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• W3088751522 abstract "Central MessageExcellent, well-documented, contemporary outcomes on acute type A aortic dissection from the Japan Cardiovascular Database.See Article page 785. Excellent, well-documented, contemporary outcomes on acute type A aortic dissection from the Japan Cardiovascular Database. See Article page 785. Okita and colleagues1Okita Y. Kumamaru H. Motomura N. Miyata H. Takamoto S. Current status of open surgery for acute type A aortic dissection in Japan.J Thorac Cardiovasc Surg. 2022; 164: 785-794.e1Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar report a very large, contemporary (2013 to 2018) experience drawing from 29,486 surgical cases of acute type A aortic dissection (AAD) registered in the Japan Cardiovascular Database. Reporting all cases to the national database is mandatory in Japan, so the data are a representative acute cohort. There is valuable information in this article. Although frequently the subject of research, the aortic arch was replaced in only 20.6% of AAD cases, with an additional 8.7% undergoing a concomitant frozen elephant trunk (FET) procedure. Outcomes were similar whether the extent of resection included zones 0 to I, 0 to III, or 0 to III + FET, with respect to hospital mortality (10.8%, 11.9%, and 10.8%, respectively), stroke (11.5%, 11.9%, and 11.5%, respectively), and prolonged ventilation (15.1%, 15.6%, 16.0%, respectively). However, the incidence of spinal cord injury (SCI) was 3.3%, 4.4%, and 6.5%, respectively. Presumably, these are de novo, postoperative SCI complications because preoperative SCI is not noted. These data are notable at both ends of the resection spectrum. Despite a number of centers reporting very low rates of spinal injury associated with the FET, this large, contemporary experience indicates that it remains a worrisome complication. On the less-aggressive side, the report of 3.3% SCI for zone 0 to I resections, presumably mostly hemiarch procedures, is highly unusual. There is no a priori reason that SCI cannot occur following a hemiarch for AAD, but in our experience, spanning more than 35 years, and an unofficial poll of other large institution experiences, the incidence of de novo postoperative SCI following a hemiarch procedure for AAD is 1 in 1000. The mortality rates were outstanding, with 11% in-hospital mortality—10.1% in the most recent cohort—consistent with contemporary outcomes in centers of excellence. Presumably, some institutions in Japan have fewer cases and less experience than centers of excellence in Japan, yet these nationwide mortality rates are considerably lower than the 17% operative mortality recently reported for acute type A dissection in the Society of Thoracic Surgeons Adult Cardiac Surgery Database.2Lee T.C. Kon Z. Cheema F.H. Grau-Sepulveda M.V. Englum B. Kim S. et al.Contemporary management and outcomes of acute type A aortic dissection: an analysis of the STS adult cardiac surgery database.J Card Surg. 2018; 33: 7-18Crossref PubMed Scopus (95) Google Scholar One might wonder whether some extreme risk cases are excluded, but examining the preoperative risks indicates that difficult cases are included because 94% underwent surgery within 24 hours, 12% had cardiogenic shock, 3.3% underwent cardiopulmonary resuscitation within 1 hour of surgery, and 20% were older than age 75 years. Clearly, like The International Registry of Acute Aortic Dissections, the Scandinavian and Canadian databases, the Japan Cardiovascular Database database will prove a valuable source of information for our specialty. Current status of open surgery for acute type A aortic dissection in JapanThe Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 3PreviewThe study objective was to report the clinical outcomes of open surgery for acute aortic dissection by using the Japan Cardiovascular Database. Full-Text PDF" @default.
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• W3088751522 date "2022-09-01" @default.
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• W3088751522 title "Commentary: Type A dissection repairs made in Japan" @default.
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• W3088751522 doi "https://doi.org/10.1016/j.jtcvs.2020.09.078" @default.
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