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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Nationwide trends in outcomes and resource utilization in surgically treated acute type A aortic dissection with
Kentaro Fukano1, Yusuke Sasabuchi2, Hiroki Matsui3
1Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Insights
Coronary malperfusion (CM) in acute type A aortic dissection (ATAAD) patients leads to significantly higher mortality and increased intensive care unit (ICU) resource use. Outcomes for these patients have not improved over time, unlike those without CM.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease
Background:
- Coronary malperfusion (CM) is a critical complication of acute type A aortic dissection (ATAAD).
- Patients with CM face poorer outcomes, yet trends in mortality and ICU resource use remain unclear.
Purpose of the Study:
- To investigate contemporary nationwide trends in in-hospital mortality for ATAAD patients with CM.
- To compare healthcare resource utilization between ATAAD patients with and without CM.
Main Methods:
- Retrospective cohort study using the Japanese Diagnosis Procedure Combination database (July 2010-March 2022).
- Included patients undergoing emergency surgery for ATAAD on admission day.
- Defined CM by acute myocardial infarction and/or coronary angiography/PCI on admission day.
Main Results:
- 3.7% of 31,522 ATAAD patients had CM, with significantly higher in-hospital mortality (34.3% vs 9.6%).
- CM was independently associated with increased mortality (aHR, 1.80).
- No temporal improvement in mortality for CM patients, unlike non-CM patients; CM patients required more ICU resources.
Conclusions:
- Coronary malperfusion in surgically treated ATAAD is linked to persistently poor outcomes.
- Patients with CM experience greater ICU resource utilization without observed improvement over time.
- These findings highlight the need for improved management strategies for CM in ATAAD.
Background:
Coronary malperfusion (CM) is a life-threatening complication of acute type A aortic dissection (ATAAD) that has been associated with poor outcomes. Although overall surgical outcomes for ATAAD have improved over time, contemporary nationwide trends in mortality and the associated use of intensive care unit (ICU)-level resources among patients with CM remain incompletely characterized.
Methods:
We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2022. Patients who underwent emergency surgery for ATAAD on the day of admission were included. CM was defined by a diagnosis of acute myocardial infarction and/or receipt of coronary angiography and/or percutaneous coronary intervention on the day of admission. Temporal trends in in-hospital mortality were examined, and healthcare resource utilization was compared according to the presence or absence of CM.
Results:
Among 31,522 patients with surgically treated ATAAD, 1167 (3.7%) were classified as having CM. In-hospital mortality was substantially higher in patients with CM than in those without CM (34.3% vs 9.6%). After multivariable adjustment, CM was associated with increased in-hospital mortality after multivariable adjustment (adjusted hazard ratio, 1.80; 95% confidence interval, 1.58-2.06). Over the study period, in-hospital mortality declined significantly in patients without CM, whereas no temporal improvement was observed in those with CM. Patients with CM required substantially greater ICU-level resources, including prolonged mechanical ventilation and higher hospitalization costs.
Conclusions:
In this nationwide cohort of patients with surgically treated ATAAD, CM was associated with persistently poor short-term outcomes and greater ICU resource utilization, without clear improvement over time.
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