Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients

Background: Mortality in acute Type A aortic dissection is still high and unpredictable. We aimed to investigate the validity of preoperative hematological markers and possible risk factors in predicting in-hospital mortality in patients operated with deep hypothermic circulatory arrest method. Methods: 78 consecutive patients who were admitted to the emergency service and operated on were retrospectively analyzed. Risk factors for in-hospital death were investigated to develop a predictive model. Results: There was no difference between patients in terms of the were demographic data of the patients. In the mortality group, only preoperative creatinine levels were found to be higher (p < 0.05). Factors affecting mortality were found as total circulatory arrest (TCA) and cross-clamp (X-clamp) times when intraoperative data were examined (p < 0.05). ROC analysis was performed to determine the power to predict mortality and to determine the cut-off point. In ROC analysis to predict mortality, X-Clamp time > 71 minutes, 68.2% sensitivity and 66.1% specificity, TCA > 44.5 minutes, 72.7% sensitivity and 73.2% specificity were found. In the mortality group, these values were found to be significantly higher than those who were discharged. Conclusion: In the surgical treatment of Type A aortic dissection under deep hypothermia, hematologic biomarkers may be insufficient in estimating the risk for mortality. Keywords: Acute; aortic dissection; biomarker; mortality

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Perioperative Risk Factors for Hospital Mortality in Patients with Acute Type A Aortic Dissection

Advances in Understanding Aortic Diseases ◽

10.1007/978-4-431-99237-0_31 ◽

2009 ◽

pp. 195-195

Author(s):

Masashi Tanaka ◽

Naoyuki Kimura ◽

Hideo Adachi ◽

Atsushi Yamaguchi ◽

Takashi Ino

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Hospital Mortality ◽

Type A ◽

Perioperative Risk ◽

Acute Type ◽

Type A Aortic Dissection ◽

Perioperative Risk Factors

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Peri-operative risk factors for in-hospital mortality in acute type A aortic dissection

Journal of Thoracic Disease ◽

10.21037/jtd.2019.09.11 ◽

2019 ◽

Vol 11 (9) ◽

pp. 3887-3895

Author(s):

Miaoyun Wen ◽

Yongli Han ◽

Jingkun Ye ◽

Gengxin Cai ◽

Wenxin Zeng ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Hospital Mortality ◽

Type A ◽

Operative Risk ◽

Acute Type ◽

Type A Aortic Dissection

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Influence of Luminal Communication on Aortic Enlargement after Hemiarch Replacement for Acute Type A Aortic Dissection

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1677886 ◽

2019 ◽

Vol 68 (04) ◽

pp. 294-300

Author(s):

Gaku Uchino ◽

Takeshi Yoshida ◽

Bunpachi Kakii ◽

Masato Furui

Keyword(s):

Risk Factors ◽

Growth Rate ◽

Aortic Dissection ◽

Univariate Analysis ◽

Type A ◽

Aortic Diameter ◽

Acute Type ◽

Type A Aortic Dissection ◽

Independent Risk Factors ◽

Hemiarch Replacement

Background Aortic enlargement after hemiarch replacement (HAR) for acute type A aortic dissection (AAAD) is a serious problem. We reviewed our experience and analyzed the risk factors for aortic enlargement. Methods During April 2005 to December 2017, 364 patients underwent HAR for AAAD. Seventy-three patients fulfilled the inclusion criteria. We analyzed the change in aortic diameter, aortic growth rate, and major adverse aortic events (MAAEs) and their association with luminal communication of the aortic arch. Results Anastomotic communication, supra-aortic communication (SAC), and distal aortic communication were found in 34 (46.6%), 28 (38.4%), and 20 (27.4%) patients, respectively. The aortic growth rate was high because of the presence of SAC, distal aortic communication, and the number of coexisting aortic communication. Univariate analysis showed that the presence of SAC and an initial aortic diameter > 35 mm at 20 mm distal to the left subclavian artery and at the pulmonary artery bifurcation (PAB) were risk factors for MAAEs. Multivariate analysis showed that SAC and an initial aortic diameter > 35 mm at the PAB were independent risk factors for MAAEs. Conclusion SAC, distal aortic communication, and the number of coexisting aortic communication are significant risk factors for aortic enlargement after HAR for AAAD. SAC and an initial aortic diameter > 35 mm at the PAB are independent risk factors for MAAEs after this procedure.

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Surgical outcome of acute type A aortic dissection: analysis of risk factors

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(02)03603-2 ◽

2002 ◽

Vol 74 (1) ◽

pp. 75-81 ◽

Cited By ~ 102

Author(s):

Teruhisa Kazui ◽

Naoki Washiyama ◽

Abul Hasan Muhammad Bashar ◽

Hitoshi Terada ◽

Takayasu Suzuki ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Surgical Outcome ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Perioperative risk factors for mortality in patients with acute type a aortic dissection

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(02)04096-1 ◽

2002 ◽

Vol 74 (6) ◽

pp. 2034-2039 ◽

Cited By ~ 41

Author(s):

Anil Z Apaydin ◽

Suat Buket ◽

Hakan Posacioglu ◽

Fatih Islamoglu ◽

Tanzer Calkavur ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Type A ◽

Perioperative Risk ◽

Acute Type ◽

Type A Aortic Dissection ◽

Perioperative Risk Factors

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Effect of different types of cerebral perfusion for acute type A aortic dissection, unilateral versus bilateral

10.21203/rs.3.rs-22196/v2 ◽

2020 ◽

Author(s):

zhengqin liu ◽

Chen Wang ◽

Xiquan Zhang ◽

Shuming Wu ◽

changcun fang ◽

...

Keyword(s):

Aortic Dissection ◽

Lower Incidence ◽

Cerebral Perfusion ◽

Type A ◽

Neurological Complications ◽

Neurological Dysfunction ◽

Acute Type ◽

Type A Aortic Dissection ◽

Neurologic Dysfunction ◽

Ventilation Time

Abstract Background: Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used way for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research was aimed to investigate the clinical effects between u-ACP and b-ACP. Methods: 321 of 356 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP and 197 patients(61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. We also analyzed perioperative variables in order to find the potential associated factors for neurolocial dysfunction (ND). Results: For u-ACP group, 54 patients (43.5%) had postoperative neurological complications including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p=0.016), higher nasopharyngeal temperature (p≦0.000), shorter ventilation time (p=0.018) and lower incidence of hypoxia (p=0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR=1.20, P= 0.028), CPB duration (OR=3.21, P=0.002 ) and type of cerebral perfusion (OR=1.48, P=0.017) were strongly associated with postoperative ND. Conclusions: In our study, we found that b-ACP procedure had shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia and neurological dysfunction compared to u-ACP. Meanwhile, we discovered the incidence of ND was independently associated with there factors, including preoperative neurological dysfunction, CPB time and type of cerebral perfusion.

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