Lund University Publications
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Lund University Lund University Publications2000-01-01T00:00+00:001dailyHospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissection
https://lup.lub.lu.se/search/publication/5262234c-dabe-4266-b29c-332ef1201834
Geirsson, ArnarAhlsson, AndersFranco-Cereceda, AndersFuglsang, SimonGunn, JarmoHansson, Emma CHjortdal, VibekeJarvela, KatiJeppsson, AndersMennander, AriNozohoor, ShahabOlsson, ChristianPan, EmilyWickbom, AndersZindovic, IgorGudbjartsson, Tomas2018-01-01OBJECTIVES: Acute Type A aortic dissection remains a life-threatening disease, but there are indications that its surgical mortality is decreasing. The aim of this report was to study how surgical mortality has changed and what influences those changes.METHODS: Nordic Consortium for Acute Type A Aortic Dissection is a retrospective database comprising 1159 patients (mean age 61.6 ± 12.2 years, 68% male) treated for acute Type A aortic dissection at 8 centres in Denmark, Finland, Iceland and Sweden from 2005 to 2014. Data gathered included demographics, symptoms, type of procedure, complications and 30-day mortality.RESULTS: The annual number of operations increased significantly from 85 in 2005 to 150 in 2014 (P < 0.001). Chest pain was present in 85% of patients, 24% were hypotensive on presentation and 28% had malperfusion syndrome. Open distal anastomosis technique under hypothermic circulatory arrest was used in 85% of cases and its use increased significantly throughout the study. The 30-day mortality decreased from 24% in 2005 to 13% in 2014 (P = 0.003). Independent predictors for 30-day mortality were preoperative cardiac arrest, malperfusion syndrome, Penn Class C, Penn Class B and C and cardiopulmonary bypass time, whereas later calendar year and higher hospital operative volumes predicted improved survival.CONCLUSIONS: Surgical mortality for acute Type A aortic dissection remains high but has decreased significantly over the last decade. This correlated with later year of operation and increased the number of operations performed per year, indicating that cumulative surgical experience contributes significantly to improved surgical outcomes.https://lup.lub.lu.se/record/5262234c-dabe-4266-b29c-332ef1201834http://dx.doi.org/10.1093/ejcts/ezx231scopus:85046578689pmid:28977415engEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery; 53(1), pp 276-281 (2018)ISSN: 1010-7940Cardiac and Cardiovascular SystemsAdultAgedAged, 80 and overAneurysm, Dissecting/mortalityAorta/surgeryAortic Aneurysm/mortalityFemaleFollow-Up StudiesHospital Mortality/trendsHospitals, High-VolumeHospitals, Low-VolumeHumansLogistic ModelsMaleMiddle AgedRetrospective StudiesScandinavian and Nordic Countries/epidemiologyHospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissectioncontributiontojournal/articleinfo:eu-repo/semantics/articletextPreoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repair
https://lup.lub.lu.se/search/publication/1f59b223-c279-45ca-a202-b1d3e3948f23
Hansson, Emma CGeirsson, ArnarHjortdal, VibekeMennander, AriOlsson, ChristianGunn, JarmoZindovic, IgorAhlsson, AndersNozohoor, ShahabChemtob, Raphaelle APivodic, AldinaGudbjartsson, TomasJeppsson, Anders2019-01-16OBJECTIVES: Acute aortic dissection type A is a life-threatening condition, warranting immediate surgery. Presentation with sudden chest pain confers a risk of misdiagnosis as acute coronary syndrome resulting in subsequent potent antiplatelet treatment. We investigated the impact of dual antiplatelet therapy (DAPT) on bleeding and mortality using the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database.METHODS: The NORCAAD database is a retrospective multicentre database where 119 of 1141 patients (10.4%) had DAPT with ASA + clopidogrel (n = 108) or ASA + ticagrelor (n = 11) before surgery. The incidence of major bleeding and 30-day mortality was compared between DAPT and non-DAPT patients with logistic regression models before and after propensity score matching.RESULTS: Before matching, 51.3% of DAPT patients had major bleeding when compared to 37.7% of non-DAPT patients (P = 0.0049). DAPT patients received more transfusions of red blood cells [median 8 U (Q1-Q3 4-15) vs 5.5 U (2-11), P < 0.0001] and platelets [4 U (2-8) vs 2 U (1-4), P = 0.0001]. Crude 30-day mortality was 19.3% vs 17.0% (P = 0.60). After matching, major bleeding remained significantly more common in DAPT patients, 51.3% vs 39.3% [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.05-2.51; P = 0.028], but mortality did not significantly differ (OR 0.88, 95% CI 0.51-1.50; P = 0.63). Major bleeding was associated with increased 30-day mortality (adjusted OR 2.44, 95% CI 1.72-3.46; P < 0.0001).CONCLUSIONS: DAPT prior to acute aortic dissection repair was associated with increased bleeding and transfusions but not with mortality. Major bleeding per se was associated with a significantly increased mortality. Correct diagnosis is important to avoid DAPT and thereby reduce bleeding risk, but ongoing DAPT should not delay surgery.https://lup.lub.lu.se/record/1f59b223-c279-45ca-a202-b1d3e3948f23http://dx.doi.org/10.1093/ejcts/ezy469scopus:85062601142pmid:30657880engEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery; 56(1), pp 182-188 (2019)ISSN: 1010-7940Cardiac and Cardiovascular SystemsPreoperative dual antiplatelet therapy increases bleeding and transfusions but not mortality in acute aortic dissection type A repaircontributiontojournal/articleinfo:eu-repo/semantics/articletext