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

*Alberto Pochettino Invited Discussant
Mayo Clinic
Rochester, MN 
United States
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Dr. Pochettino was born in Milan, Italy. He moved Cleveland during high school. He went on to attend undergraduate and medical school at Northwest University in Chicago. He did his general surgery residency in Brooklyn at the State University of New York Downstate Medical Center/King’s County Hospital System. During his general surgical training, he spent two years carrying out basic research at Wayne State University/Harper Hospital in Detroit, Michigan, where he worked on ventricular assist device research. Upon completion of his general surgical training, he moved to the University of Pennsylvania Medical Center where he received his thoracic and cardiovascular surgical training. He stayed one extra year within the University of Pennsylvania Health System to due additional work on cardiopulmonary transplantation and aortic surgery. Before that, as part of his thoracic and cardiovascular training, he spent a significant amount of his time at a children’s hospital in Philadelphia where he received extensive congenital training. At the completion of his fellowship, he joined the staff at University of Pennsylvania Health System where he became an Associate Professor. During his tenure at University of Pennsylvania, he was placed in charge of the lung transplant program and was instrumental in the establishment of the adult congenital cardiosurgical program where he was appointed as Co-Surgical Director.

In 2012, he was recruited to Mayo Clinic to establish a vibrant, complex, aortic practice as well as participate actively in the adult congenital practice and cardiopulmonary transplant service. His present practice spans the entire spectrum of cardiovascular disease including adult congenital but is focused on aortic disease including aortic root surgery, valve-sparing root replacement, aortic arch reconstruction, thoracoabdominal reconstruction, and endovascular treatment of the thoracic and thoracoabdominal aorta in combination with the Vascular Team.

 

*Hitoshi Ogino Abstract Presenter
Tokyo Medical University Hospital
Tokyo, Tokyo 
Japan
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Full Name (First Name, Last Name): Hitoshi Ogino, MD, PhD

Present Position: Professor and chairman of Cardiovascular Surgery, Tokyo Medical University

Academic or Medical Associations Position: Professor and chairman of Cardiovascular Surgery, Tokyo Medical University

Educational background & professional experience (in sequence of the latest year): 

1976 - 1982         Hiroshima University

1992                    Ph.D. from Kyoto University

 

1982 - 84             Resident of Thoracic and Cardiovascular Surgery,  Kobe General Hospital, Kobe, Japan             

1984 - 87             Senior resident of Thoracic and Cardiovascular Surgery,  Kobe General Hospital, Kobe, Japan

1987 - 91             Staff surgeon of Cardiovascular Surgery, Kyoto University Hospital, Kyoto, Japan

1991 - 92             Staff surgeon of Cardiovascular Surgery, Takeda Hospital, Kyoto, Japan

1992 - 94             Senior registrar of Cardiothoracic Surgery, Harefield Hospital, Middle-sex, U.K.

1994 - 97             Staff surgeon of Cardiovascular Surgery, Tenri Hospital, Nara, Japan

1997 - 2000         Vice-director of Cardiovascular Surgery, Tenri Hospital, Nara, Japan

2000 - 01             Consultant surgeon of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan

2001 - 11             Chief of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan

2011 - present     Professor and Chairman of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan

Saturday, May 6, 2023: 9:00 AM - 9:15 AM
15 Minutes 
Los Angeles Convention Center 
Room: 515B 

Description

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.

Presentation Duration

7 minute presentation; 7 minute discussion 

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