Impact of body mass index on early and mid-term outcomes after surgery for acute Stanford type A aortic dissection

Abstract Background Obesity is dramatically increasing worldwide, and more obese patients may develop aortic dissection and present for surgical repair. The study aims to analyse the impact of body mass index (BMI) on surgical outcomes in patients with acute Stanford type A aortic dissection (ATAAD). Methods From January 2017 to June 2019, the clinical data of 268 ATAAD patients in a single centre were retrospectively reviewed. They were divided into three groups based on the BMI: normal weight (BMI 18.5 to < 25 kg/m2, n = 110), overweight (BMI 25 to < 30 kg/m2, n = 114) and obese (BMI ≥30 kg/m2, n = 44). Results There was no statistical difference among the three groups in terms of the composite adverse events including 30-day mortality, stroke, paraplegia, renal failure, hepatic failure, reintubation or tracheotomy and low cardiac output syndrome (20.9% vs 21.9% vs 18.2% for normal, overweight and obese, respectively; P = 0.882). No significant difference was found in the mid-term survival among the three groups. The proportion of prolonged ventilation was highest in the obese group followed by the overweight and normal groups (59.1% vs 45.6% vs 34.5%, respectively; P = 0.017). Multivariable logistic regression analysis suggested that BMI was not associated with the composite adverse events, while BMI ≥30 kg/m2 was an independent risk factor for prolonged ventilation (OR 2.261; 95% CI 1.056–4.838; P = 0.036). Conclusions BMI had no effect on the early major adverse outcomes and mid-term survival after surgery for ATAAD. Satisfactory surgical outcomes can be obtained in patients with ATAAD at all weights.

Download Full-text

European registry of type A aortic dissection (ERTAAD) - rationale, design and definition criteria

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01536-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Fausto Biancari ◽

Giovanni Mariscalco ◽

Hakeem Yusuff ◽

Geoffrey Tsang ◽

Suvitesh Luthra ◽

...

Keyword(s):

Adverse Events ◽

Aortic Dissection ◽

Treatment Strategies ◽

Kidney Injury ◽

Type A ◽

Salvage Procedure ◽

Type A Aortic Dissection ◽

Mortality And Morbidity ◽

Link Type ◽

The Impact

Abstract Background Acute Stanford type A aortic dissection (TAAD) is a life-threatening condition. Surgery is usually performed as a salvage procedure and is associated with significant postoperative early mortality and morbidity. Understanding the patient’s conditions and treatment strategies which are associated with these adverse events is essential for an appropriate management of acute TAAD. Methods Nineteen centers of cardiac surgery from seven European countries have collaborated to create a multicentre observational registry (ERTAAD), which will enroll consecutive patients who underwent surgery for acute TAAD from January 2005 to March 2021. Analysis of the impact of patient’s comorbidities, conditions at referral, surgical strategies and perioperative treatment on the early and late adverse events will be performed. The investigators have developed a classification of the urgency of the procedure based on the severity of preoperative hemodynamic conditions and malperfusion secondary to acute TAAD. The primary clinical outcomes will be in-hospital mortality, late mortality and reoperations on the aorta. Secondary outcomes will be stroke, acute kidney injury, surgical site infection, reoperation for bleeding, blood transfusion and length of stay in the intensive care unit. Discussion The analysis of this multicentre registry will allow conclusive results on the prognostic importance of critical preoperative conditions and the value of different treatment strategies to reduce the risk of early adverse events after surgery for acute TAAD. This registry is expected to provide insights into the long-term durability of different strategies of surgical repair for TAAD. Trial registration ClinicalTrials.gov Identifier: NCT04831073.

Download Full-text

The Impact of Age in Acute Type A Aortic Dissection: a Retrospective Study

10.21203/rs.3.rs-970708/v1 ◽

2021 ◽

Author(s):

Junxia Wang ◽

Yunxing Xue ◽

Xiyu Zhu ◽

Hoshun Chong ◽

Zhong Chen ◽

...

Keyword(s):

Retrospective Study ◽

Aortic Dissection ◽

Surgical Therapy ◽

Age Groups ◽

Type A ◽

Acute Type ◽

Term Survival ◽

Type A Aortic Dissection ◽

Surgical Methods ◽

The Impact

Abstract Background: Acute type A aortic dissection (aTAAD) is a lethal disease and age is an important risk factor for outcomes. This retrospective study was to analyze the impact of age stratification in aTAAD, and to provide clues for surgeons when they make choices of therapy strategies. Methods: From January 2011 to December 2019, 1092 aTAAD patients from Nanjing Drum Tower Hospital received surgical therapy. Patients were divided into 7 groups according to every ten-year interval (20s-80s). The differences between the groups were analyzed in terms of the baseline preoperative conditions, surgical methods and postoperative outcomes of patients of different age groups. During a median follow-up term of 17 months, the survival rates were compared among 7 groups through Kaplan-Meier analysis.Results: The median age was 52.0 years old in whole cohort. The multiple comorbidities were more common in old age groups (60s, 70s, 80s), while the 20s group patients had the highest proportion of Marfan syndrome (28.1%). Preoperative hypotension was highest in 80s (16.7%, P=0.038). Young age groups (20s-60s) had a higher rate of root replacement and total arch replacement, which led to a longer duration of operation and hypothermic circulation arrest. The overall mortality was 14.1%, the tendency of mortality was increased with age except 20s group (33.3% in 80s, P=0.016). The postoperative morbidity of gastrointestinal bleeding and bowel ischemia were 16.7% and 11.1% in 80s group. Conclusions: Age is a major impact factor for aTAAD surgery. Old patients presented more comorbidities before surgery, the mortality and complications rate were significantly higher even with less invasive and conservative surgical therapy. But the favorable long term survival indicated that the simple or less extensive arch repair is the preferred surgery for patients over 70 years old.

Download Full-text

Perioperative Results and Risk Factors for In-Hospital Mortality In Patients With Stanford Type A Aortic Dissection Undergoing Sun’s Procedure - A Single Center Study

The Heart Surgery Forum ◽

10.1532/hsf.1909 ◽

2018 ◽

Vol 21 (6) ◽

pp. E432-E437 ◽

Cited By ~ 1

Author(s):

YuHui Wu ◽

Rui Jiang ◽

Ping Xu ◽

Guanron Wang ◽

Jianhu Wang ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Cardiopulmonary Bypass ◽

Aortic Dissection ◽

Hospital Mortality ◽

Body Mass ◽

Type A ◽

The Body ◽

Type A Aortic Dissection ◽

Cardiopulmonary Bypass Time

Background: The study was to analyze the therapeutic effect and risk factors of in-hospital mortality in patients with acute Stanford type A aortic dissection operated by Sun’s procedure. Methods: From Jan. 2010 to March 2016, 72 patients whose data was fully accessible underwent Sun’s procedure in our hospital due to acute Stanford type A aortic dissection. Patients were divided into the survival group and the death group, and the risk factors for in-hospital mortality were collected and analyzed. Results: All 72 patients were diagnosed as acute Stanford type A aortic dissection by CT angiography in which the ascending aorta, aortic arch and descending aorta were involved; these patients were operated by Sun’s procedure. The operation of proximal aorta included 39 Bentall procedure, one David surgery, and 32 ascending aorta replacement. The in-hospital mortality rate was 19.4% (14 patients). Studies showed the risk factors for the in-hospital mortality included the body mass index, cardiopulmonary bypass time, operation time, intraoperative transfusion of red blood cells and plasma volume, and the total perioperative transfusion of red blood cells, plasma and cryoprecipitate volume. Independent risk factors included the body mass index and cardiopulmonary bypass time. Conclusion: Acute Stanford type A aortic dissection is a severe, complex disease with high in-hospital mortality, though the Sun’s procedure is an effective surgical approach in treating this kind of disease in some center. Body mass index and cardiopulmonary bypass time are independent risk factors for in-hospital mortality.

Download Full-text

Type A aortic dissection: involvement of carotid artery and impact on cerebral malperfusion

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320984329 ◽

2020 ◽

pp. 021849232098432

Author(s):

Wahaj Munir ◽

Jun Heng Chong ◽

Amer Harky ◽

Mohamad Bashir ◽

Benjamin Adams

Keyword(s):

Carotid Artery ◽

Aortic Dissection ◽

Type A ◽

Current Evidence ◽

Management Approach ◽

Complex Nature ◽

Acute Type ◽

Type A Aortic Dissection ◽

Cerebral Malperfusion ◽

The Impact

Acute type A aortic dissection is a surgical emergency and management of such pathology can be complex with poor outcomes when there is organ malperfusion. Carotid artery involvement is present in 30% of patients diagnosed with acute type A aortic dissection, and given its emergency and complex nature, there is much controversy regarding the approach, extent of treatment, and timing of the intervention. It is clear that the occurrence of cerebral malperfusion adds an extra layer of complexity to the decision-making framework for treatment. Standardization and validation of the optimal management approach is required, and this should ideally be addressed with large-scale studies. Nonetheless, current literature supports the need for rapid recognition and diagnosis of acute type A aortic dissection with cerebral malperfusion, immediate and extensive surgical repair, and the appropriate use of cerebral perfusion techniques. This paper aims to discuss the current evidence regarding the impact of carotid artery involvement in both the management and outcomes of acute type A aortic dissection.

Download Full-text

The Impact of Pre-Operative Malperfusion on Outcome in Acute Type A Aortic Dissection

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.04.030 ◽

2015 ◽

Vol 65 (24) ◽

pp. 2628-2635 ◽

Cited By ~ 117

Author(s):

Martin Czerny ◽

Florian Schoenhoff ◽

Christian Etz ◽

Lars Englberger ◽

Nawid Khaladj ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

The Impact

Download Full-text

The Impact of Dedicated Aortic Teams and Centralisation of Aortic Services, and Surgeon or Centre Specific Volumes on Outcomes of Acute Type A Aortic Dissection

Journal of Cardiology & Cardiovascular Therapy ◽

10.19080/jocct.2018.12.555828 ◽

2018 ◽

Vol 12 (1) ◽

Cited By ~ 4

Author(s):

Amer Harky

Keyword(s):

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

The Impact ◽

Specific Volumes

Download Full-text

Abstract 459: The TripleCPR 16 Study: Does Rhythm Truly Needed to Be Checked Every 2 Minutes in Cardiopulmonary Arrest Patients?

Circulation ◽

10.1161/circ.140.suppl_2.459 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Ryosuke Takegawa ◽

Tadahiko Shiozaki ◽

Mitsuo Ohnishi ◽

Arisa Muratsu ◽

Jotaro Tachino ◽

...

Keyword(s):

Adverse Events ◽

Aortic Dissection ◽

Chest Compression ◽

Cardiopulmonary Arrest ◽

Cardiac Activity ◽

Type A ◽

Type A Aortic Dissection ◽

Shockable Rhythm ◽

Mechanical Chest Compression ◽

Severe Adverse Events

Purpose: Current guidelines recommend rhythm checks every 2 minutes during CPR, but evidence for this recommendation is insufficient. Recent reports identified regional cerebral oxygen saturation (rSO 2 ) monitoring as useful in detecting ROSC and that coronary and cerebral perfusion decrease with the 2-minute rhythm check. On the basis of our previous study, we began the TripleCPR 16 study, which omits 2-minute rhythm checks because stopping chest compression to check rhythm may increase cerebral damage and decrease the ROSC. Methods: The multicenter, prospective TripleCPR 16 study began in January 2017. The inclusion criterion is a cardiopulmonary arrest patient aged ≥16 years with a non-shockable rhythm on hospital arrival. Subjects are divided into 3 groups based on their mean cerebral rSO 2 value in the first minute of arrival: ≥50%, <50% to 40%, and <40%. Continuous mechanical chest compression is performed on all subjects for 16 minutes or until their rSO 2 value exceeds the initial value by 10%, 20%, or 35%, respectively. We are comparing the TripleCPR 16 study results with our previous hospital data obtained from 86 patients with non-shockable rhythm who underwent every 2-minute rhythm checks and mechanical chest compression. Result: Currently, 218 patients are registered. Rates of ROSC were 34.9% for these patients and 39.5% for the previous 86 patients (p=0.51). There were no severe adverse events. Subanalysis of the data of Osaka University Hospital alone showed no significant increase of rSO 2 value in the 48 patients with non-sonographic cardiac activity and 26 patients with Stanford type A aortic dissection diagnosed by CT scan, and only two patient in each group achieved ROSC. When excluding the patients with Stanford type A aortic dissection, rates of ROSC was 47.8% for the patients in this study and 39.0% for the previous 86 patients (p=0.26). Conclusion: The TripleCPR 16 study is ongoing without severe adverse events. In the patients with non-sonographic cardiac activity or Stanford type A aortic dissection, rSO 2 values did not increase and it was difficult to achieve ROSC. A simpler CPR protocol could be devised that omits the 2-minute rhythm check in patients with a non-shockable rhythm.

Download Full-text