Clinical benefits of fast-track rehabilitation program for patients with uncomplicated type B acute aortic dissection
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ORIGINAL ARTICLE
Clinical benefits of fast‑track rehabilitation program for patients with uncomplicated type B acute aortic dissection Takayoshi Kato1 · Yusuke Motoji1 · Mototsugu Tamaki1 · Masahiro Inagaki1 · Tomohiro Tsunekawa1 · Akihiro Hirakawa2 · Yasuhide Okawa1 · Shinji Tomita1 Received: 2 January 2020 / Accepted: 25 March 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objectives Uncomplicated type B acute aortic dissection (UTBAAD) has traditionally been treated medically. Although patients are treated based on the rehabilitation program established by the Japanese Circulation Society, we sometimes encounter patients with complications related to the long duration of bed rest. We performed novel fast-track rehabilitation for UTBAAD, which consisted of short-duration bed rest and the early initiation of walking under secure blood pressure control. Methods and results From April 2009 to February 2017, there were 73 consecutive cases of UTBAAD. Conventional medical treatment was administered to 39 patients (group G) during the early period. From August 2013, 34 patients (group F) received our ‘fast-track’ rehabilitation program, which consisted of the following: oral intake and assuming a sitting position from day 1 after the onset, standing by the bed from day 2, walking in their room from day 4, and discharge from day 16 if all goes smoothly. Group F had a significantly earlier initiation of standing and walking, first defecation, and weaning from oxygen and intravenous antihypertensive agents than group G. The pneumonia complication rate was significantly lower in group F than in group G. The hospitalization duration was markedly shorter and the in-hospital expense lower in group F than in group G. There were no significant differences in the rate of late adverse aortic events within 12 months after onset. Conclusions Our fast-track rehabilitation program for patients with UTBAAD resulted in a better in-hospital clinical course and lower expense than conventional medical treatment without any adverse aortic events. Keywords Type B acute aortic dissection · Optimal medical treatment · Fast-track · Rehabilitation · Guideline
Introduction Type B acute aortic dissection (TBAAD) is a life-threatening disease and the most common aortic emergency, with a 5-year mortality of about 30–40% [1]. It is caused by a tear in the intimal layer of the descending aorta, which allows blood flow between the intima and media, resulting in separation of these layers. Due to severe complications, such as rupture or organ malperfusion, the mortality rate is highest within the first 7 days after the onset, and the combined neurological complication rate within 30 days of medical management is approximately 10% [2, 3]. * Takayoshi Kato [email protected] 1
Department of Cardiovascular Surgery, Gifu Heart Center, 4‑14‑4 Yabuta‑minami, Gifu, Gifu 500‑8384, Japan
Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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According t
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