| 11. |
- Geirsson, Arnar, et al.
(författare)
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Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection
- 2019
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Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier. - 0022-5223 .- 1097-685X. ; 157:5, s. 1750-1758
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Open-distal anastomosis is the preferred technique over clamp-on technique for surgical repair of acute type A aortic dissection (ATAAD). The aim of this study was to define how outcomes of ATAAD were affected by the use of either technique.Methods: Nordic Consortium for Acute Type A Aortic Dissection includes 8 academic cardiothoracic hospitals in 4 Nordic countries. The cohort consisted of 1134 patients, 153 clamp-on and 981 open-distal, from 2005 to 2014.Results: Patients who underwent operation with the clamp-on were younger, more frequently had coronary artery disease, bicuspid aortic valve, hypotension/shock or syncope, and a greater PennClass than open-distal patients. Postoperative cerebral vascular accident occurred less frequently in clamp-on (14/153, 10%) compared with the open-distal group (190/981, 20%). Clamp-on had greater 30-day mortality (39/153, 25%) than the open-distal group (158/981, 16%), and 5-year survival was also worse in clamp-on (61.8% +/- 4.4%) compared with the open-distal group (73.0% +/- 1.6%). The open-distal technique was used more frequently in greater-volume hospitals but was not independently associated with 30-day mortality. Preoperative condition was an independent risk factor whereas hospital volume and later year of operation were beneficial in regard to short-term outcome. Open-distal was independently associated with improved mid-term survival.Conclusions: Patients who underwent operation with the clamp-on were sicker on presentation and had worse short-and mid-term survival compared with the open-distal group. Patients in the open-distal group had greater rates of cerebrovascular complications. The results support the routine use of open-distal anastomosis as the primary operative strategy for ATAAD, although clamp-on can be performed successfully in select cases.
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| 12. |
- Olsson, Christian, et al.
(författare)
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Medium-term survival after surgery for acute Type A aortic dissection is improving
- 2017
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press. - 1010-7940 .- 1873-734X. ; 52:5, s. 852-857
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To report long-term survival and predictors of mortality in patients included in a large, contemporary, multicentre, multinational database: Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD), which consists of 8 centres in 4 Nordic countries.METHODS: Currently, NORCAAD includes 1159 patients operated between 2005 and 2014. In 30-day survivors (n = 955, 82%), the Kaplan-Meier and Cox proportional hazard methods were used to analyse medium-term (up to 8 years) survival and relative survival versus a matched normal population. Pre- and intraoperative predictors were expressed as hazard ratio (HR) with 95% confidence interval (95% CI).RESULTS: Cumulative follow-up was 3514 patient-years with a median of 3.2 years (range 0-10.2 years). Survival was 95% (95% CI 93-96) at 1 year, 86% (95% CI 83-88) at 5 years and 76% (95% CI 72-81) at 8 years. Relative survival versus a matched normal population was 95% (95% CI 94-97) at 1 year, 90% (95% CI 87-93) at 5 years and 85% (95% CI 80-90) at 8 years. In multivariable analysis, increased age (HR 1.05 per year, 95% CI 1.04-1.07), previous abdominal or thoracic aortic repair (HR 3.2, 95% CI 1.6-6.4) and chronic renal disease (HR 2.7, 95% CI 1.2-6.2) were associated with increased medium-term mortality. Open distal anastomosis (HR 0.55, 95% CI 0.35-0.87) and operation in the 2010-2014 period (HR 0.90, 95% CI 0.83-0.97) were associated with decreased medium-term mortality.CONCLUSIONS: Medium-term survival after acute Type A aortic dissection in the NORCAAD registry is satisfactory, close to a matched normal population and improved in the later part of the study period. The use of open distal anastomosis was associated with decreased medium-term mortality.
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| 13. |
- Oudin, Anna, et al.
(författare)
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Impact of national holidays and weekends on incidence of acute type A aortic dissection repair
- 2022
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies have demonstrated that environmental and temporal factors may affect the incidence of acute type A aortic dissection (ATAAD). Here, we aimed to investigate the hypothesis that national holidays and weekends influence the incidence of surgery for ATAAD. For the period 1st of January 2005 until 31st of December 2019, we investigated a hypothesised effect of (country-specific) national holidays and weekends on the frequency of 2995 surgical repairs for ATAAD at 10 Nordic cities included in the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) collaboration. Compared to other days, the number of ATAAD repairs were 29% (RR 0.71; 95% CI 0.54–0.94) lower on national holidays and 26% (RR 0.74; 95% CI 0.68–0.82) lower on weekends. As day of week patterns of symptom duration were assessed and the primary analyses were adjusted for period of year, our findings suggest that the reduced surgical incidence on national holidays and weekends does not seem to correspond to seasonal effects or surgery being delayed and performed on regular working days.
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| 14. |
- Pan, Emily, et al.
(författare)
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Outcome after type A aortic dissection repair in patients with preoperative cardiac arrest
- 2019
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Ingår i: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 144, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- AIM OF THE STUDY: Patients presenting with acute type A aortic dissection (ATAAD) and cardiac arrest before surgery are considered to have very poor prognosis, but limited data is available. We used a large database to evaluate the outcome of ATAAD patients with a cardiac arrest before surgery.METHODS: We evaluated 1154 surgically treated ATAAD patients from the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database between 2005 and 2014. Patients with (n = 44, 3.8%) and without preoperative cardiac arrest were compared and variables univariably associated with mortality in the cardiac arrest group were identified. Median follow-up time was 2.7 years (interquartile range 0.5-5.5).RESULTS: Thirty-day mortality in the arrest and non-arrest group was 43.2% and 16.6%, respectively (odds ratio [OR] 3.83, CI 2.06-7.09; P < 0.001). In the nine patients with ongoing cardiopulmonary resuscitation when cardiopulmonary bypass was initiated, five died intraoperatively and one died after 65 days. In patients surviving the operation, stroke was significantly more common in the arrest group (48.4% vs 18.2%; OR 4.21, CI 2.05-8.67; P < 0.001). In total, 50.0% (22/44) of the arrest patients survived to the end of follow-up. Non-survivors in the arrest group more often had DeBakey type I dissection, cardiac tamponade, cardiac malperfusion and higher preoperative serum lactate (all P < 0.05).CONCLUSIONS: Early mortality and complications after ATAAD surgery in patients with a preoperative cardiac arrest are high, but mid-term outcome after surviving the initial period is acceptable. Preoperative cardiac arrest should not be considered an absolute contraindication for a surgical ATAAD repair.
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| 15. |
- Uimonen, Mikko, et al.
(författare)
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Outcome After Surgery for Acute Type A Aortic Dissection With or Without Primary Tear Resection
- 2022
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Ingår i: Annals of Thoracic Surgery. - : Elsevier. - 0003-4975 .- 1552-6259. ; 114:2, s. 492-501
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The outcome in patients after surgery for acute type A aortic dissection without replacement of the part of the aorta containing the primary tear is undefined.METHODS: Data of 1122 patients who underwent surgery for acute type A aortic dissection in 8 Nordic centers from January 2005 to December 2014 were retrospectively analyzed. The patients with primary tear location unfound, un-known, not confirmed, or not recorded (n = 243, 21.7%) were excluded from the analysis. The patients were divided into 2 groups according to whether the aortic reconstruction encompassed the portion of the primary tear (tear resected [TR] group, n = 730) or not (tear not resected [TNR] group, n = 149). The restricted mean survival time ratios adjusted for patient characteristics and surgical details between the groups were calculated for all-cause mortality and aortic reoperation-free survival. The median follow-up time was 2.57 (interquartile range, 0.53-5.30) years.RESULTS: For the majority of the patients in the TR group, the primary tear was located in the ascending aorta (83.6%). The reconstruction encompassed both the aortic root and the aortic arch in 7.4% in the TR group as compared with 0.7% in the TNR patients (P < .001). There were no significant differences in all-cause mortality (adjusted restricted mean survival time ratio, 1.01; 95% confidence interval, 0.92-1.12; P = .799) or reoperation-free survival (adjusted restricted mean survival time ratio, 0.98; 95% confidence interval, 0.95-1.02; P = .436) between the TR and TNR groups.CONCLUSIONS: Primary tear resection alone does not determine the midterm outcome after surgery for acute type A aortic dissection. (Ann Thorac Surg 2022;114:492-501) (c) 2022 by The Society of Thoracic Surgeons.
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| 16. |
- Zindovic, Igor, et al.
(författare)
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Malperfusion in acute type A aortic dissection : An update from the Nordic Consortium for Acute Type A Aortic Dissection
- 2019
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Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier. - 0022-5223 .- 1097-685X. ; 157:4, s. 1324-1333
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate the effect of preoperative malperfusion on 30-day and late mortality and postoperative complications using data from the Nordic Consortium for Acute Type A Aortic Dissection (ATAAD) registry.Methods: We studied 1159 patients who underwent ATAAD surgery between January 2005 and December 2014 at 8 Nordic centers. Multivariable logistic and Cox regression analyses were performed to identify independent predictors of 30-day and late mortality.Results: Preoperative malperfusion was identified in 381 of 1159 patients (33%) who underwent ATAAD surgery. Thirty-day mortality was 28.9% in patients with preoperative malperfusion and 12.1% in those without. Independent predictors of 30-day mortality included any malperfusion (odds ratio, 2.76; 95% confidence interval [CI], 1.94-3.93), cardiac malperfusion (odds ratio, 2.37; 95% CI, 1.34-4.17), renal malperfusion (odds ratio, 2.38; 95% CI, 1.23-4.61) and peripheral malperfusion (odds ratio, 1.95; 95% CI, 1.26-3.01). Any malperfusion (hazard ratio, 1.72; 95% CI, 1.21-2.43), cardiac malperfusion (hazard ratio, 1.89; 95% CI, 1.24-2.87) and gastrointestinal malperfusion (hazard ratio, 2.25; 95% CI, 1.18-4.26) were predictors of late mortality. Malperfusion was associated with significantly poorer survival at 1, 3, and 5 years (95.0% +/-0.9% vs 88.7% +/-1.9%, 90.1% +/-1.3% vs 84.0% +/-2.4%, and 85.4% +/-1.7% vs 80.8% +/-2.7%; log rank P = .009).Conclusions: Malperfusion has a significant influence on early and late outcomes in ATAAD surgery. Management of preoperative malperfusion remains a major challenge in reducing mortality associated with surgical treatment of ATAAD.
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| 17. |
- Ahlsson, Anders, 1962-
(författare)
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Atrial fibrillation in cardiac surgery
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. In cardiac surgery, one-third of the patients experience episodes of AF during the first postoperative days (postoperative AF), and patients with preoperative AF (concomitant AF) can be offered ablation procedures in conjunction with surgery, in order to restore ordinary sinus rhythm (SR). The aim of this work was to study the relation between postoperative AF and inflammation; the long-term consequences of postoperative AF on mortality and late arrhythmia; and atrial function after concomitant surgical ablation for AF. In 524 open-heart surgery patients, C-reactive protein (CRP) serum concentrations were measured before and on the third day after surgery. There was no correlation between levels of CRP and the development of postoperative AF. All 1,419 patients with no history of AF, undergoing primary aortocoronary bypass surgery (CABG) in the years 1997–2000 were followed up after 8.0 years. The mortality rate was 191 deaths/1,000 patients (19.1%) in patients with no AF and 140 deaths/419 patients (33.4%) in patients with postoperative AF. Postoperative AF was an age-independent risk factor for late mortality, with a hazard ratio (HR) of 1.56 (95% CI 1.23–1.98). Postoperative AF patients had a more than doubled risk of death due to cerebral ischaemia, myocardial infarction, sudden death, and heart failure compared with patients without AF. All 571 consecutive patients undergoing primary CABG during the years 1999–2000 were followed-up after 6 years. Questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.3% of all patients. In postoperative AF patients, 14.1% had AF at follow-up, compared with 2.8% of patients with no AF at surgery (p<.001). An episode of postoperative AF was found to be an independent risk factor for development of late AF, with an adjusted risk ratio (RR) of 3.11 (95% CI 1.41–6.87). Epicardial microwave ablation was performed in 20 open-heart surgery patients with concomitant AF. Transthoracic echocardiography was performed preoperatively and at 6 months postoperatively. At 12 months postoperatively 14/19 patients (74%) were in SR with no anti-arrhythmic drugs. All patients in SR had preserved left and right atrial filling waves (A-waves) and Tissue velocity echocardiography (TVE) showed preserved atrial wall velocities and atrial strain. In conclusion, postoperative AF is an independent risk factor for late mortality and later development of AF. There is no correlation between the inflammatory marker CRP and postoperative AF. Epicardial microwave ablation of concomitant AF results in SR in the majority of patients and seems to preserve atrial mechanical function.
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| 18. |
- Ahlsson, Anders, et al.
(författare)
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Atrial function after epicardial microwave ablation in patients with atrial fibrillation
- 2008
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Ingår i: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 42:3, s. 192-201
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study epicardial microwave ablation of concomitant atrial fibrillation and its effects on heart rhythm and atrial function during follow-up. DESIGN: The study included 20 open-heart surgery patients with concomitant atrial fibrillation. Transthoracic echocardiography with flow and tissue Doppler recordings was performed preoperatively and at 6 months postoperatively. Blood samples were obtained preoperatively and postoperatively for analysis of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and amino terminal precursor of brain natriuretic peptide (NT-proBNP). RESULTS: Fourteen of 19 patients (74%) were in sinus rhythm with no antiarrhythmic drugs at 12 months. All patients in sinus rhythm had preserved left and right atrial-filling waves through atrioventricular valves during atrial contraction. Tissue velocity echocardiography on patients in sinus rhythm showed preserved atrial wall velocities, atrial strain, and atrial strain rate. Levels of natriuretic peptides tended to decrease in patients with stable sinus rhythm at one year compared to patients in atrial fibrillation. CONCLUSIONS: Epicardial microwave ablation results in sinus rhythm in a majority of patients and seems to preserve atrial mechanical function
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| 19. |
- Ahlsson, Anders J., et al.
(författare)
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Postoperative atrial fibrillation is not correlated to C-reactive protein
- 2007
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 83:4, s. 1332-1337
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The peak incidence of postoperative atrial fibrillation (AF) occurs around the second postoperative day, a time at which serum inflammatory markers are elevated. The aim of this study was to investigate differences between patients with and without postoperative AF with special regard to C-reactive protein (CRP) serum levels. METHODS: The study cohort included all heart surgery patients who had sinus rhythm preoperatively, survived postoperative day 3, and were operated on between July 1, 2004, and June 30, 2005 (n = 524). Any episode of AF during the first 7 postoperative days defined the patient as belonging to the postoperative AF group. Creatine kinase-myocardial band (CK-MB) was measured at postoperative day 1, and CRP was measured preoperatively and at postoperative day 3. Risk factors for postoperative AF were determined using bivariate and multivariate regression analysis. RESULTS: Of 524 patients, 182 had at least one episode of AF (34.7%). Preoperative and postoperative CRP concentrations did not differ between the groups (postoperative CRP 175.4 +/- 64.4 versus 175.3 +/- 60.1 mg/L respectively, p = 0.99). Atrial fibrillation patients were significantly older (p < 0.001) and had higher CK-MB levels (33.6 +/- 53.1 microg/L versus 22.5 +/- 26.7 microg/L, respectively, p = 0.009). The odds ratio for postoperative AF with postoperative CK-MB greater than 70 microg/L was 3.5 (confidence interval: 1.4 to 8.6). CONCLUSIONS: Postoperative AF has no correlation to the inflammatory marker CRP in heart surgery patients. Ischemic myocardial injury might predispose for postoperative AF.
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| 20. |
- Ahlsson, Anders, 1962-, et al.
(författare)
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Kirurgisk behandling av förmaksflimmer i samband med hjärtkirurgi [Surgical treatment of atrial fibrillation in connection with cardiac surgery] : konsensusrapport från Sveriges arytmiansvariga hjärtkirurger [Consensus report from Swedish cardiac surgeons responsible for arrhythmia]
- 2012
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Ingår i: Läkartidningen. - Stockholm : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 109:5, s. 214-217
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Tidskriftsartikel (refereegranskat)abstract
- Förmaksflimmer är vanligt och förekommer hos 6–10 procent av de patienter som ska genomgå kranskärlsoperation eller klaffkirurgi. Kirurgisk ablation av förmaksflimmer i samband med kranskärlsoperation eller klaffkirurgi bör erbjudas alla symtomatiska och utvalda asymtomatiska patienter. Cox-maze III (labyrintoperation) är den metod som gett bäst resultat vad avser frihet från förmaksflimmer 1 år efter ingreppet.Under senare år har flera nya metoder utvecklats för att åstadkomma elektriskt isolerande lesioner i hjärtats förmak. Dessa är tekniskt enklare och mindre invasiva. De är dock behäftade med sämre resultat än den ursprungliga Cox-maze III-operationen. Arytmiansvariga kirurger på landets samtliga hjärtkirurgiska kliniker har nått samstämmighet om hur förmaksflimmer bör behandlas i samband med annan hjärtkirurgi. Denna konsensus, vilken presenteras här, betonar vikten av att vid kirurgisk ablation följa lesionsmönstret i Cox-maze III och helst behandla både höger och vänster förmak för bästa långtidsresultat.
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