Neutrophil–lymphocyte ratio may predict in-hospital mortality in patients with acute type A aortic dissection

Abstract OBJECTIVES Surgery for acute type A aortic dissection (type AAD) in non-agenarians is usually contraindicated due to advanced age. The aim of this study was to assess and compare outcomes after surgical or conservative treatment for acute type AAD in non-agenarians by evaluating frailty. METHODS Between October 2012 and September 2018, 273 patients underwent open repair for type AAD at the Shonan Kamakura General Hospital and the Shonan Fujisawa Tokushukai Hospital, and here, we retrospectively reviewed the case reports of 10 surgically treated non-agenarians and 15 conservatively treated non-agenarians. Exclusion criteria for surgery were the patient’s refusal of surgery, severe dementia and coma. In patients considered to be at a high risk, our judgements were based on the results of comprehensive evaluation. RESULTS Both in-hospital mortality and 30-day mortality in the surgical group were zero, while in-hospital mortality in conservatively treated non-agenarians was 73.3%. Importantly, 1-year survival in the surgical group and conservative group was 90% and 25%, respectively. The 5-year survival in the surgical group and conservative group was 49.2% and 25%, respectively (log-rank test, P = 0.0105). Four of 6 patients with preoperative clinical frailty scores not higher than 4 were still alive at 1 year with the same level of preoperative frailty. CONCLUSIONS Surgery for acute type AAD in non-agenarians can be performed with acceptable outcomes in carefully selected patients, particularly in those with preoperative clinical frailty scores not higher than 4.

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A nomogram for predicting in-hospital mortality in acute type A aortic dissection patients

Journal of Thoracic Disease ◽

10.21037/jtd.2020.01.41 ◽

2020 ◽

Vol 12 (3) ◽

pp. 264-275 ◽

Cited By ~ 1

Author(s):

Guifang Yang ◽

Yang Zhou ◽

Huaping He ◽

Xiaogao Pan ◽

Xizhao Li ◽

...

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Common carotid artery true lumen flow impairment in patients with type A aortic dissection

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa322 ◽

2020 ◽

Author(s):

Maximilian Kreibich ◽

Nimesh D Desai ◽

Joseph E Bavaria ◽

Wilson Y Szeto ◽

Prashanth Vallabhajosyula ◽

...

Keyword(s):

Carotid Artery ◽

Aortic Dissection ◽

Hospital Mortality ◽

Common Carotid Artery ◽

Type A ◽

Acute Type ◽

Imaging Data ◽

True Lumen ◽

Type A Aortic Dissection ◽

Logistic Regression Models

Abstract OBJECTIVES Our aim was to evaluate clinical and neurological effects of common carotid artery (CCA) true lumen flow impairment or occlusion in patients with type A aortic dissection. METHODS Characteristics and imaging data of patients with dissected CCA secondary to acute type A aortic dissection from 3 institutions were analysed. We defined true lumen blood flow as unimpaired when the maximum true lumen diameter exceeded 50% of the complete CCA diameter, as impaired when the true lumen was compressed to ˃50% of the complete lumen, or as occluded. RESULTS Out of 440 patients, 207 presented unimpaired CCA flow, 172 impaired CCA flow and CCA occlusion was present in 61 patients. Preoperative shock (P = 0.045) or a neurological deficit (P < 0.001) were least common in patients with unimpaired CCA flow and most common in those with CCA occlusion. Non-cerebral, other-organ malperfusion was common in 37% of all patients, but the incidence was similar (P = 0.69). In patients with CCA occlusion, postoperative stroke (P < 0.001) and in-hospital mortality (0.011) were significantly higher, while the incidences were similar between patients with unimpaired and impaired CCA flow. Mixed-effects logistic regression models showed that CCA flow impairment (P = 0.23) or occlusion (P = 0.55) was not predictive for in-hospital mortality, but CCA occlusion was predictive for in-hospital stroke (odds ratio 2.166, P = 0.023) CONCLUSIONS Shock and non-cerebral, other-organ malperfusion are common in patients with CCA dissection. While there is a high risk for stroke in patients with CCA occlusion, CCA flow impairment and occlusion were not predictive for in-hospital mortality. Surgery should not be denied to patients with CCA flow impairment or occlusion.

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Prognostic nutritional index predicts in-hospital mortality in patients with acute type A aortic dissection

Heart & Lung ◽

10.1016/j.hrtlng.2020.06.004 ◽

2021 ◽

Vol 50 (1) ◽

pp. 159-164

Author(s):

Yanjuan Lin ◽

Qiong Chen ◽

Yanchun Peng ◽

Yiping Chen ◽

Xizhen Huang ◽

...

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Prognostic Nutritional Index ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Nutritional Index

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External validation of Leipzig-Halifax scores for aortic dissection in Armenia

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320945479 ◽

2020 ◽

pp. 021849232094547

Author(s):

Kristine Poghosyan ◽

Yeva Sahakyan ◽

Michael E Thompson ◽

Hagop Hovaguimian ◽

Hasmik Minasyan ◽

...

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

External Validation ◽

Type A ◽

Assessment Tools ◽

Acute Type ◽

Type A Aortic Dissection ◽

Receiver Operating Characteristic Curves ◽

Predict Hospital Mortality ◽

Potential Improvement

Background Few prognostic tools are currently available to predict hospital mortality in patients with acute type A aortic dissection. The aim of this study was to validate the performance of two existing risk-assessment tools, the original and the adjusted Leipzig-Halifax scorecards, to predict hospital mortality among Armenian patients with acute type A aortic dissection. Methods This retrospective cohort study included all consecutive patients with acute type A aortic dissection who were admitted to two tertiary cardiac centers in Armenia and underwent surgery from January 2008 to April 2018. We evaluated the predictive power of the original and adjusted Leipzig-Halifax scorecards using logistic regression analysis. Results Overall, 211 patients (76% males, mean age 57 ± 9 years) were included in the study, of whom 37 (17.5%) died during hospitalization. The adjusted Leipzig-Halifax score, but not the original Leipzig-Halifax score, was a significant predictor of hospital mortality. Patients with medium and high adjusted Leipzig-Halifax scores had a significantly higher odds of death compared to patients with low scores (odds ratio = 3.0 vs. 3.9, 95% confidence interval: 1.3–6.9 vs. 1.0–14.9, respectively). The areas under the receiver operating characteristic curves were 0.58 and 0.63, respectively, p > 0.05. Conclusion The adjusted Leipzig-Halifax score performed slightly better than the original Leipzig-Halifax score in the Armenian acute type A aortic dissection population. The adjusted Leipzig-Halifax score should now be applied prospectively to generate more data for further validation and potential improvement.

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Clinical Outcomes of Limited Repair And Conservative Approaches In Older Patients With Acute Type A Aortic Dissection

10.21203/rs.3.rs-772479/v1 ◽

2021 ◽

Author(s):

Yasumi Maze ◽

Toshiya Tokui ◽

Masahiko Murakami ◽

Bun Nakamura ◽

Ryosai Inoue ◽

...

Keyword(s):

Conservative Treatment ◽

Aortic Dissection ◽

Hospital Mortality ◽

Surgical Outcomes ◽

Older Patients ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Treatment Groups ◽

Significant Difference

Abstract Background: Surgical indication and the selection of surgical procedures for acute type A aortic dissection in older patients are controversial; therefore, we examined the surgical outcomes in older patients.Methods: From January 2012 through December 2019, 174 patients surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the older (≥80 years old) and below-80 (≤79 years old) age groups. Additionally, we compared the surgical and conservative treatment groups.Results: The primary entry was found in the ascending aorta in 51.6% and 32.8% of the older and below-80 groups, respectively (p = 0.049). Ascending or hemiarch replacement was performed in all older group cases and 57.3% of the below-80 group cases (total arch replacement was performed in the remaining 42.7%; p < 0.001). Hospital mortality rates were similar in both groups. The significant risk factors for hospital mortality were age, preoperative intubation, cardiopulmonary bypass time, and postoperative stroke. The 5-year survival rates were 48.4% ± 10.3% (older group) and 86.7% ± 2.9% (below-80 group; p < 0.001). The rates of freedom from aortic events at 5 years were 86.9% ± 8.7% (older group) and 86.5% ± 3.9% (below-80 group; p = 0.771). The 5-year survival rate of the conservative treatment group was 19.2% ± 8.0% in the older group. There was no significant difference between the surgical treatment groups (p = 0.103).Conclusion: The surgical approach did not achieve a significant survival advantage over conservative treatment and may not always be the reasonable treatment of choice for older patients.

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Unilateral versus bilateral anterograde cerebral perfusion in acute type A aortic dissection repair: A systematic review and meta-analysis

10.22541/au.163984724.41557799/v1 ◽

2021 ◽

Author(s):

Panagiotis T. Tasoudis ◽

Dimitrios N. Varvoglis ◽

Evangelos Vitkos ◽

John Ikonomidis ◽

Thanos Athanasiou

Keyword(s):

Systematic Review ◽

Renal Failure ◽

Aortic Dissection ◽

Hospital Mortality ◽

Neurological Deficit ◽

Cerebral Perfusion ◽

Type A ◽

Cochrane Library ◽

Acute Type ◽

Type A Aortic Dissection

Objectives: The aim of the study is to compare the safety and efficacy of unilateral anterograde cerebral perfusion (UACP) and bilateral anterograde cerebral perfusion (BACP) for acute type A aortic dissection (ATAAD). Methods: A systematic review of MEDLINE (PubMed), Scopus, and Cochrane Library databases (last search: August 7 , 2021) was performed according to the PRISMA statement. Studies directly comparing UACP versus BACP for ATAAD were included. Random-effects meta-analyses were performed. Results: Eight retrospective cohort studies were identified, incorporating 2416 patients (UACP: 843, BACP: 1573). No statistically significant difference was observed regarding in-hospital mortality (odds ratio [OR]:1.05 [95% Confidence Interval (95%CI):0.70-1.57]), permanent neurological deficit (PND) (OR: 0.94 [95%CI:0.52-1.70]), transient neurological deficit (TND) (OR: 1.37 [95%CI:0.98-1.92]), renal failure (OR: 0.96 [95%CI:0.70-1.32]), and re-exploration for bleeding (OR: 0.77 [95%CI:0.48-1.22]). Meta-regression analysis revealed that PND and TND were not influenced by differences in rates of total arch repair, Bentall procedure and concomitant CABG in UACP and BACP groups. Cardiopulmonary bypass time (Standard Mean Difference [SMD]:-0.11 [95%CI:-0.22, 0.44]), Cross clamp time (SMD:-0.04 [95%CI:-0.38, 0.29]) and hypothermic circulatory arrest time (SMD:-0.12 [95%CI:-0.55, 0.30]) were comparable between UACP and BACP. Intensive care unit stay was shorter in BACP arm (SMD:0.16 [95%CI:0.01, 0.31]), however, length of hospital stay was shorter in UACP arm (SMD:-0.25 [95%CI:-0.45, -0.06]). Conclusions: UACP and BACP had similar results in terms of in-hospital mortality, PND, TND, renal failure and re-exploration for bleeding rate in patients with ATAAD. ICU stay was shorter in the BACP arm while LOS was shorter in the UACP arm.

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