Surgical outcomes of DeBakey type I and type II acute aortic dissection: a propensity score-matched analysis in 599 patients

Abstract Background The DeBakey classification divides Stanford acute type A aortic dissection (ATAAD) into DeBakey type I (D1) and type II (D2) according to the extent of acute aortic dissection (AAD). This retrospective study aimed to compare the early and late outcomes of D1-AAD and D2-AAD through a propensity score-matched analysis. Methods Between January 2009 and April 2020, 599 consecutive patients underwent ATAAD repair at our institution, and were dichotomized into D1 (n = 543; 90.7%) and D2 (n = 56; 9.3%) groups. Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 56 patients per group. The clinical features, postoperative complications, 5-year cumulative survival and freedom from reoperation rates were compared. Results In the overall cohort, the D1 group had a lower rate of preoperative shock and more aortic arch replacement with longer cardiopulmonary bypass time. The D1 group had a higher in-hospital mortality rate than the D2 group in overall (15.8% vs 5.4%; P = 0.036) and matched cohorts (19.6% vs 5.4%; P = 0.022). For patients that survived to discharge, the D1 and D2 groups demonstrated similar 5-year survival rates in overall (77.0% vs 85.2%; P = 0.378) and matched cohorts (79.1% vs 85.2%; P = 0.425). The 5-year freedom from reoperation rates for D1 and D2 groups were 80.0% and 97.1% in overall cohort (P = 0.011), and 93.6% and 97.1% in matched cohort (P = 0.474), respectively. Conclusions Patients with D1-AAD had a higher risk of in-hospital mortality than those with D2-AAD. However, for patients who survived to discharge, the 5-year survival rates were comparable between both groups.

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Surgical Treatment of Acute Type A Aortic Dissection with 18-Litre Bleeding

Aorta ◽

10.1055/s-0041-1722897 ◽

2021 ◽

Vol 09 (01) ◽

pp. 030-032

Author(s):

Sergey Y. Boldyrev ◽

Kirill O. Barbukhatty ◽

Vladimir A. Porhanov

Keyword(s):

Surgical Treatment ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Type I ◽

Acute Type ◽

Drug Induced ◽

Type A Aortic Dissection ◽

Mortality And Morbidity ◽

Perioperative Bleeding

AbstractSurgical treatment of Type-A acute aortic dissection is associated with high mortality and morbidity. One of the reasons is perioperative bleeding, which may lead to worse outcomes. We present a case of successful treatment of a patient with 18-litre perioperative blood loss in DeBakey Type-I acute aortic dissection with drug-induced hypocoagulation and malperfusion of a lower extremity.

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Relationship of admission neutrophil-to-lymphocyte ratio with in-hospital mortality in patients with acute type I aortic dissection

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-1301-136 ◽

2014 ◽

Vol 44 ◽

pp. 186-192 ◽

Cited By ~ 10

Author(s):

Gökhan LAFÇI ◽

Ömer Faruk ÇİÇEK ◽

Hacı Alper UZUN ◽

Adnan YALÇINKAYA ◽

Adem İlkay DİKEN ◽

...

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Neutrophil To Lymphocyte Ratio ◽

Type I ◽

Acute Type ◽

Lymphocyte Ratio ◽

Relationship Of

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Early Spontaneous Resolution of an Iatrogenic Acute Type A Aortic Dissection

Aorta ◽

10.12945/j.aorta.2016.16.067 ◽

2016 ◽

Vol 04 (06) ◽

pp. 235-239

Author(s):

Mohammad Zafar ◽

Philip Pang ◽

Glen Henry ◽

Bulat Ziganshin ◽

Maryann Tranquilli ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Type I ◽

Acute Type ◽

Computed Tomography Scan ◽

Descending Aorta ◽

Type A Aortic Dissection ◽

Tomography Scan

AbstractAcute aortic dissection is a rare but devastating complication during cardiac catheterization. We present the case of an elderly female who incurred a Stanford Type A/DeBakey Type I acute aortic dissection extending into the arch vessels and descending aorta likely occurring during right coronary artery engagement for angioplasty. The patient was treated successfully by immediately sealing the entrance of the dissection via the placement of a stent and anti-impulse therapy. Follow-up computed tomography scan showed complete resolution of the dissection within one month.

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Bentall surgery for acute aortic dissection (type-a) in a patient with marfan syndrome

KYAMC Journal ◽

10.3329/kyamcj.v9i2.38156 ◽

2018 ◽

Vol 9 (2) ◽

pp. 95-100

Author(s):

Mohammad Arifur Rahman ◽

Md Lutfar Rahman ◽

Prakash Chandra Munshi ◽

Taslim Yusuf Tamal ◽

Mejbaur Rahman ◽

...

Keyword(s):

Aortic Dissection ◽

Marfan Syndrome ◽

Acute Aortic Dissection ◽

Axillary Artery ◽

Clinical Manifestations ◽

Type A ◽

Moderate Hypothermia ◽

Type I ◽

Acute Type ◽

Aortic Dissection Type A

Background: Marfan syndrome is an autosomal-dominant hereditary connective tissue disorder with the clinical manifestations involving the ocular, skeletal, and cardiovascular systems. The cardiovascular manifestations include aortic root dilatation, aortic valvular insufficiency, mitral valve prolapse, mitral regurgitation, aortic dissection and aortic rupture. Acute aortic dissection is one of the most common catastrophes involving the aorta. A high index of suspicion is important in patients who have predisposing risk factors. Classification is based on the location of dissection and its duration. Stanford type A (De bakey type I /type II) dissection should be treated surgically in essentially all cases.Objective: To report our experience in Bentall surgery in Acute aortic dissection (type A ). The efficacy of right axillary artery cannulation was investigated.Materials & Methods: Patient with acute type A aortic dissection involving coronary sinuses with 3 vessels of the arch free of lesions underwent aortic valve with ascending aorta and hemiarch replacement with composite valve graft (Bentall procedure) and reimplantation of coronary arteries under moderate hypothermia. The axillary artery was used for arterial cannulation.Results: Weaning from CPB was smooth. Perioperative period was eventless. Follow-up Echo revealed normal cardiac parameters.Conclusion: Prompt establishment of the diagnosis, through focused physical examination and noninvasive imaging, followed by rapid medical and surgical therapy, are the only effective methods to alter survival in patients with acute aortic dissection.KYAMC Journal Vol. 9, No.-2, July 2018, Page 95-100

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Early outcomes of hybrid type II arch repair versus total arch replacement with frozen elephant trunk in acute DeBakey type I aortic dissection: a propensity score-matched analysis

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa121 ◽

2020 ◽

Vol 31 (4) ◽

pp. 565-572

Author(s):

Yanxiang Liu ◽

Shenghua Liang ◽

Bowen Zhang ◽

Yunfeng Li ◽

Lucheng Wang ◽

...

Keyword(s):

Propensity Score ◽

Aortic Dissection ◽

Protective Factor ◽

Total Arch Replacement ◽

Type I ◽

Type Ii ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Low Cardiac Output Syndrome ◽

Hybrid Type

Abstract OBJECTIVES The aim was to evaluate the short-term outcomes of hybrid type II arch repair (HAR) and total arch replacement with frozen elephant trunk (TAR with FET) for acute DeBakey type I aortic dissection patients. METHODS From January 2017 to June 2019, the clinical data of acute DeBakey type I aortic dissection patients in a single centre were retrospectively reviewed; there were 92 cases of HAR and 268 cases of TAR with FET, with 56 pairs by propensity score matching. RESULTS After matching, the composite end points including 30-day mortality, stroke, paraplegia, renal failure, hepatic failure, reintubation or tracheotomy and low cardiac output syndrome were comparable (21.4%, 12/56 in the HAR group vs 21.4%, 12/56 in the TAR with FET group, P = 1.000). The rate of acute kidney injury (AKI) was significantly lower in the HAR group (58.9%, 33/56 vs 80.4%, 45/56, P = 0.031). The distribution of AKI stage according to the Kidney Disease Improving Global Outcomes criteria was different (P = 0.039), with more patients suffering from high-grade AKI in the TAR with FET group. Multivariable logistic analysis showed that the procedure type (HAR or TAR with FET) was not an independent predictor of composite adverse events or stroke. HAR was identified as a protective factor against AKI (odds ratio 0.485, 95% confidence interval 0.287–0.822; P = 0.007). CONCLUSIONS In the treatment of acute DeBakey type I aortic dissection, no significant differences were found in early outcomes between the 2 groups, but HAR was associated with a significantly lower incidence of AKI.

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Influence of Body Mass Index on Outcomes of Patients Undergoing Surgery for Acute Aortic Dissection: A Propensity-Matched Analysis

Texas Heart Institute Journal ◽

10.14503/thij-17-6365 ◽

2019 ◽

Vol 46 (1) ◽

pp. 7-13 ◽

Cited By ~ 4

Author(s):

Antonio Lio ◽

Emanuele Bovio ◽

Francesca Nicolò ◽

Guglielmo Saitto ◽

Antonio Scafuri ◽

...

Keyword(s):

Body Mass Index ◽

Aortic Dissection ◽

Body Mass ◽

Acute Aortic Dissection ◽

Survival Rates ◽

Type A ◽

Pulmonary Complications ◽

Obese Group ◽

Matched Cohort ◽

Low Cardiac Output Syndrome

To determine whether body mass index ≥30 kg/m2 affects morbidity and mortality rates in patients undergoing surgery for type A acute aortic dissection, we conducted a retrospective study of 201 patients with type A dissection. Patients were divided into 2 groups according to body mass index (BMI): nonobese (BMI, <30 kg/m2; 158 patients) and obese (BMI, ≥30 kg/m2; 43 patients). Propensity score matching was used to reduce selection bias. The overall mortality rate was 19% (38/201 patients). The perioperative mortality rate was higher in the obese group, both in the overall cohort (33% vs 15%; P=0.01) and in the propensity-matched cohort (32% vs 12%; P=0.039). In the propensity-matched cohort, patients with obesity had higher rates of low cardiac output syndrome (26% vs 6%; P=0.045) and pulmonary complications (32% vs 9%; P=0.033) than those without obesity. The overall 5-year survival rates were 52.5% ± 7.8% in the obese group and 70.3% ± 4.4% in the nonobese group (P=0.036). In the propensity-matched cohort, the 5-year survival rates were 54.3% ± 8.9% in the obese group and 81.6% ± 6.8% in the nonobese group (P=0.018). Patients with obesity (BMI, ≥30 kg/m2) who underwent surgery for type A acute aortic dissection had higher operative mortality rates and an increased risk of low cardiac output syndrome, pulmonary complications, and other postoperative morbidities than did patients without obesity. Additional extensive studies are needed to confirm our findings.

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Utility of double arterial cannulation for surgical repair of acute type A dissection

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa007 ◽

2020 ◽

Vol 57 (6) ◽

pp. 1068-1075 ◽

Cited By ~ 1

Author(s):

Sho Kusadokoro ◽

Naoyuki Kimura ◽

Daijiro Hori ◽

Masahiro Hattori ◽

Wataru Matsunaga ◽

...

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Femoral Artery ◽

Axillary Artery ◽

Survival Rates ◽

Left Ventricular ◽

Ascending Aorta ◽

Acute Type ◽

Arterial Cannulation ◽

Left Ventricular Apex

Abstract OBJECTIVES Outcomes of planned and unplanned (rescue) double arterial cannulation (DAC) in surgery for acute type A aortic dissection were investigated retrospectively. METHODS The study involved 805 patients who were divided into 4 groups according to the cannulation strategy: single cannulation of the femoral artery (n = 338), axillary artery (n = 256), left ventricular apex (n = 52) or ascending aorta (n = 5) (total, n = 57), and DAC (n = 154). Patients who underwent DAC were divided between planned (n = 132) and rescue (n = 22) usage. Characteristics and outcomes were compared between groups. Both unmatched and propensity score-matched analyses were performed. RESULTS Shock (39%, 19%, 33% and 14%, in the femoral artery, axillary artery, left ventricular apex/ascending aorta and DAC, respectively) and leg malperfusion (5%, 16%, 16% and 26%, respectively) differed significantly (P < 0.001), but in-hospital mortality did not (9%, 8%, 18% and 7%, respectively; P = 0.096). The 5-year survival rates were 79.4%, 79.7%, 78.6% and 82.2%, respectively. Propensity score-matched analysis showed no statistically significant differences in in-hospital mortality rates (10%, 12%, 14% and 9%, respectively; P = 0.78) and 5-year survival rates (78.4%, 72.3%, 82.3% and 78.0%, respectively). The leading vessel combination and indications for planned and rescue DAC were the femoral and axillary arteries (98%) and true lumen narrowing and/or leg malperfusion (34%), and the axillary followed by femoral (77%) artery and low cardiopulmonary bypass flow (36%). In-hospital mortality in the planned and rescue DAC groups was 7% and 9%, respectively. CONCLUSIONS DAC seems effective for both prevention and management of intraoperative malperfusion.

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Predicting In-Hospital Mortality in Acute Type B Aortic Dissection: Evidence From International Registry of Acute Aortic Dissection

Journal of Vascular Surgery ◽

10.1016/j.jvs.2014.11.056 ◽

2015 ◽

Vol 61 (1) ◽

pp. 282

Author(s):

J.L. Tolenaar ◽

W. Froehlich ◽

F.H.W. Jonker

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Acute Aortic Dissection ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

International Registry

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Does Profound Hypothermic Circulatory Arrest Improve Survival in Patients With Acute Type A Aortic Dissection?

Circulation ◽

10.1161/01.cir.0000032890.55215.27 ◽

2002 ◽

Vol 106 (12_suppl_1) ◽

Author(s):

David T. Lai ◽

Robert C. Robbins ◽

R. Scott Mitchell ◽

Kathleen A. Moore ◽

Philip E. Oyer ◽

...

Keyword(s):

Aortic Dissection ◽

Cox Regression ◽

Propensity Score Analysis ◽

Circulatory Arrest ◽

Survival Rates ◽

Type A ◽

Hypothermic Circulatory Arrest ◽

Acute Type ◽

Type A Aortic Dissection ◽

Reoperation Rates

Objective No evidence exists that profound hypothermic circulatory arrest (PHCA) improves survival or reduces the likelihood of distal aortic reoperation in patients with acute type A aortic dissection. Methods Records of 307 patients with acute type A aortic dissection from 1967 to 1999 were retrospectively reviewed. The influence of repair using PHCA (n=121) versus without PHCA (n=186) on death and freedom from distal aortic reoperation was analyzed using multivariable Cox regression models. Propensity score analysis identified a subset of 152 comparable patients in 3 quintiles (QIII–V) in which the effects of PHCA (n=113) versus no PHCA (n=39) were further compared. Results For all patients, 30-day, 1-year, and 5-year survival estimates were 81±2%, 74±3%, and 63±3% (±1 SE). Survival rates and actual freedom from distal aortic reoperation was not significantly different between treatment methods in the entire patient cohort nor in the matched patients in quintiles III–V. Treatment method was not associated with differences in early major complications, late survival, or distal aortic reoperation rates in the entire patient sample or in quintiles III–V. Conclusions Aortic repair with or without circulatory arrest was associated with comparable early complications, survival, and distal aortic reoperation rates in patients with acute type A aortic dissection. Despite the lack of concrete evidence favoring the use of PHCA, it does no harm, and most of our group uses PHCA regularly because of its practical technical advantages and theoretical potential merit.

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