Management of patients with type-A aortic dissection: lessons learned from the registry

Résumé fourni par la source

Objective: We developed a web-based database to record peri-operative and mid-term data of patients who had undergone surgery for type-A aortic dissections with the aim to learn from analyzing the data how to improve surgical treatment. We also aimed to identify parameters affecting patient outcome. Methods: All connected cardiac centers have online access to the registry on the GSTCS' homepage. Data concerning pre- and intra-operative states, post-operative complications, mid-term results and circumstances of death have been recorded. This data analysis was done for the period between July 1, 2006 and June 30, 2008. Results: Over a 2-year period, 33 cardiac centers entered data on 676 patients. Completed data were evaluated in 497 cases. Pre-operative data are illustrated in Table 1, intra-operative data in Table 2, and postoperative data in Table 3. Cerebral perfusion data show a mean perfusion time of 31.5min at an average perfusion temperature of 21.8°C with a mean flow of 537.4ml/min and a mean perfusion pressure of 58.2mmHg. Pre-operative data mean age (range) 59.8 (20.6–89.0) arterial hypertension 288 (57.9%) aneurysm/ectasia 139 (28.0%) atherosclerosis 97 (19.5%) Marfan-Syndrome 21 (4.2%) Ehlers-Danlos-Syndrome 5 (1.0%) aortic valve insufficiency I.° and II° 139 (28.0%) aortic valve insufficiency III° and IV.° 139 (28.0%) pericardial effusion 144 (29.0%) pericardial tamponade 104 (20.9%) Intra-operative data supracoronary ascending replacement 356 (71.6%) composite 103 (20.7%) T. David 28 (5.6%) Yacoub 10 (2.0%) subclavian or axillary artery cannulation 157 (31.6%) femoral artery cannulation 146 (29.4%) ascending aorta or arch cannulation 131 (26.4%) innominate aorta cannulation 28 (5.6%) carotid artery cannulation 18 (3.6%) other cannulation 17 (3.4%) Postoperative data time on respirator (h) 27.3 (median) ICU stay (d) 5 (median) in-hospital stay (d) 13 (median) bleeding complications 106 (21.3%) re-operation for bleeding 81 (16.3%) hemiparesis/-plegia 32 (6.4%) paraparesis/-plegia 6 (1.2%) aphasia 6 (1.2%) not accessible 10 (2.0%) 30-day-mortality 92 (18.5%) Conclusion: We have thereby succeeded in collecting initial results and trends from the register that are now available to all of the participating centers. All the centers can benefit from this shared pool of registered data by continuously optimizing their therapy regimes and comparing their success with that in all the other centers.

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