Current Status of Surgical Treatment for Acute Aortic Dissection in Japan: Nation-wide Database Analysis

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Abstract Submission 

Hitoshi Ogino (1), Hiraku Kumamaru (2), Noboru Motomura (3), Yutaka Okita (4), Kenji Minatoya (5), Hitoshi Matsuda (6), Yosuke Inoue (7), Hideyuki Shimizu (8), Kimihiro Komori (9), Nobuya Zempo (10), Nobuyoshi Azuma (11), Toshiki Fujiyoshi (12), Yusuke Shimamara (13), kentaro kamiya (13), Toru Iwahashi (13), Yuichi Ueda (14)

(1) Tokyo Medical University Hospital, Tokyo, Tokyo, (2) Healthcare Quality Assessment, University of Tokyo, Tokyo, NA, (3) Toho University Sakura Medical Center, Sakura-City, Chiba, (4) Takatsuki General Hospital, Kobe, Hyogo, (5) Kyoto University Hospital, Kyoto, outside of US, (6) National Cerebral and Cardiovascular Center, Suita, Osaka, (7) National Cerebral and Cardiovascular Center, Suita, Suita, (8) Keio University Hospital, Tokyo, Tokyo, (9) Nagoya University, Nagoya, NA, (10) Kansai Medical University, HIrakata, NA, (11) Asahikawa Medical University, Asahikawa, NA, (12) Tokyo Medical Univesity, Tokyo, NA, (13) Tokyo Medical University, Tokyo, NA, (14) Nara Prefectural Hospital Organization, Nara, JAPAN

*Hitoshi Ogino    -  Contact Me
Tokyo Medical University Hospital

Hiraku Kumamaru    -  Contact Me
Healthcare Quality Assessment, University of Tokyo

Noboru Motomura    -  Contact Me
Toho University Sakura Medical Center

*Yutaka Okita    -  Contact Me
Takatsuki General Hospital

*Kenji Minatoya    -  Contact Me
Kyoto University Hospital

*Hitoshi Matsuda    -  Contact Me
National Cerebral and Cardiovascular Center

Yosuke Inoue    -  Contact Me
National Cerebral and Cardiovascular Center

*Hideyuki Shimizu    -  Contact Me
Keio University Hospital

Kimihiro Komori    -  Contact Me
Nagoya University

Nobuya Zempo    -  Contact Me
Kansai Medical University

Nobuyoshi Azuma    -  Contact Me
Asahikawa Medical University

Toshiki Fujiyoshi    -  Contact Me
Tokyo Medical Univesity

Yusuke Shimamara    -  Contact Me
Tokyo Medical University

kentaro kamiya    -  Contact Me
Tokyo Medical University

Toru Iwahashi    -  Contact Me
Tokyo Medical University

Yuichi Ueda    -  Contact Me
Nara Prefectural Hospital Organization

*Hitoshi Ogino    -  Contact Me
Tokyo Medical University Hospital

Objective: Acute aortic dissection (AAD) is a sudden-onset and life-threating disease. For life saving, emergency surgical treatments for most of type A (AAAD) and a part of type B (BAAD) are required. We report the surgical outcome using the prospectively collected Japanese nation-wide database. Methods: A total of 7,194 patients (68.1±13.3 years) undergoing surgical treatment for AAD in 2021 were enrolled from the Japan Cardiovascular Database (JCVSD): AAAD in 89.2% and BAAD in 10.8%. The false lumen was patent in 60.3%. Preoperative critical co-morbidities such as loss of consciousness in 11.0%, acute myocardial ischemia in 4.4%, shock in 11.1%, and cardiopulmonary resuscitation (CPR) in 2.8% were recognized. Including these, 12.0% had organ malperfusion: carotid artery in 4.4%, coronary artery in 1,4%, super mesenteric artery (SMA) in 4.5%, and iliac artery in 4.9%. Open repairs in 6,449 patients (AAAD 6,285 : BAAD 164) and endovascular repairs in 769 (148 : 621) were performed: emergent in 77.7%, urgent in 17.3%, elective in 3.6%, and salvage in 1.4%. The graft replacement was root alone in 56, ascending (+ root) in 2,331 (248), partial arch (+ root) in 1,149 (119), and total arch (+ root) in 2,784 (181). Frozen elephant trunk was used in 1,956 (AAAD 1,876 : BAAD 80). Results: The primary entry was located in root in 3.1%, zone 0 in 50.8%, zone 1 in 8.6%, zone 2 in 7.5%, zone 3 in 10.4%, distal from zone 4 in 5.2%, arch-vessel in 1.2%, and unknown in 5.4%. It was resected in 65.1% of AAAD. The in-hospital mortality was 9.9% in all (AAAD 9.8 : BAAD 10.3). The major morbidities were stroke in 12.2%, coma in 5.1%, paraplegia/paraparesis in 4.3%, acute renal failure in 17.6%, dialysis required in 7.2%, multi-system failure in 3.1%, bleeding in 5.5%. In all, age over 80 years, SMA malperfusion, shock, CPR, mechanical circulatory support, impaired left ventricular function, classical dissection, old cerebral infarction, old myocardial infarction, and rather rapid surgery within 2 hours from admission were independent risk factor for mortality. In AAAD, chronic kidney disease was added in the above risk factors for mortality. Conclusions: The current status of surgical treatments of AAD were demonstrated with favorable outcomes for A/B AAD. However, advanced age and preoperative comorbidities including shock, CPR, and vital organ malperfusion were risk factors. To improve the entire outcome, preoperative critical cares for such comorbidities are mandatory.

Aorta and Great Vessels