scholarly journals Age-dependent differences in the prognostic relevance of body composition-related variables in type A aortic dissection patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zeng-Rong Luo ◽  
Xiao-Dong Chen ◽  
Liang-wan Chen
Keyword(s):  
Body Composition ◽  
Aortic Dissection ◽  
Body Mass ◽  
Age Groups ◽  
Type A ◽  
The Elderly ◽  
Young Group ◽  
Type A Aortic Dissection ◽  
Cumulative Mortality ◽  
Cox Proportional Hazard

Abstract Background The current research is allocated to appraise the association between the parameters of body composition and findings in type A aortic dissection (TAAD) cases in diverse age groups. Methods Data from consecutive TAAD patients undergoing implantation of modified triple-branched stent-graft from January 2017 and December 2019 were prospectively collected and analyzed. A regression model of Cox proportional hazard was employed to assess correlations among body composition-related variables (body mass index [BMI], lean body mass [LBM], body surface area [BSA], and LBM index) as well as cumulative mortality. Results Overall, 258 patients (53.9 ± 11.1 years old; 72.9% male) were separated into young (n = 110) and elderly (n = 148) age groups based upon whether they were younger or older than 50 years of age. Of these patients, 247 survivors were included in subsequent analyses over an average 26.8 ± 11.6 month follow-up duration. Multivariate analyses in the elderly group instead of young group indicated that increased BMI (p = 0.042), BMI ≤ 18.5 kg/m2 (p = 0.025), and lower LBM index values (p = 0.019) were significant predictors of increased total all-cause cumulative mortality. BMI was considerably positively correlated with estimated all-cause cumulative mortality in elderly but not young TAAD cases. Conclusion Briefly, these results suggest that BMI and LBM indices are only significant predictors of TAAD patient all-cause mortality in elderly patient cohorts, whereas they do not offer significant prognostic value for younger patients. As such, these age differences must be taken into consideration when conducting stratified risk assessments based upon TAAD patient body composition characteristics.

scholarly journals Age-Dependent Differences in the Prognostic Relevance of Body Composition-Related Variables in Type a Aortic Dissection Patients

2021 ◽  
Author(s):  
Zeng-Rong Luo ◽  
Xiao-Dong Chen ◽  
Liang-wan Chen
Keyword(s):  
Body Composition ◽  
Aortic Dissection ◽  
Body Mass ◽  
Age Groups ◽  
Type A ◽  
The Elderly ◽  
Young Group ◽  
Type A Aortic Dissection ◽  
Cumulative Mortality ◽  
Cox Proportional Hazard

Abstract Background: The current research is allocated to appraise the association between the parameters of body composition and findings in type A aortic dissection (TAAD) cases in diverse age groups. Methods: Data from consecutive TAAD patients undergoing implantation of modified triple-branched stent-graft from January 2017 and December 2019 were prospectively collected and analyzed. A regression model of Cox proportional hazard was employed to assess correlations among body composition-related variables (body mass index [BMI], lean body mass [LBM], body surface area [BSA], and LBM index) as well as cumulative mortality. Results: Overall, 258 patients (53.9±11.1 years old; 72.9% male) were separated into young (n=110) and elderly (n=148) age groups based upon whether they were younger or older than 50 years of age. Of these patients, 247 survivors were included in subsequent analyses over an average 26.8 ± 11.6 month follow-up duration. Multivariate analyses in the elderly group instead of young group indicated that increased BMI (p=0.042), BMI ≤ 18.5 kg/m2 (p=0.025), and lower LBM index values (p=0.019) were significant predictors of increased total all-cause cumulative mortality. BMI was considerably positively correlated with estimated all-cause cumulative mortality in elderly but not young TAAD cases. Conclusion: Briefly, these results suggest that BMI and LBM indices are only significant predictors of TAAD patient all-cause mortality in elderly patient cohorts, whereas they do not offer significant prognostic value for younger patients. As such, these age differences must be taken into consideration when conducting stratified risk assessments based upon TAAD patient body composition characteristics.

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

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yanxiang Liu ◽  
Bowen Zhang ◽  
Shenghua Liang ◽  
Yaojun Dun ◽  
Luchen Wang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Adverse Events ◽  
Aortic Dissection ◽  
Body Mass ◽  
Surgical Outcomes ◽  
Type A ◽  
Term Survival ◽  
Type A Aortic Dissection ◽  
Prolonged Ventilation ◽  
The Impact

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.

scholarly journals 293 * EARLY AND LATE OUTCOME AFTER SURGERY FOR ACUTE TYPE A AORTIC DISSECTION IN THE ELDERLY

2014 ◽  
Vol 19 (suppl 1) ◽  
pp. S88-S88
Author(s):  
P. G. Malvindi ◽  
A. Modi ◽  
S. Miskolczi ◽  
S. K. Ohri ◽  
C. W. Barlow ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
The Elderly ◽  
Acute Type ◽  
Late Outcome ◽  
Type A Aortic Dissection

scholarly journals Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era

2002 ◽  
Vol 40 (4) ◽  
pp. 685-692 ◽  
Author(s):  
Rajendra H. Mehta ◽  
Patrick T. O’Gara ◽  
Eduardo Bossone ◽  
Christoph A. Nienaber ◽  
Truls Myrmel ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Clinical Characteristics ◽  
Type A ◽  
The Elderly ◽  
Acute Type ◽  
Type A Aortic Dissection

scholarly journals Optimal Degree of Hypothermia in Total Arch Replacement for Type A Aortic Dissection

2021 ◽  
Vol 8 ◽  
Author(s):  
Jinlin Wu ◽  
Juntao Qiu ◽  
Zhongrong Fang ◽  
Qipeng Luo ◽  
Yao Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Odds Ratio ◽  
Type A ◽  
The Elderly ◽  
Total Arch Replacement ◽  
Sensitivity Analyses ◽  
Paradigm Change ◽  
Type A Aortic Dissection ◽  
Primary Endpoints ◽  
Significant Protective Effect

Background: We sought to investigate the best degree of hypothermic cardiac arrest (HCA) in type A aortic dissection (TAAD) with a cohort of 1,018 cases receiving total arch replacement from 2013 to 2018 in Fuwai Hospital.Method: The cohort was divided by DHCA (≤24°C, n = 580) vs. MHCA (&gt;24°C, n = 438), and interquartile range (Q1–Q4). Primary endpoints included mortality, stroke, paraplegia, and continuous renal replacement therapy (CRRT), which were summarized as composite major outcomes (CMO).Results: The Odds Ratio (OR) of CMO for MHCA was 0.7 (95% CI: 0.5–1.0, p = 0.06) (unadjusted) and 0.6 (95% CI: 0.4–1.0, p = 0.055) (adjusted). DHCA group tended to have a significantly longer CPB time (175.6 ± 45.6 vs. 166.8 ± 49.8 min, p = 0.003), longer hospital stay (16.0 ± 13.6 vs. 13.5 ± 6.8 days, p &lt; 0.001), and ICU stay [5.0 (3.9–6.6) vs. 3.8 (2.0–5.6) days]. A significantly greater blood loss was observed in DHCA group, with a greater requirement for RBC and platelet transfusion. Of note, MHCA showed a significant protective effect (60% risk reduction) for older patients (above 60 years) (OR 0.4; 95% CI: 0.2–0.8; p = 0.009). By quartering, Q1 had significantly higher mortality (10.9%) than Q4 (5.2%) (p = 0.035). For other comparisons, the gap was significantly widened in quartering between Q1 and Q4, i.e., the lower the temperature, the worse the outcomes, and vice versa. Propensity score matching and sensitivity analyses confirmed the above findings.Conclusions: A paradigm change from DHCA to MHCA may be encouraged in TAAD arch operation, especially for the elderly.

scholarly journals Treatment for Acute Type A Aortic Dissection in the Elderly

2003 ◽  
Vol 32 (4) ◽  
pp. 209-214
Author(s):  
Saeki Tsukamoto ◽  
Shoji Shindo ◽  
Masahiro Obana ◽  
Kenji Akiyama ◽  
Motomi Shiono ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
The Elderly ◽  
Acute Type ◽  
Type A Aortic Dissection

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

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.

scholarly journals Clinical Outcomes of Limited-repair Strategy and Conservative Approach for the Elderly With Acute Type A Aortic Dissection

2021 ◽  
Author(s):  
Yasumi Maze ◽  
Toshiya Tokui ◽  
Masahiko Murakami ◽  
Bun Nakamura ◽  
Ryosai Inoue ◽  
...  
Keyword(s):  
Survival Rate ◽  
Treatment Group ◽  
Aortic Dissection ◽  
Type A ◽  
The Elderly ◽  
Elderly Group ◽  
Acute Type ◽  
Conservative Approach ◽  
Type A Aortic Dissection ◽  
Hemiarch Replacement

Abstract BackgroundThere is controversy regarding surgical indication and surgical procedure of acute type A aortic dissection for the elderly. We examined surgical outcomes for the elderly.MethodsFrom January 2012 to December 2019, 174 patients underwent surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the elderly group (≧80 years old) and the non-elderly group (≦79 years old). Additionally, we compared the surgical treatment group with the conservative treatment group.ResultsThe primary entry was found in the ascending aorta in 51.6% of the elderly group and in 32.8% of the non-elderly group (p= 0.049). In the elderly group, ascending or hemiarch replacement was performed in all cases, while in the non-elderly group, ascending or hemiarch replacement was performed in 57.3% (p<0.001). The hospital mortality was similar in both groups. The 5-year survival rate was 48.4±10.3% in the elderly group and 86.7±2.9% in the non-elderly group (p<0.001). The rates of freedom from aortic event at 5 years was 86.9±8.7% in the elderly group and 86.5±3.9% in the non-elderly group (p=0.771). The 5-year survival rate of conservative treatment group was 19.2±8.0% in the elderly. There was no significant difference from the surgical treatment group (p=0.103).ConclusionsThe surgical approach may not always be the reasonable treatment of choice for the elderly because the significant survival merit was not achieved compared with the conservative approach.

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