Outcomes after surgery for acute type A aortic dissection in \u201cnon-Marfan syndrome\u201d patients with long life expectancy: A 24-year follow-up

Background Long-term survival and risk of reoperation in \u201cnon-Marfan syndrome\u201d patients with a long life expectancy who undergo emergency surgery for acute type A aortic dissection (aTAAD) are not well known. Aim To analyse survival, risk of reoperation and quality of life in this population. Methods From 1990 to 2010, all patients aged  64 50 years and not affected by Marfan syndrome, who underwent emergency surgery for aTAAD at two institutions, were included in this analysis. Patients were categorized into four groups according to the extension of the aortic replacement: SUPRACORONARY, ROOT, ARCH and EXTENSIVE. Results Sixty-six patients (mean age 45 \ub1 4 years; range 34\u201350 years) were considered eligible for this analysis. Overall in-hospital mortality was 24% (16/66 patients); and 25%, 23%, 20.5% and 43% in the SUPRACORONARY, ROOT, ARCH and EXTENSIVE groups, respectively. Mean follow-up among survivors was 10.5 \ub1 7.2 years (range: 0.1\u201324.7 years). Overall 10-year survival was 55 \ub1 6%; and 75 \ub1 12%, 69 \ub1 13%, 47 \ub1 8% and 28 \ub1 17% in the SUPRACORONARY, ROOT, ARCH and EXTENSIVE groups, respectively. Overall freedom from reoperation on the aorta was 73 \ub1 7.5%; and 40 \ub1 20%, 75 \ub1 21%, 78 \ub1 8% and 100% in the SUPRACORONARY, ROOT, ARCH and EXTENSIVE groups, respectively. Conclusions In our experience, patients who underwent isolated supracoronary ascending aorta or root replacement showed the most satisfactory late survival. However, because the risk of reoperation is low when the replacement is extended to the root, our data suggest that root replacement could represent a good compromise between operative mortality and long-term survival

[Cryopreserved amniotic membranes use in resistant vascular ulcers]

International audienceBACKGROUND AND OBJECTIVE: Amniotic membranes are used with success in ophthalmology to treat corneal wounds and ulcers. In this pilot study, we attempt to assess the tolerance of amniotic membranes in the management of resistant venous and/or arterial vascular ulcers. MATERIAL AND METHODS: We prospectively included 8 patients, 7 males and 1 female, mean age 69.5+/- 9.6 years, with venous and/or arterial ulcers resistant after 6 months with usual medical care and/or after revascularisation failure. Amniotic membranes were applied on a weekly basis with the fetal side on the ulcer, covered by a secondary bandage. The primary end-point was evaluation of tolerance of amniotic membranes on vascular ulcers. The secondary end-points were a >50% reduction of ulcer's area, a significant (P50% reduction of ulcer area at weeks 26, 31 and 32 for 3 patients. A sixth patient had an ulcer area reduction <50% and the 2 remaining showed no improvement. A significant improvement was noticed for visual pain scale and the health feeling dimension in the SF-36 questionnaire. No adverse effect or amputation requirement was noted. CONCLUSION: These preliminary results are encouraging and require a larger confirmatory study. Further studies are required to clarify the action mode of this therapeutic option

Benefits of a 14-year surgical site infections active surveillance programme in a French teaching hospital

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