leontyev, J Légaré, MA Borger, K Buth, AK.

Osaka University Graduate School of Medicine Division of Cardiovascular Surgery Strategy of TEVAR for acute aortic dissection Osaka University Graduate.

Aortic Emergencies LISA BROUGHTON, PHD, RN, CCRN.

以多重死因資料比較台灣美國腦中風併發吸入性肺炎之趨勢奇美醫學中心張嘉祐醫師. Stroke Statistics -- A Report From the American Heart Association Approximately 56% of stroke deaths in 2009.

Peripheral Artery Disease in Orthopaedic Patients with Asymptomatic Popliteal Artery Calcification on Plain X-ray Adam Podet, MS; Julia Volaufova, phD,;

Traumatic arterial injuries: endovascular treatment Martha A. Quiodettis May 25, 2010.

Ten Year Outcome of Coronary Artery Bypass Graft Surgery Versus Medical Therapy in Patients with Ischemic Cardiomyopathy Results of the Surgical Treatment.

Objective Bleeding events are grave and sometimes life threatening complications after prosthetic valve replacement, especially in hemodialysis patients.

Ventilator-associated Pneumonia Among Elderly Medicare Beneficiaries in Long-term Care Hospitals William Buczko, Ph.D. Research Analyst Centers for Medicare.

Date of download: 7/14/2016 Copyright © The American College of Cardiology. All rights reserved. From: Thoracic Aortic Aneurysm and Dissection J Am Coll.

MedStar Washington Hospital Center Cardiac Catheterization Conference

TEVAR for Chronic Type B Dissection

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Predictive Value of 18F-FDG PET/CT in Patients with.

Justin M. Schaffer, MD, Bharathi Lingala, PhD, D. Craig Miller, MD, Y

Jay J. Idrees, MD Eric E. Roselli, MD Lars G. Svensson, MD

Open descending thoracic or thoracoabdominal aortic approaches for complications of endovascular aortic procedures: 19-year experience Konstantinos Spiliotopoulos,

The “first generation” of endovascular stent-grafts for patients with aneurysms of the descending thoracic aorta Michael D. Dake, MD, D.Craig Miller,

Midterm Change of Descending Aortic False Lumen After Repair of Acute Type I Dissection Kay-Hyun Park, MD, PhD, Cheong Lim, MD, PhD, Jin Ho Choi, MD,

Indications for aortic replacement

Efficacy of thoracic endovascular stent repair for chronic type B aortic dissection with aneurysmal degeneration Salvatore T. Scali, MD, Robert J. Feezor,

Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period Wei-Guo Ma, MD, PhD, Wei Zhang, MD, Long-Fei.

Successful surgical treatment of multilevel aortic aneurysms combined with renal transplantation Ivan Matia, MD, PhD, Jan Pirk, MD, PhD, Květoslav Lipar,

A decade after the Surgical Treatment for Ischemic Heart Failure (STICH) trial: Weaving firm clinical recommendations from lessons learned Robert E.

CASE PRESENTAION DR.ANJU CHAUDHARY BJMC.

Management of acute type B aortic dissection

Enlargement of aortic arch vessels after surgical repair of type A aortic dissection Takashi Yamauchi, MD, PhD, Suguru Kubota, MD, PhD, Toshihiro Ohata,

Successful treatment of disseminated intravascular coagulation associated with aortic dissection Masahiko Fujii, MD, Hiroyuki Watanabe, MD, Masayoshi.

Clinical outcomes and rates of aortic growth and reoperation after 1-stage repair of extensive chronic thoracic aortic dissection Nicholas T. Kouchoukos,

Complications after endovascular repair of acute symptomatic and chronic expanding Stanford type B aortic dissections Dittmar Böckler, MD, Hardy Schumacher,

Successful treatment of disseminated intravascular coagulation associated with aortic dissection Masahiko Fujii, MD, Hiroyuki Watanabe, MD, Masayoshi.

Coil embolization of persistent false lumen after stent graft repair of type B aortic dissection Enrique María San Norberto, MD, Vicente Manuel Gutiérrez,

Midterm results of extensive primary repair of the thoracic aorta by means of total arch replacement with open stent graft placement for an acute type.

The Futility of Surveillance for Old and Small Aneurysms

Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection Naoyuki Kimura, MD, PhD, Satoshi Itoh, MD, PhD,

Aortic remodeling after endovascular repair with stainless steel-based stent graft in acute and chronic type B aortic dissection Chih-Pei Ou Yang, MD,

Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection Naoyuki Kimura, MD, Masashi Tanaka, MD, Koji Kawahito,

Long-term follow-up of acute type B aortic dissection: Ulcer-like projections in thrombosed false lumen play a role in late aortic events Shunsuke Miyahara,

Retrograde ascending Stanford B aortic dissection complicating a routine infrarenal endovascular aortic reconstruction Apostolos T. Mamopoulos, MD, Thomas.

Presentation transcript:

Long-term Result of Acute Type B Aortic Dissection Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Hyogo Brain and Heart Center at Himeji, Hyogo, Japan Shunsuke Miyahara Yuya Tauchi Naoto Izawa Masaomi Fukuzumi Naoto Morimoto Hirohisa Murakami Tasuku Honda Keitaro Nakagiri Masato Yoshida Nobuhiko Mukouhara Nobuhiko Mukouhara

Background Patients with Stanford type B dissection, treated medically during the acute phase, have the risk of late aortic events, such as surgery and aortic rupture. We investigated predictors of late aortic events, focusing on the status of the false lumen at the time of onset.

Objective September 2000～May consecutive acute type B aortic dissections Surgical interventions in acute phase: 22 cases Surgery for other true aneurysms : 5 cases Follow up interval < 6 months : 4 cases ＜Exclusion Criteria ＞ Acute type B aortic dissection 160 cases Age 66.1±11.6 y.o Female 37 cases (23.1%) Follow-up 44.6±25.4 mo.

Patients and Methods Acute type B aortic dissection N=160 Group T :Thrombosed false lumen without ULP N=49(30.6%) Group U ：Thrombosed false lumen+ULP N=52(32.5%) Group P：Patent false lumen N=59(36.9%)

Characteristics Group TGroup UGroup P Age (y.o)69.5±8.9 n.s 70.5±7.9 p< ±15.4 p= Sex(Female%)36.7 p= n.s 16.9 p=0.020 Peripheral artery disease (%) 4.1 n.s 13.4 n.s 8.5 n.s Hyper tension (%)34.7 n.s 38.4 n.s 30.5 n.s Ischemic heart disease (%) 6.1 n.s 5.8 n.s 5.1 n.s Maximum aortic diameter at onset (mm) 36.5±5.1 p< ±6.0 p= ±6.3 p=0.028

Growth Length of Maximum Aortic Diameter ⊿Diameter(mm) Follow up (mo.) T:-0.016±0.23mm/mo. U:0.40±0.91mm/mo. P:0.44±0.49mm/mo. n.s P< P=0.0024

Freedom from Aortic Events Follow-up 33.6±20.5 mo. N Freedom from Aortic Event Months T U P P= P= P= Descending aortic replacement 10 Thoracoabdominal aortic replacement 8 Total arch replacement 5 TEVAR 3 Abdominal aortic replacement 1 Rupture 4 Other 1

Survival Follow-up 44.6±25.4mo Survival Months N % 5years 78.7% 5years 91.9% 5years T U P P=0.670 P= P= Rupture 4 SAH 3 Respiratory failure 3 Pneumonia 2 Malignancy 2 Trauma 1 Heart failure 1 Rena failure 1 Sudden death 1

Statistical Analysis of Predictors for Late Aortic Events DeBakey Ⅲ a Hyper Tension Peripheral artery diseases Ischemic Heart Disease Patent false lumen or ULPs < Max diameter at onset Aortic dilation in distal arch Female Age 95% CI*Hazard Ratio P valueUnivariate pVariables *CI: Confidence Interval Cox Proportional Hazard Analysis

Maximum Aortic Diameter at Onset Maximum Aortic Diameter at Onset (mm) 40.5mm Sensitivity for Late Aortic Events Specificity for Late Aortic Events ROC Curve P< %CI

Cases ①59y.o Female Group T Thrombosed false lumen without ULP resulted in regression. 12mo. 27mo. ②63y.o Male Group U ULP progressed to saccular aneurysm in distal arch. 6mo. ③74y.o Male Group U ULP in thrombosed false lumen recanalized into patent false lumen. 34mm 30mm 47mm59mm

Conclusions Incidence of late aortic events is higher in patients with thrombosed false lumen complicated by ULPs as well as those with patent false lumen, especially with a maximum aortic diameter >40mm at onset. Careful and regular follow-up CT examinations are needed and surgical interventions should be taken into account for these entities.