This study used the Japan Cardiovascular Database to describe the clinical results of open surgery for acute aortic dissection. The Japan Cardiovascular Database recorded 29,486 patients with acute aortic dissection who underwent open surgery between 2013 and 2018. There were around 50% male patients. At the time of surgery, the average age of the patients was 59.8 ± 14.2 years; 61% of patients were under 65 years old, and 21% were over 75 years old. In 1.2% of the patients, connective tissue illness was discovered. Patients with disturbed consciousness accounted for 13% of the total, whereas cardiogenic shock accounted for 12%. Aortic valve regurgitation was found in 11% of patients, while acute myocardial infarction was found in 2.3%. Approximately 94% of patients had surgery within 24 hours of being diagnosed. In 74% of patients, antegrade cerebral perfusion was employed, and they used hypothermic circulatory arrest with retrograde cerebral perfusion in 17.1% of patients and deep hypothermic circulatory arrest in 9.4% of patients. The total time for the cardiopulmonary bypass was 216 ± 90 minutes, while the whole time for cardiac ischemia was 132 ± 60 minutes. 24.6°C ± 3.2°C was the lowest body temperature. In 69% of patients, they replaced the ascending aorta (zone I) and performed total arch replacement (zone 0 to zone II, III-) was in 29% of patients. In 7.9% of patients, the aortic valve was replaced, whereas 4.4% repaired it.
The 30-day mortality rate was 9.2%, and the in-hospital mortality rate was 11%. Throughout the study period, the number of surgeries has grown. In-hospital mortality has been steady or decreased in recent years. The stroke affected 12% of patients, new hemodialysis affected 7.3% of patients, spinal cord ischemia affected 3.9% of patients, and prolonged ventilation affected 15% of patients. According to a countrywide Japanese database, around 30,000 patients with acute aortic dissection underwent open surgery in the last six years (2013-2018). The number of procedures has risen, whereas in-hospital mortality has remained stable or decreased in recent years. Although the early results are promising, people with prior comorbidities still have space for improvement.
Reference:www.jtcvs.org/article/S0022-5223(20)33045-2/fulltext
