scholarly journals Rapid Diagnosis and Treatment of Patients with Acute Type A Aortic Dissection and Malperfusion Syndrome May Normalize Survival to that of Patients with Uncomplicated Type A Aortic Dissection

Aorta ◽  
2019 ◽  
Vol 07 (02) ◽  
pp. 042-048 ◽  
Author(s):  
Syed Usman Bin Mahmood ◽  
Makoto Mori ◽  
Jiajun Luo ◽  
Yawei Zhang ◽  
Basmah Safdar ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Surgery ◽  
Type A ◽  
Multivariate Regression Analysis ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Acute Type A Dissection ◽  
Operative Outcomes ◽  
Nonsignificant Difference ◽  
Malperfusion Syndrome

Objectives Malperfusion syndrome in the setting of acute Type A dissection (ATAD) is typically associated with poor prognosis. We evaluated the contemporary outcomes of patients with ATAD presenting with and without malperfusion syndrome who underwent aortic surgery. Methods We performed a single-center, retrospective review of 103 consecutive patients that underwent surgery for ATAD. The cohort was dichotomized by patients with and without malperfusion syndromes. Multivariate and bivariate analyses were performed to evaluate association between the presence of malperfusion syndrome and operative outcomes. Results A total of 29 (28.1%) patients presented with malperfusion syndrome. The 30-day mortality for patients presenting with and without malperfusion was 13.7 and 9.4%, respectively (p = 0.49). Patients with malperfusion syndrome had a shorter mean admission-to-incision interval of 4.3 ± 2.5 hours compared with 6.3 ± 4.6 hours for those without malperfusion (p = 0.02). Difference in 30-day mortality for patients with and without malperfusion syndrome was found to be nonsignificant on multivariate regression analysis (odds ratio: 1.53; 95% confidence interval: 0.40–5.82, p = 0.49). Conclusions This series demonstrated that there was nonsignificant difference in early- or midterm outcomes for patients with and without malperfusion syndrome. Patients with malperfusion were taken to the operating room more rapidly than those without, which offers a potential explanation for the comparable outcome of the malperfusion cohort.

scholarly journals Impacts of eosinophil percentage on prognosis acute type A aortic dissection patients

2021 ◽  
Author(s):  
Yue Shao ◽  
Liu Ye ◽  
Hao-ming Shi ◽  
Xin-mei Wang ◽  
Jun Luo ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Aortic Dissection ◽  
Multivariate Regression ◽  
Medical Information ◽  
External Validation ◽  
Inflammatory Cells ◽  
Type A ◽  
Multivariate Regression Analysis ◽  
Acute Type ◽  
Type A Aortic Dissection

Abstract Background Eosinophils are pro-inflammatory cells involved in thrombosis and have been proposed as a prognosis marker in acute ischemic stroke and ST-elevation myocardial Infarction. Here, we sought to clarify the prognostic value of eosinophil percentage (EOS%) in patients with acute type A aortic dissection (AAAD). Methods We examined 183 consecutive AAAD patients. Based on the optimum cut-off value of EOS% determined by X-tile software, patients were classified into the low EOS% (EOS%≤0.1) and high EOS% groups (EOS%>0.1). We performed multivariate regression analysis and Kaplan-Meier (KM) survival curves to assess the association between EOS% and mortality. Eosinophil accumulation in aortic dissection intraluminal thrombus was confirmed using hematoxylin–eosin (H&E) staining. An external cohort from Medical Information Mart for Intensive Care IV was performed to validate the results. Results Relative to surviving patients, those who died during hospitalization had significantly lower EOS% (p=0.001) but significantly higher WBC (p=0.002) and neutrophil (p=0.001) counts. Multivariate regression analysis identified EOS% as an independent predictor of in-hospital and 1-year mortality. KM curves revealed that 1-year cumulative mortality was significantly higher in the low EOS% group, although it was mainly attributed to the higher 30-day mortality. H&E staining revealed massive infiltration of eosinophils in all 20 thrombus specimens. The external validation confirmed that relative to survivors, patients with in-hospital (p=0.010) had significantly lower EOS%. Moreover, multivariate regression analyses identified that decreased EOS% was independently significantly associated with in-hospital mortality. Conclusions Low EOS% is significantly related to increased mortality rates in AAAD patients.

scholarly journals Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: A 20-year experience

2019 ◽  
Vol 158 (3) ◽  
pp. 675-687.e4 ◽  
Author(s):  
Bo Yang ◽  
Elizabeth L. Norton ◽  
Carlo Maria Rosati ◽  
Xiaoting Wu ◽  
Karen M. Kim ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Malperfusion Syndrome

Comparison of Risk Scores for the Prediction of Outcomes after Surgery for Acute Type A Aortic Dissection

2019 ◽  
pp. 1-4
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Operative Mortality ◽  
External Validation ◽  
Type A ◽  
Risk Scores ◽  
Acute Type ◽  
Risk Models ◽  
Type A Aortic Dissection ◽  
Malperfusion Syndrome

We compared the performance of four existing risk models and a newly developed risk score for type A acute aortic dissection surgery. In 327 consecutives with type A aortic dissection surgery patients during 2003/03-2017/03 at our centre, operative mortality occurred in 65 (19.9%). Independent predictors of operative mortality were critical pre-operative state and malperfusion syndrome, and a novel additive “CritMal” Score was constructed from this. C-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.60 (0.52-0.67), EuroSCORE II 0.64 (0.57-0.72), Rampoldi 0.68 (0.59-0.76), Leontyev 0.56 (0.48-0.64), and CritMal 0.72 (0.64-0.80) respectively. This is the first study externally assessing surgical scores for aortic dissection surgery, with modest accuracy for all and moderate for CritMal. There is room for improvement of these risk models, and further refinements and external validation are warranted for clinical application.

scholarly journals Endovascular Fenestration/Stenting First Followed by Delayed Open Aortic Repair for Acute Type A Aortic Dissection With Malperfusion Syndrome

Circulation ◽  
2018 ◽  
Vol 138 (19) ◽  
pp. 2091-2103 ◽  
Author(s):  
Bo Yang ◽  
Carlo Maria Rosati ◽  
Elizabeth L. Norton ◽  
Karen M. Kim ◽  
Minhaj S. Khaja ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aortic Repair ◽  
Open Aortic Repair ◽  
Malperfusion Syndrome

Malperfusion in Acute Type A Aortic Dissection: Management Strategies

2021 ◽  
pp. 153857442110171
Author(s):  
Mona Jaffar-Karballai ◽  
Tien Thuy Tran ◽  
Oyinkan Oremakinde ◽  
Somama Zafar ◽  
Amer Harky
Keyword(s):  
Aortic Dissection ◽  
Aortic Surgery ◽  
Management Strategies ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Post Surgery ◽  
Time Optimal ◽  
The Many ◽  
Almost All

Over the decades, it has been well established that malperfusion complicates a number of acute type A aortic dissection (ATAAD) patients. Of the many complications that arise from ATAAD is malperfusion, which is the result of true lumen compression secondary to the dissection, and it is one of the most dangerous complications. Left untreated, malperfusion can eventually compromise circulation to the vascular beds of almost all vital organs. Clinicians must consider the diagnosis of malperfusion promptly following a diagnosis of acute aortic dissection. The outcomes post-surgery for patients with ATAAD with concomitant malperfusion remains poor, despite mortality for aortic surgery improving over time. Optimal management for ATAAD with associated malperfusion has yet to be implemented, further research is warranted to improve the detection and management of this potentially fatal pathology. In this review, we explore the literature surrounding the complications of malperfusion in ATAAD and the various symptom presentations, investigations, and management strategies available.

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