ARE FACTORS ASSOCIATED WITH IN-HOSPITAL AND LONG-TERM MORTALITY DIFFERENT IN PATIENTS WITH ACUTE TYPE A AORTIC DISSECTION?

ObjectiveHeart rate (HR) is a risk factor of mortality in many cardiovascular diseases but no clinical studies have focused on the association between HR and prognosis in patients with acute type A aortic dissection (ATAAD). This study aimed to evaluate the association between HR and long-term mortality and establish the criteria of HR in patients with ATAAD who underwent total aortic arch replacement combined with the frozen elephant trunk (TAR+FET).Design, setting and participantsRetrospective cohort study that studied all consecutive patients with ATAAD who underwent TAR+FET in the Fuwai Hospital between 2009 and 2015.Main outcomes and measures30-day postoperative, and estimated long-term mortality.ResultsOverall, 707 patients with ATAAD who underwent TAR+FET were followed up for a median duration of 29 months (range, 5–77 months). In multivariate logistic analysis, HR (p<0.001), age (p<0.001), renal insufficiency (p=0.033), ejection fraction (p=0.005), cardiopulmonary bypass time (p<0.001) and intraoperative blood loss (p=0.002) were significantly associated with 30-day postoperative and estimated long-term mortalities. A hinge point with a sharp increase in estimated long-term mortality was identified at 80 beats/min (bpm), and compared with HR ≤80 bpm, HR >80 bpm was associated with an almost threefold higher long-term mortality. HRs ≤60, 60–70, 70–80, 80–90, 90–100, 100–110 and >110 bpm were associated with 3.9%, 4.0%, 3.8%, 7.2%, 9.5%, 10.1% and 14.4% yearly risks of death, respectively.ConclusionsHR is a powerful predictor of long-term mortality in patients with ATAAD undergoing TAR+FET. HR >80 bpm is independently associated with elevated long-term mortality for patients with ATAAD.

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Extended repair for acute type A aortic dissection: long-term outcomes of the frozen elephant trunk technique beyond 10 years

The Journal of Cardiovascular Surgery ◽

10.23736/s0021-9509.20.11293-x ◽

2020 ◽

Vol 61 (3) ◽

Cited By ~ 3

Author(s):

Wei-Guo Ma ◽

Yu Chen ◽

Wei Zhang ◽

Qing Li ◽

Jian-Rong Li ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Frozen Elephant Trunk ◽

Long Term Outcomes ◽

Elephant Trunk ◽

Type A Aortic Dissection ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique

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OC20 EARLY AND LONG-TERM RESULTS OF LATE REOPERATION AFTER REPAIRED ACUTE TYPE A AORTIC DISSECTION

Journal of Cardiovascular Medicine ◽

10.2459/01.jcm.0000549849.06386.1d ◽

2018 ◽

Vol 19 ◽

pp. e2

Author(s):

D. Piani ◽

I. Vendramin ◽

A. Lechiancole ◽

V. Ferrara ◽

M. Meneguzzi ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Long Term Results ◽

Acute Type ◽

Type A Aortic Dissection

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Neomedia Repair of the Valsalva Sinus in the Treatment of Acute Type-A Aortic Dissection: Long-term Effectiveness and a Case of Pathology

Annals of Vascular Diseases ◽

10.3400/avd.oa.20-00113 ◽

2020 ◽

Vol 13 (3) ◽

pp. 248-254

Author(s):

Nobuhisa Ohno ◽

Toshi Maeda ◽

Otohime Kato ◽

Hirofumi Sato ◽

Go Ueno ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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GENDER-RELATED DIFFERENCES IN LONG-TERM OUTCOMES OF HOSPITAL SURVIVORS WITH ACUTE TYPE A AORTIC DISSECTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)32272-0 ◽

2016 ◽

Vol 67 (13) ◽

pp. 2271

Author(s):

Eduardo Bossone ◽

Hans-Henning Eckstein ◽

Elizabeth Jackson ◽

Sherene Shalhub ◽

Marc Bonaca ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Long Term Outcomes ◽

Type A Aortic Dissection

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Long-term Outcomes After Controlled Pericardial Drainage for Acute Type A Aortic Dissection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2020.01.078 ◽

2020 ◽

Vol 110 (4) ◽

pp. 1357-1363

Author(s):

Chikashi Nakai ◽

So Izumi ◽

Tomonori Haraguchi ◽

Yasushi Okada ◽

Shinichi Ijuin ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Long Term Outcomes ◽

Type A Aortic Dissection ◽

Pericardial Drainage

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Interfacility Transfer of Medicare Beneficiaries With Acute Type A Aortic Dissection and Regionalization of Care in the United States

Circulation ◽

10.1161/circulationaha.118.038867 ◽

2019 ◽

Vol 140 (15) ◽

pp. 1239-1250 ◽

Cited By ~ 12

Author(s):

Andrew B. Goldstone ◽

Peter Chiu ◽

Michael Baiocchi ◽

Bharathi Lingala ◽

Justin Lee ◽

...

Keyword(s):

Aortic Dissection ◽

Operative Mortality ◽

Type A ◽

High Volume ◽

The United States ◽

Acute Type ◽

Medicare Beneficiaries ◽

Type A Aortic Dissection ◽

High Volume Hospital

Background: The feasibility and effectiveness of delaying surgery to transfer patients with acute type A aortic dissection—a catastrophic disease that requires prompt intervention—to higher-volume aortic surgery hospitals is unknown. We investigated the hypothesis that regionalizing care at high-volume hospitals for acute type A aortic dissections will lower mortality. We further decomposed this hypothesis into subparts, investigating the isolated effect of transfer and the isolated effect of receiving care at a high-volume versus a low-volume facility. Methods: We compared the operative mortality and long-term survival between 16 886 Medicare beneficiaries diagnosed with an acute type A aortic dissection between 1999 and 2014 who (1) were transferred versus not transferred, (2) underwent surgery at high-volume versus low-volume hospitals, and (3) were rerouted versus not rerouted to a high-volume hospital for treatment. We used a preference-based instrumental variable design to address unmeasured confounding and matching to separate the effect of transfer from volume. Results: Between 1999 and 2014, 40.5% of patients with an acute type A aortic dissection were transferred, and 51.9% received surgery at a high-volume hospital. Interfacility transfer was not associated with a change in operative mortality (risk difference, –0.69%; 95% CI, –2.7% to 1.35%) or long-term mortality. Despite delaying surgery, a regionalization policy that transfers patients to high-volume hospitals was associated with a 7.2% (95% CI, 4.1%–10.3%) absolute risk reduction in operative mortality; this association persisted in the long term (hazard ratio, 0.81; 95% CI, 0.75–0.87). The median distance needed to reroute each patient to a high-volume hospital was 50.1 miles (interquartile range, 12.4–105.4 miles). Conclusions: Operative and long-term mortality were substantially reduced in patients with acute type A aortic dissection who were rerouted to high-volume hospitals. Policy makers should evaluate the feasibility and benefits of regionalizing the surgical treatment of acute type A aortic dissection in the United States.

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