The treatment of patients with Type A aortic dissection - predictors for in hospital mortality in 534 patients as two center experience

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

Herz ◽

10.1007/s00059-014-4121-2 ◽

2014 ◽

Vol 40 (4) ◽

pp. 716-721 ◽

Cited By ~ 8

Author(s):

S. Karakoyun ◽

M.O. Gürsoy ◽

T. Akgün ◽

L. Öcal ◽

M. Kalçık ◽

...

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio

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Effects of seasonal and climate variations on in-hospital mortality and length of stay in patients with type A aortic dissection

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01639-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zeng-Rong Luo ◽

Zhi-Qin Lin ◽

Liang-wan Chen ◽

Han-Fan Qiu

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Length Of Stay ◽

Aortic Dissection ◽

Hospital Mortality ◽

Type A ◽

Descending Aorta ◽

Type A Aortic Dissection ◽

Medical Quality ◽

Increased Risk

Abstract Objective To investigate the effects of seasonal and climatic changes on postoperative in-hospital mortality and length of stay (LOS) in patients with type A acute aortic dissection (AAD). Methods Patients undergoing implantation of the modified triple-branched stent graft to replace the descending aorta in addition to aortic root reconstruction for type A AAD in our hospital from January 2016 to December 2019 were included. Relevant data were retrospectively collected and analyzed. Results A total of 404 patients were included in our analyses. The multivariate unconditional logistic regression analysis showed that patients admitted in autumn (OR 4.027, 95% CI 1.023–17.301, P = 0.039) or with coronary heart disease (OR 8.938, 95% CI 1.991–29.560, P = 0.049) were independently associated with an increased risk of postoperative in-hospital mortality. Furthermore, patients admitted in autumn (OR 5.956, 95% CI 2.719–7.921, P = 0.041) or with hypertension (OR 3.486, 95% CI 1.192–5.106, P = 0.035) were independently associated with an increased risk of longer LOS. Conclusion Patients admitted in autumn or with coronary heart disease are at higher risk of in-hospital mortality following surgery for type A AAD. Also, patients admitted in autumn or with hypertension have a longer hospital LOS. In the autumn of the temperature transition, we may need to strengthen the management of medical quality after surgery for type A AAD.

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Characteristics and outcomes of Stanford type A aortic dissection patients with post-operation severe hyperbilirubinemia: a retrospective cohort study

10.21203/rs.3.rs-30855/v1 ◽

2020 ◽

Author(s):

Xiaolan Chen ◽

Ming Bai ◽

Lijuan Zhao ◽

Yangping Li ◽

Yan Yu ◽

...

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Aortic Dissection ◽

Hospital Mortality ◽

Multivariate Logistic Regression Analysis ◽

Kidney Injury ◽

Type A ◽

Type A Aortic Dissection ◽

Post Operation ◽

Severe Hyperbilirubinemia

Abstract Background Hyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the report on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients is limited. Methods Patients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints. Results 271 (12.3%) patients were included. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. In-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9%, 33.9%, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age (P < 0.033), AKI stage 3 (P < 0.001), the amount of blood transfusion after surgery (P = 0.019), mean arterial pressure (MAP) in the first postoperative day (P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) (P = 0.02), and the peak total bilirubin (TB) concentration (P = 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 µmol/l. Survival analysis showed significantly decreased survival for patients who developed severe, rather than mild, hyperbilirubinemia. Conclusions Post-operation severe hyperbilirubinemia is a common clinical presentation in AAD surgery patients. Post-operation severe hyperbilirubinemia AAD patients with older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB had higher risk of in-hospital mortality.

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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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