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Long-term Outcomes After Controlled Pericardial Drainage for Acute Type A Aortic Dissection
Chikashi Nakai1, So Izumi2, Tomonori Haraguchi2
1Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital, Kobe, Japan.
The Annals of Thoracic Surgery
|March 11, 2020
Summary
Controlled pericardial drainage (CPD) effectively stabilizes patients with cardiac tamponade due to acute aortic dissection type A. This minimally invasive procedure shows satisfactory early and late outcomes, improving survival rates.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Emergency Medicine
Background:
- Acute aortic dissection type A (AADA) with cardiac tamponade presents a high risk of mortality.
- Previous studies suggest percutaneous pericardial drainage (CPD) can stabilize critical patients.
- This study aims to evaluate the efficacy of CPD in managing cardiac tamponade associated with AADA.
Purpose of the Study:
- To assess the early and late outcomes of controlled pericardial drainage in patients with cardiac tamponade and acute aortic dissection type A.
- To determine the safety and effectiveness of CPD as a stabilization strategy prior to aortic repair.
Main Methods:
- Retrospective analysis of 308 patients with AADA from September 2003 to July 2018.
- Focus on 49 patients with cardiac tamponade unresponsive to volume resuscitation who underwent CPD.
- Data collection included hemodynamic parameters, volume drained, procedural success, and patient outcomes.
Main Results:
- CPD significantly improved systolic blood pressure in all 49 patients.
- A small volume (≤30 mL) was sufficient for 61% of patients.
- Early hospital mortality was 16%, with no CPD-related deaths; 5-year survival rate was 63.4%.
Conclusions:
- Controlled pericardial drainage is a safe and effective method for stabilizing patients with critical cardiac tamponade and AADA.
- CPD facilitates timely surgical intervention, leading to satisfactory early and late patient outcomes.
- This approach offers a valuable option for managing life-threatening cardiac tamponade in the context of AADA.
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