scholarly journals N-terminal pro-B-type natriuretic peptide and outcomes in type B aortic dissection in China: a retrospective multicentre study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029885 ◽  
Author(s):  
Changjun Luo ◽  
Jianwei Zhou ◽  
Si Xiong ◽  
Zhongqiang Kang ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Multicentre Study ◽  
Natriuretic Peptide ◽  
Area Under The Curve ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Clinical Events

ObjectivesN-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is an unfavourable factor responsible for poor outcomes in the cardiovascular diseases. Nevertheless, the prognostic role of NT-pro-BNP in type B aortic dissection (TBAD) remains unclear. The aim of the current study was to investigate the relationship between NT-pro-BNP levels and in-hospital and long-term adverse prognosis in patients with TBAD.DesignA retrospective multicentre study.SettingLiutie Central Hospital, Nanfang Hospital and Huiyang Hospital in China.ParticipantsA total of 657 consecutive patients with TBAD were enrolled in the study. NT-pro-BNP was measured at admission and included patients were divided into three groups according to the tertiles of NT-pro-BNP (pg/mL): <95 (n=220), 95–312 (n=218) and >312 (n=219).Primary and secondary outcome measuresLong-term mortality and in-hospital major adverse clinical events.ResultsOverall, in-hospital death occurred in 27 patients (4.1%), which was significantly higher in upper tertiles of NT-pro-BNP (0.5% vs 4.1% vs 7.8%, p<0.001). The incident of in-hospital major adverse clinical events increased along with higher NT-pro-BNP (1.4% vs 11.5% vs 15.5%, p<0.001). NT-pro-BNP >210 pg/mL had 81.5% sensitivity and 58.6% specificity for predicting in-hospital death (area under the curve= 0.774, 95% CI 0.692 to 0.855; p<0.001). After a median of 3.1 years of follow-up, 97 (14.8%) patients died. The Kaplan-Meier analysis indicated that the long-term cumulative mortality was higher in patients with NT-pro-BNP >210 pg/mL compared with patients with NT-pro-BNP ≤210 pg/mL (log-rank=26.92, p<0.001). In multivariable Cox survival modelling, NT-pro-BNP >210 pg/mL was independently associated with long-term death (adjusted HR 2.47, 95% CI 1.45 to 4.22, p=0.001).ConclusionsNT-pro-BNP resulted as an independent predictor of adverse prognosis in patients with TBAD, thus could be used as a potential risk-stratification tool.

P2787Gender differences in acute type B aortic dissection

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Chatani ◽  
R Murai ◽  
Y Kawase ◽  
T Tada ◽  
K Kadota
Keyword(s):  
Gender Differences ◽  
Aortic Dissection ◽  
Smoking History ◽  
Hospital Death ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Men And Women ◽  
Long Term Prognosis

Abstract Background The incidence of aortic dissection has been reported to be lower in women; however, women have a poor prognosis. Also, the incidence of false lumen thrombosis has been reported to be different between Europe, the United States, and Japan. We aimed to determine gender differences in long-term prognosis of acute type B aortic dissection. Methods We retrospectively reviewed 220 consecutive patients hospitalized for acute type B aortic dissection between January 2012 to December 2017. After exclusion criteria of unknown onset time, >14 days after the onset, in-hospital death, and aortic events requiring additional treatment during hospitalization were applied, 186 patients were analyzed by gender: 133 men and 53 women. The patient background, treatment method, prognosis, and outcome were compared and examined. Results Both the proportions of smoking history and patients receiving oxygen therapy during hospitalization were significantly higher in men (59% vs. 22%, p<0.01; 91% vs. 72%, p<0.01, respectively), whereas that of classical aortic dissection was similar between men and women (41% vs. 32%, p=0.36). The avoidance rate of a composite of all deaths and aortic events 2 years after discharge was similar (hazard ratio, 0.99; 95% confidence interval, 0.52 to 1.59; p=0.966).(Picture1) Picture 1 Conclusion The long-term prognosis of acute type B aortic dissection treated by medical therapy during hospitalization was equivalent in men and women despite gender differences in several background factors.

scholarly journals Impact of timing on major complications after thoracic endovascular aortic repair for uncomplicated type B aortic dissection

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E.M Xie ◽  
J.T Liu ◽  
F Yang ◽  
H.Y Ding ◽  
B.Q Hu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Spinal Cord Ischemia ◽  
Limb Ischemia ◽  
Hospital Death ◽  
Funding Source ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Major Complications ◽  
The Impact

Abstract Background This study aimed to analyze the impact of the timing of intervention from presentation of symptoms to TEVAR and its relation to major complications for uncomplicated TBAD. Methods We retrospectively analyzed the data of 390 patients who underwent TEVAR for acute, subacute and chronic uncomplicated type B aortic dissection from January, 2010 to December 2017. Standard univariate and survival methods were used. The primary outcome of interest was in-hospital mortality. The Secondary outcomes of interest was long-term death and in-hospital adverse events, including postoperative coma, postoperative endoleak, postoperative stroke, postoperative spinal cord ischemia, postoperative limb ischemia, postoperative mesenteric ischemia/infraction. Results Of the 390 TEVARs for uncomplicated TBAD, 145 were performed within 14 days of presentation of symptoms (acute), 172 between 14 hours and 90 days (sub-acute), and 73 were beyond 90 days (chronic). Demographic characteristics were similar among groups (Table 1). A slight increase of in-hospital death, post-operative endoleak and limb ischemia, were observed in the acute intervention group compared with the sub-acute group (4.8% vs 2.3%, 11.7% vs 9.3%, 2.8% vs 2.3%, respectively). The chronic group patients had a highest rates of post-operative endoleak. However, there are no significantly differences between the three groups (Table 2). During long-term follow-up (median duration 36.9 months, interquartile range, 22.5–67.7 months), overall survival was similar among groups (log-rank test, P=0.280) (Figure). Conclusion TEVER performed for uncomplicated TBAD within 14 days to the presentation of symptoms, as compared with TEVAR between 14 hours and 90 days or beyond 90 days, neither appear to increase the risk of in-hospital complications nor long-term mortality. Long-term All-cause Mortality Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): This research was supported by grant DFJH201807 from High-level Hospital Construction Project of Guangdong Provincial People's Hospital.

Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

Angiology ◽  
2021 ◽  
pp. 000331972098795
Author(s):  
Songyuan Luo ◽  
Yi Zhu ◽  
Enmin Xie ◽  
Huanyu Ding ◽  
Fan Yang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Landing Zone ◽  
End Point ◽  
Male Patients ◽  
Long Term Mortality

We aimed to investigate whether sex differences influence the clinical outcomes of patients who undergo thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). We retrospectively analyzed a prospectively maintained single-center cohort of patients with TBAD who underwent TEVAR between January 2010 and June 2017. We evaluated the in-hospital and long-term mortality and composite end point. Of the 913 patients, 793 (86.8%) were male and 120 (13.1%) were female. Compared to male patients, the female patients were older, more likely to have diabetes mellitus, but less likely to smoke or have hypertension. The proximal landing zone in 0 and 1 was higher in male patients ( P = .023), who were more likely to require an aortic arch bypass. Endoleak, delirium, and ICU stay after stent-graft implantation were also more frequent in men. Sex factor was not associated with in-hospital or long-term mortality or the composite end point in the multivariable regression analyses and Cox regression model. The mean estimated survival time was similar between males and females (2462.9 ± 141.2 vs 2804.1 ± 117.4 days, P = .167) in the propensity score–matched cohort. Despite distinct characteristics between sex, there was no sex-related difference in long-term clinical outcomes after TEVAR for TBAD.

Favorable Impact of Thoracic Endovascular Aortic Repar on Long-term Survival of Patients with Acute Uncomplicated Type B Aortic Dissection

2017 ◽  
Vol 225 (4) ◽  
pp. S117
Author(s):  
James C. Iannuzzi ◽  
Sahael M. Stapleton ◽  
Yanik J. Bababekov ◽  
David C. Chang ◽  
Robert Lancaster ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Elevated preoperative neutrophil‐to‐lymphocyte ratio predicts early adverse outcomes in uncomplicated type B aortic dissection undergoing TEVAR

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hongqiao Zhu ◽  
Lei Zhang ◽  
Taiping Liang ◽  
Yiming Li ◽  
Jian Zhou ◽  
...  
Keyword(s):  
Adverse Events ◽  
Aortic Dissection ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Neutrophil To Lymphocyte Ratio ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Independent Predictive Factor ◽  
Lymphocyte Ratio ◽  
Clinical Events

Abstract Background Thoracic aortic endovascular repair (TEVAR) of uncomplicated type B aortic dissection (uTBAD) has favorable long-term outcomes but higher early adverse events compared with the optimal medical treatment. Recently, clinical evidence concerning vascular surgery indicates that elevated preoperative systemic inflammatory response predicts adverse clinical events. The aim of our study was to evaluate the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and early outcomes of uTBAD patients undergoing TEVAR. Results 216 patients diagnosed with uTBAD were included in this retrospective study between January 2015 and December 2018. The median (IQR) follow-up period was 21 (15–33) months. An early adverse event was defined as occurring within 2 years after the procedure. Median patient age was 60 (IQR, 48–68) years and 78.7 % were male. Early adverse events occurred in 24 patients (11.1 %). In the multivariable analysis, preoperative NLR (HR per SD, 1.98; 95 % CI, 1.14–3.44; P = 0.015) was associated with 2-year adverse events. Conclusions NLR is an independent predictive factor of early adverse events in uTBAD patients undergoing TEVAR.

Type B Aortic Dissection Complicated by Intimo-Intimal Intussusception and Extensive Intimal Denuding: Case Report with Long-term Follow-up

2020 ◽  
Vol 69 ◽  
pp. 451.e5-451.e10
Author(s):  
Mary Lin ◽  
Alison O. Flentje ◽  
Charles Drucker ◽  
Siamak Dahi ◽  
Aakash Shah ◽  
...  
Keyword(s):  
Case Report ◽  
Aortic Dissection ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Long Term Follow Up ◽  
Intimal Intussusception

Long-term Results of Thoracic Endovascular Aortic Repair for Type B Aortic Dissection and Risk Factors for Survival

2020 ◽  
Vol 27 (3) ◽  
pp. 358-367 ◽  
Author(s):  
Dong-lin Li ◽  
Yun-jun He ◽  
Xiao-hui Wang ◽  
Yang-yan He ◽  
Zi-heng Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Thoracic Endovascular Aortic Repair ◽  
Long Term Results ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Patients ◽  
Aneurysmal Dilatation ◽  
Factors Influencing

Purpose: To compare characteristics of acute, subacute, and chronic type B aortic dissection and their influence on long-term results of thoracic endovascular aortic repair (TEVAR). Materials and Methods: In a single-center, retrospective cohort study, 314 patients (median age 52 years; 244 men) with acute (n=165), subacute (n=115), or chronic (n=34) type B aortic dissection underwent TEVAR between January 2009 and December 2013. Patient demographics, risk factors, and imaging characteristics were compared among the groups. Univariable and multivariable Cox regression analyses were performed to identify any factors influencing survival. Results: The acute and subacute patients exhibited more complications at presentation than chronic patients. However, the chronic patients exhibited more aneurysmal dilatation (p<0.001) and true lumen collapse (p<0.001). Over a mean follow-up of 68.1±22.9 months (range 2–108), subacute patients showed a lower reintervention rate (3.6% vs 12.1% vs 12.1%, p=0.045), a lower major complication rate (14.4% vs 33.1% vs 27.3%, p=0.002), and better cumulative overall survival (p=0.03) than the acute and chronic groups, respectively. Furthermore, acute patients developed more stent-graft–induced distal erosion (p=0.017) and retrograde type A dissection (RTAD) (p=0.036), whereas chronic patients had less aortic remodeling in the stented segment (p<0.001), distal thoracic aorta (p<0.001), and abdominal aorta (p=0.047). Finally, multivariable analysis demonstrated age >52 years, visceral malperfusion, and RTAD as independent factors influencing overall survival; aneurysmal dilatation, rupture/impending rupture, and RTAD were independent factors influencing aorta-specific survival. Conclusion: Acute and subacute patients had increased risks of rupture and complications at presentation, whereas chronic patients had increased risks for aneurysmal dilatation. From a long-term perspective, the subacute phase might be an optimal time for TEVAR in cases of type B aortic dissection that do not need emergent interventions. The risk factors influencing survival should be identified, carefully managed, and possibly prevented.

scholarly journals Open stented elephant trunk for complicated Stanford type B aortic dissection: a single-center experience

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Hongtao Tie ◽  
Lingwen Kong ◽  
Zhengjie Tu ◽  
Dan Chen ◽  
Delai Zheng ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Aortic Dissection ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Elephant Trunk ◽  
Open Set ◽  
Long Term Follow Up ◽  
Stanford Type B

Abstract Background Open stented elephant trunk (SET) or SET with left subclavian artery (LSCA) to left common carotid artery (LCCA) bypass is proven to a potentially alternative treatment for complicated Stanford type B aortic dissection (TBAD). In the current study, we reported our experience with ten consecutive TBAD patients who underwent open SET. Methods Patients with complicated TBAD underwent open SET from May 2016 to November 2018 in our institution were included. Patients’ clinical data were obtained from the electronic medical record system, and long-term clinical outcomes were collected by telephone interviews or outpatient interviews. Results A total of ten patients with nine males and one female were included, and the average age was 47.3 (31–65) years. Increased D-dimer and fibrinogen degradation products were observed in all patients at admission, and two patients had renal insufficiency. The average postoperative mechanical ventilation time, length of stay in intensive care unit, and postoperative hospital length of stay were 46.9 (6.7–151.2) hours, 7.7 (4–17) days, and 15.7 (10–26) days. No postoperative death occurred. Acute kidney injury and other complications were observed, and they were recovered well when discharge. In long-term follow-up, computed tomography angiography indicated that aortas were completely well remodeled, and blood supply of the brachiocephalic trunks was normal without anastomotic complications. All patients lived well. Conclusion SET or SET with subclavian artery correction shows satisfactory clinical outcomes, and it could be considered as an alternative treatment. Well-designed, large-scale studies with long-term follow-up are still needed.

Sign in / Sign up

Export Citation Format

Share Document