Differences in the Area of Proximal and Distal Entry Tears at CT                     Angiography Predict Long-term Clinical Outcomes in Aortic                     Dissection

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.

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Different aortic arch surgery methods for type A aortic dissection: clinical outcomes and follow-up results

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa095 ◽

2020 ◽

Vol 31 (2) ◽

pp. 254-262

Author(s):

Yunxing Xue ◽

Jun Pan ◽

Hailong Cao ◽

Fudong Fan ◽

Xuan Luo ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Clinical Outcomes ◽

Type A ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Type A Aortic Dissection ◽

Aortic Arch Surgery

Abstract OBJECTIVES The aim of this study was to investigate the clinical outcomes and follow-up results among 5 main aortic arch surgery methods for type A aortic dissection in a single centre. METHODS From 2002 to 2018, 958 type A aortic dissection patients who received surgical repair were divided into 5 groups according to the arch surgery method: hemiarch replacement (n = 206), island arch replacement (n = 54), total arch replacement with frozen elephant trunk (n = 425), triple-branched stent (n = 39) and fenestrated stent (n = 234). The indications for the different arch methods were related to the patient’s preoperative status, the location and extent of the dissection and the surgical ability of the surgeons. A comparative study was performed to identify the differences in the perioperative data, and the Kaplan–Meier analysis was used to assess the long-term survival and reintervention rates. Thirty matched surviving patients that were included in each group completed Computed tomography angiography to determine long-term reshaping effect. RESULTS The 30-day mortality rate was 15.8%, and there was no difference among the 5 groups (P = 0.848). The follow-up survival rates were similar among the 5 groups (P = 0.130), and the same was true for patients without reintervention (P = 0.471). In the propensity matching study, patients with stents (frozen elephant trunk, triple-branched stent, fenestrated stent) had a slower aortic dilation rate and a higher ratio of thrombosis in the false lumen at the descending aortic and abdominal aortic levels than patients without stents. CONCLUSIONS No standard method is available for arch surgery, and indications and long-term effects should be identified with clinical data. In our experiences, simpler surgical procedures could reduce mortality in critically ill patients and stents in the distal aorta could improve long-term reshape effects.

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Coronary CT angiography versus standard of care strategies to evaluate patients with potential coronary artery disease; effect on long term clinical outcomes

Atherosclerosis ◽

10.1016/j.atherosclerosis.2014.09.038 ◽

2014 ◽

Vol 237 (2) ◽

pp. 494-498 ◽

Cited By ~ 10

Author(s):

Matthew J. Budoff ◽

Sandy Liu ◽

David Chow ◽

Ferdinand Flores ◽

Brian Hsieh ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Clinical Outcomes ◽

Ct Angiography ◽

Coronary Ct Angiography ◽

Standard Of Care ◽

Coronary Ct ◽

Artery Disease ◽

Disease Effect

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Preoperative proteinuria and clinical outcomes in type B aortic dissection after thoracic endovascular aortic repair

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-0765 ◽

2019 ◽

Vol 57 (5) ◽

pp. 752-758

Author(s):

Hongwei Yang ◽

Jianwei Zhou ◽

Keli Huang ◽

Tao Yu ◽

Zuhui Wang ◽

...

Keyword(s):

Aortic Dissection ◽

Clinical Outcomes ◽

Multivariate Logistic Regression Analysis ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Urine Dipstick ◽

Aortic Repair

Abstract Background Proteinuria is a marker of poor outcomes in several diseases; however, few studies have been conducted to explore the prognostic value of proteinuria, assessed by urine dipstick test, for clinical outcomes in patients with type B acute aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR). Methods Consecutive patients with TBAD undergoing TEVAR were enrolled from January 2010 to July 2015. Proteinuria was defined as trace or higher, according to the results of urine dipstick testing. Associations among proteinuria and adverse events were evaluated. Results In total, 671 patients with a mean age of 44±15 years were included in the analysis. Proteinuria was detected in 281 patients (41.9%) before TEVAR. Multivariate logistic regression analysis showed that C-reactive protein and impaired renal function were independent predictors for proteinuria. During hospitalization, 21 patients died. In-hospital mortality was higher in patients with proteinuria (1.5% vs. 5.3%, p=0.005). After a median 3.4 years follow up, the post-TEVAR death rate was 10.4% (85 patients were lost to follow-up). The long-term cumulative mortality was significantly higher in patients with proteinuria (17.2% vs. 8.2%, log-rank=11.36, p=0.001). Multivariate Cox survival modeling indicated that proteinuria was significantly associated with long-term death, after adjustment for potential confounding risk factors (HR=1.92, p=0.012). Conclusions Pre-TEVAR proteinuria was identified as a prognostic marker in patients with TBAD and has potential for application as a convenient and simple risk assessment method before TEVAR.

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