Influence of Age on Postoperative Neurological Outcomes after Surgery of Acute Type A Aortic Dissection

BackgroundAcute type A aortic dissection (AAAD) is considered a fatal disease which requires an emergent surgical intervention. This study focuses onthe neurological outcome after surgical repair in cases of AAAD in comparison between elderly and young patients.Methodsa retrospective analysis of 368 consecutive patients who underwent emergency surgery of ascending aorta in moderate hypothermic circulatory arrest (MHCA) (20-24 °C) and antegrade cerebral perfusion after AAAD between 2001 and 2016. Patients were divided into two groups: those aged 75 years and older (68 (18.5%)) and those younger than 75 years (300 (81.5%)).ResultsComparing both groups, average age was 79.0 ± 3.2 vs. 59.2 ± 10.7 years (p < 0.001); female gender represents 58.8% of elderly patients vs. 28.7% in younger patients (p < 0.001). Intraoperatively, cardiopulmonary bypass time (155 min (131; 187) vs. 171 min (137; 220); p = 0.012), cross-clamping time (79 min (60; 105) vs. 93 min (71; 134); p = 0.001] and circulatory arrest time (29 min (22; 40) vs. 33 min (26; 49); p = 0.011) were significantly shorter in elderly than younger group. Postoperatively, there was no significant difference in delirium (11.8% vs. 20.5%; p = 0.0968) or stroke (11.8% vs. 16.1%; p = 0.369). The 30-day mortality was satisfactory for both groups but significantly higher in the elderly group (27.9% vs. 14.3%; p = 0.007).ConclusionThe current study concluded that surgical treatment of AAAD in elderly patients can be applied safely without increasing risk of neurological complication. However, minimizing operation time may help limit the occurrence of postoperative neurological complication

Active Infective Native and Prosthetic Valve Endocarditis: Short- and Long-Term Outcomes of Patients after Surgical Treatment

BackgroundActive infective endocarditis (IE) is a serious disease associated with high mortality. The current study represents our experience over 18 years with surgical treatment for active infective native and prosthetic valve endocarditis (INVE, IPVE).MethodAnalysis of 413 patients (171 with IPVE vs. 242 with INVE) who underwent cardiac surgery due to IE between 2002 and 2020.ResultsPatients with IPVE were significantly older (64.9 ± 13.2 years vs. 58.3 ± 15.5 years; p < 0.001) with higher EuroSCORE II (21.2 (12.7; 41.8) vs. 6.9 (3.0; 17.0); p < 0.001)) and coronary heart disease (50.6% vs. 38.0%; p < 0.011). Preoperative embolization was significantly higher within INVE (35.5% vs. 16.4%; p < 0.001) with high incidence of cerebral embolization (18.6% vs. 7.6%; p = 0.001) and underwent emergency curative surgery than the IPVE group (19.6% vs. 10.6%; p < 0.001). However, patients with IPVE were significantly represented with intracardiac abscess (44.4% vs.15.7%; p < 0.001). Intraoperatively, the duration of surgery was expectedly significantly higher in the IPVE group (356 min vs. 244 min.; p = 0.001) as well as transfusion of blood (4 units (0-27) vs. 2 units (0-14); p < 0.001). Post-operatively, the incidence of bleeding was markedly higher within the IPVE group (700 mL (438; 1163) vs. 500 mL (250; 1075); p = 0.005). IPVE required significantly more permanent pacemakers (17.6% vs. 7.5%: p = 0.002). The 30-day mortality was higher in the IPVE group (24.6% vs. 13.2%; p < 0.003).ConclusionPatients with INVE suffered from a higher incidence of cerebral embolization and neurological deficits than patients with IPVE. Surgical treatment in INVE is performed mostly as an emergency indication. However, patients with IPVE were represented commonly with intracardiac abscess, and had a higher indication of pacemaker implantation. The short- and long-term mortality rate among those patients was still high

Outcome of Unilateral Pulmonary Edema after Minimal-Invasive Mitral Valve Surgery: 10-Year Follow-Up

The study was approved by the institutional review board (IRB) at the University Medical Center Campus Kiel, Kiel, Germany (reference number: AZ D 559/18) and registered at the German Clinical Trials Register (reference number: DRKS00022222). Objective Unilateral pulmonary edema (UPE) is a complication after minimally invasive mitral valve surgery (MIMVS). We analyzed the impact of this complication on the short- and long-term outcome over a 10-year period. Methods We retrospectively observed 393 MIMVS patients between 01/2009 and 12/2019. The primary endpoint was a radiographically and clinically defined UPE within the first postoperative 24 h, secondary endpoints were 30-day and long-term mortality and the percentage of patients requiring ECLS. Risk factors for UPE incidence were evaluated by logistic regression, and risk factors for mortality in the follow-up period were assessed by Cox regression. Results Median EuroSCORE II reached 0.98% in the complete MIMVS group. Combined 30-day and in-hospital mortality after MIMVS was 2.0% with a 95, 93 and 77% survival rate after 1, 3 and 10 years. Seventy-two (18.3%) of 393 patients developed a UPE 24 h after surgery. Six patients (8.3%) with UPE required an extracorporeal life-support system. Logistic regression analysis identified a higher creatinine level, a worse LV function, pulmonary hypertension, intraoperative transfusion and a longer aortic clamp time as predictors for UPE. Combined in hospital mortality and 30-day mortality was slightly but not significantly higher in the UPE group (4.2 vs. 1.6%; p = 0.17). Predictors for mortality during follow-up were age ≥ 70 years, impaired RVF, COPD, drainage loss ≥ 800 mL and length of ventilation ≥ 48 h. During a median follow-up of 4.6 years, comparable survival between UPE and non-UPE patients was seen in our analysis after 5 years (89 vs. 88%; p = 0.98)

Post‐Last Glacial Maximum glacier fluctuations in the southern Écrins massif (westernmost Alps): insights from 10 Be cosmic ray exposure dating

International audienceOnly a few chronological constraints on Lateglacial and Early Holocene glacier variability in the westernmost Alps have hitherto been obtained. In this paper, moraines of two palaeoglaciers in the southern ecrins massif were mapped. The chronology of the stabilization of selected moraines was established through the use of Be-10 cosmic ray exposure (CRE) dating. The equilibrium line altitude (ELA) during moraine deposition was reconstructed assuming an accumulation area ratio (AAR) of 0.67. Ten pre-Little Ice Age (LIA) ice-marginal positions of the Rougnoux palaeoglacier were identified and seven of these have been dated. The Be-10 CRE age of a boulder on the lowermost sampled moraine indicates that the landform may have been first formed during a period of stable glaciers at around 16.2 +/- 1.7 ka (kiloyears before AD 2017) or that the sampled boulder experienced pre-exposure to secondary cosmic radiation. The moraine was re-occupied or, alternatively, shaped somewhat before 12.2 +/- 0.6 ka when the ELA was lowered by 230 m relative to the LIA ELA. At least six periods of stable ice margins occurred thereafter when the ELA was 220-160 m lower than during the LIA. The innermost dated moraine stabilized at or before 10.9 +/- 0.7 ka. Three Be-10 CRE ages from a moraine of the Prelles palaeoglacier indicate a period of stationary ice margins at or before 10.9 +/- 0.6 ka when the ELA was lowered by 160 m with respect to the end of the LIA. The presented Be-10 CRE ages are in good agreement with those of moraines that have been attributed to the Egesen stadial. Assuming unchanged precipitation, summer temperature in the southern ecrins massif at ~12 ka must have been at least 2 degrees C lower relative to the LIA

Post-Last Glacial Maximum glacier fluctuations in the southern Écrins massif (westernmost Alps) : insights from 10Be cosmic ray exposure dating

Only a few chronological constraints on Lateglacial and Early Holocene glacier variability in the westernmost Alps have hitherto been obtained. In this paper, moraines of two palaeoglaciers in the southern Écrins massif were mapped. The chronology of the stabilization of selected moraines was established through the use of 10Be cosmic ray exposure (CRE) dating. The equilibrium line altitude (ELA) during moraine deposition was reconstructed assuming an accumulation area ratio (AAR) of 0.67. Ten pre-Little Ice Age (LIA) ice-marginal positions of the Rougnoux palaeoglacier were identified and seven of these have been dated. The 10Be CRE age of a boulder on the lowermost sampled moraine indicates that the landform may have been first formed during a period of stable glaciers at around 16.2±1.7 ka (kiloyears before AD 2017) or that the sampled boulder experienced pre-exposure to secondary cosmic radiation. The moraine was re-occupied or, alternatively, shaped somewhat before 12.2±0.6 ka when the ELA was lowered by 230 m relative to the LIA ELA. At least six periods of stable ice margins occurred thereafter when the ELA was 220–160 m lower than during the LIA. The innermost dated moraine stabilized at or before 10.9±0.7 ka. Three 10Be CRE ages from a moraine of the Prelles palaeoglacier indicate a period of stationary ice margins at or before 10.9±0.6 ka when the ELA was lowered by 160 m with respect to the end of the LIA. The presented 10Be CRE ages are in good agreement with those of moraines that have been attributed to the Egesen stadial. Assuming unchanged precipitation, summer temperature in the southern Écrins massif at ~12 ka must have been at least 2 °C lower relative to the LIA

Cardiac Myxomas Resembling Malignant Neoplasia: Incidentally Diagnosed vs. Cerebral Embolized Myxomas

Background: Cardiac myxomas (CM) are the most common primary cardiac tumors in adults. They are usually benign; however, malignant changes are known to occur but are extremely rare. Embolization is a common complication of cardiac myxomas and can cause neurological deficits before their surgical removal. The current study analyzed the outcomes after operative myxoma excision in patients, with and without cerebral embolic events prior to excision. Methods: All 66 consecutive patients who underwent a surgical excision of CM between 2005 and 2019 at our department were analyzed retrospectively. Patients with (n = 14) and without (n = 52) preoperative strokes caused by cerebral tumor embolization were compared. Results: The mean age was 58.4 ± 12.7 years in the stroke group (SG) and 62.8 ± 11.7 years in the non-stroke group (N-SG) (p = 0.226). Gender (35.7% vs. 61.5% female; p = 0.084) did not differ significantly, and comorbidities were comparable in both groups. The left hemisphere in the territory of the middle cerebral artery was affected by preoperative cerebral infarction most commonly (28.6%). The time from diagnosis to cardiac surgery procedure was 7 (3–24) days in the SG and 23 (5–55) days in the N-SG (p = 0.120). Cardiac myxomas were localized in the left atrium in both groups more frequently (SG: 92.9% vs. N-SG: 78.8%; p = 0.436). In the SG, 57.1% of CM had a non-solid surface, were localized in the left heart, and had a pedunculated attachment away from the fossa ovalis. In the N-SG, 92.3% of CM did not meet all these criteria (p p = 0.538). The operation times (192.5 (139.3–244.5) min vs. 215.5 (184.5–273.3) min; p = 0.046) and the cross-clamp times (54.5 (33.3–86.5) min vs. 78.5 (55–106.8) min; p = 0.035) were significantly shorter in the SG. Only in the N-SG were reconstructions of the endocardium with bovine pericardium required after resection (51.9% vs 0%; p p = 0.007). Patients in the N-SG required significantly shorter ICU care after surgery (p = 0.020). Other postoperative courses did not differ significantly. After tumor removal, 1.9% of the N-SG suffered their first stroke and 14.3% of the SG had a cerebral re-infarction (p = 0.111). The 30-day mortality rates were 1.9% in the N-SG and 7.1% in the SG (p = 0.382). In one case in the N-SG, a tumor recurrence was diagnosed. The Kaplan–Meiercurves showed a significantly better long-term prognosis for patients in the N-SG (p = 0.043). Conclusions: After the surgical removal of CM, the outcome is compromised if preoperative cerebral embolization occurs. Surgical treatment is therefore indicated as soon as possible, especially when CM have a non-solid surface, are localized in the left heart, and have a pedunculated attachment away from the fossa ovalis