Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

Objectives: The aim of this study was to evaluate independent risk factors predictive for mortality of patients with Stanford A acute aortic dissection. Methods: From January 2006 to March 2015, a total of 240 consecutive patients diagnosed with acute Stanford A acute aortic dissection underwent surgical aortic repair in our center. After analysis of pre- and perioperative variables, univariate logistic and multivariate logistic regression analyses were performed for mortality of patients. Subsequently, Kaplan–Meier estimation analysis of short- and long-term survival of these variables was carried out. Results: Primary entry tear in descending aorta (odds ratio = 4.71, p = 0.021), preoperative international normalized ratio higher than 1.2 (odds ratio = 7.36, p = 0.001), additional coronary artery bypass grafting (odds ratio = 3.39, p = 0.003), cannulation in ascending aorta (odds ratio = 3.22, p = 0.005), preoperative neurological coma (odds ratio = 3.30, p = 0.003), and reduced perfusion (odds ratio = 2.91, p = 0.006) as well as prolonged reperfusion time (odds ratio = 3.36, p = 0.002) showed to be independent predictors for early mortality as well as for late mortality (hazard ratio of all variables p < 0.05). Kaplan–Meier survival estimation analysis with up to 9-year-follow-up in terms of these risk factors showed significantly poorer short- and long-term survival (log-rank and Breslow test all p < 0.05). Conclusion: Our study revealed that early and late mortality of patients with Stanford A acute aortic dissection surgery was significantly influenced by preoperative and perioperative variables as independent predictors especially of variables displaying coronary, cerebral, and visceral malperfusion. Also, short- and long-term survival of patients was significantly poorer in terms of these risk factors.

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Impact of Different Aortic Entry Tear Sites on Early Outcomes and Long-Term Survival in Patients with Stanford A Acute Aortic Dissection

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1649511 ◽

2018 ◽

Vol 67 (05) ◽

pp. 363-371

Author(s):

Julia Merkle ◽

Anton Sabashnikov ◽

Antje Christin Deppe ◽

Saskia Weber ◽

Navid Mader ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Acute Aortic Dissection ◽

Term Survival ◽

Long Term Survival ◽

Kaplan Meier ◽

Cerebrovascular Events ◽

Short And Long Term ◽

The Impact

Background Stanford A acute aortic dissection (AAD) is a life-threatening emergency. The aim of this study was to compare the impact of three different aortic entry tear sites on early outcomes and long-term survival of patients with Stanford A AAD. Methods From January 2006 to April 2015, a total of 240 consecutive patients with diagnosed Stanford A AAD underwent emergent, isolated surgical aortic repair in our center. Patients were divided into three groups comprising isolated ascending aorta, proximal aortic arch, and distal aortic arch entry tear site and were followed up for up to 9 years. Results Thirty-day mortality as well as major cerebrovascular events were significantly different between the three groups (p = 0.007 and p = 0.048, respectively). Overall cumulative short- and long-term survival of all patients revealed significant differences (Log-Rank p = 0.002), whereas survival of all patients free from major cerebrovascular events was similar (Log-Rank p = 0.780). Subgroup analysis of short- and long-term survival of patients showed significant differences in terms of men (Log-Rank p = 0.043), women (Log-Rank p = 0.004), patients over 65 years of age (Log-Rank p = 0.007), and hypertensive patients (Log-Rank p = 0.003). Kaplan–Meier survival estimation plots significantly showed poorest survival for distal aortic arch entry tear site group. Conclusion The location of the primary entry tear in patients with Stanford A AAD significantly influences early outcomes, short- and long-term survival of patients, whereas survival of patients free from major cerebrovascular events showed similar results among the three groups. Distal aortic entry tear site showed poorest outcomes and survival.

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Abstract 274: Follow-Up of Young Acute Aortic Dissection Patients: How They Differ from Older Patients

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a274 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Ellen K Brinza ◽

Lindsay Hagan ◽

Arturo Evangelista ◽

Eric M Isselbacher ◽

Marek P Ehrlich ◽

...

Keyword(s):

Adverse Events ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Categorical Variables ◽

Term Survival ◽

Long Term Survival ◽

Kaplan Meier ◽

Chi Square Analysis

Background: Young patients (pts) with acute aortic dissection (AAD) have distinct risk factors and presenting symptoms compared to older pts, but whether these differences extend past discharge is relatively unknown. Methods: Among pts presenting with AAD enrolled in the International Registry of Acute Aortic Dissection, pts <40 (N=280) were compared with pts ≥ 40 (N=3585). Chi-square analysis or Fischer’s Exact test were performed for categorical variables; age was compared using Student’s T-test. Kaplan-Meier curves were generated for freedom from adverse events rates 0-60 months following discharge. Mean follow-up was 28.6 months. Results: Significant differences in demographics and history were noted between pts <40 and the older cohort. Young pts more commonly had type A AAD (71.8%, 201/280, v. 64.6%, 2317/ 3585, p<0.016), while type B AAD was more typical in older pts (p<0.016). On imaging studies, pts <40 were less likely to present with IMH (7.3%, 246/3355, v. 2.3%, 6/266, p=0.002), but were more likely to have a patent false lumen (77.9%, 141/181, v. 62.1%, 1425/2295, p<0.001). Surgical management was more common in young pts, for both AAD types. In-hospital complications or mortality did not differ between groups. Kaplan-Meier analysis demonstrated better long-term survival in young pts compared to those ≥ 40 (p=0.029). Kaplan-Meier analyses of freedom from adverse events at 5 years illustrated no difference in aortic growth between groups, but significantly more late interventions in younger pts (p=0.006). Conclusions: Young pts show distinct differences in comparison to older pts, specifically regarding presentation, AAD type and management. Long-term survival and follow-up intervention rates are higher in young pts.

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Impact of hypertension on short- and long-term survival of patients who underwent emergency surgery for type A acute aortic dissection

Journal of Thoracic Disease ◽

10.21037/jtd-20-2336 ◽

2020 ◽

Vol 12 (11) ◽

pp. 6618-6628

Author(s):

Zhigang Wang ◽

Min Ge ◽

Tao Chen ◽

Cheng Chen ◽

Qiuyan Zong ◽

...

Keyword(s):

Aortic Dissection ◽

Emergency Surgery ◽

Acute Aortic Dissection ◽

Type A ◽

Term Survival ◽

Long Term Survival ◽

Short And Long Term

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Hepatic dysfunction in patients who received acute DeBakey type I aortic dissection repair surgery: incidence, risk factors, and long-term outcomes

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01676-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zhigang Wang ◽

Min Ge ◽

Cheng Chen ◽

Lichong Lu ◽

Lifang Zhang ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Hepatic Dysfunction ◽

Type I ◽

Acute Type ◽

Term Survival ◽

Long Term Survival ◽

Kaplan Meier ◽

Independent Risk Factors

Abstract Background Hepatic dysfunction (HD) increases the morbidity and mortality rates after cardiac surgery. However, few studies have investigated the association between HD and acute DeBakey type I aortic dissection (ADIAD) surgery. This retrospective study aimed to identify risk factors for developing HD in patients who received acute type I aortic dissection repair and its consequences. Methods A total of 830 consecutive patients who received ADIAD surgery from January 2014 to December 2019 at our center were screened for this study. The End-Stage Liver Disease (MELD) score more than 14 was applied to identify postoperative HD. Logistic regression model was applied to identify risk factors for postoperative HD, Kaplan–Meier survival analysis and Cox proportional hazards regression assay were conducted to analyze the association between HD and postoperative long-term survival. Results Among 634 patients who eventually enrolled in this study, 401 (63.2%) experienced postoperative HD with a 30-Day mortality of 15.5%. Preoperative plasma fibrinogen level (PFL) [odds ratio (OR): 0.581, 95% confidence interval (CI): 0.362–0.933, P = 0.025], serum creatinine (sCr) on admission (OR: 1.050, 95% CI 1.022–1.079, P < 0.001), cardiopulmonary bypass (CPB) time (OR: 1.017, 95% CI 1.010–1.033, P = 0.039), and postoperative mechanical ventilation (MV) duration (OR: 1.019, 95% CI 1.003–1.035, P = 0.020) were identified as independent risk factors for developing postoperative HD by multivariate analyses. In addition, the Kaplan–Meier analysis indicated that the long-term survival rate was significantly different between patients with or without postoperative HD. However, the hazard ratios of long-term survival for these two groups were not significantly different. Conclusions HD was a common complication after ADIAD surgery and associated with an increasing 30-Day mortality rate. Decreased PFL, elevated sCr, prolonged CPB duration, and longer postoperative MV time were independent risk factors for postoperative HD.

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