scholarly journals Marijuana: An Underappreciated Risk Factor for Acute Type A Aortic Dissection?

2021 ◽  
Vol 24 (1) ◽  
pp. E137-E142
Author(s):  
Iam Claire Sarmiento ◽  
Ashley Giammarino ◽  
S Jacob Scheinerman ◽  
Antonio Guirola ◽  
Alan Hartman ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Risk Factor ◽  
Aortic Dissection ◽  
Type A ◽  
The United States ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Urine Toxicology ◽  
Toxicology Screening

Background: Stimulants such as cocaine and amphetamines are well-established risk factors for acute aortic dissection. Despite the fact that marijuana is the most commonly used illicit drug in the United States, its relationship to acute aortic syndromes has not been well studied. Methods: A comprehensive retrospective review was undertaken of all consecutive patients who presented with acute Stanford type A aortic dissection from January 2017 to December 2019. Of 152 patients identified, 51 (33.6%) underwent comprehensive urine toxicology screening at clinical presentation. The characteristics and outcomes of the patients with urine results positive for tetrahydrocannabinol (THC) (n = 9, 17.6%) were compared with the 42 patients who had no evidence of recent marijuana consumption. Results: Of the 51 dissection patients who underwent broad-spectrum urine toxicology screening upon presentation, 9 (17.6%) returned positive results for THC, a proportion higher than would be expected for the general population. All THC patients were male; 3 concurrently tested positive for cocaine, and 3 others had evidence of recent amphetamine use. The THC patients were significantly younger than the non-THC patients (mean ± standard deviation age 48 ± 11.3 versus 61.4 ± 12.3 years, respectively, P = .004). A greater proportion of the THC cohort had a known diagnosis of aortic aneurysm before the dissection (44.4% versus 4.8%, P = .006). All patients underwent expeditious surgical repair. Thirty-day mortality for the entire cohort of 51 patients was 19.6% (10 deaths); for the THC group, it was 11.1% (1 death). There was no difference in the incidence of major postoperative complications between the 2 groups. Conclusion: Marijuana is the third most commonly used substance in the United States, after alcohol and tobacco. Although marijuana use is understudied, our results suggest that marijuana may be a contributing risk factor for acute type A aortic dissection, particularly in patients with other predisposing risk factors. Given the recent national trend to legalize marijuana, with the concomitant potential for exponential increases in its consumption, we suggest that the diagnosis of aortic dissection be considered earlier in any younger patient who presents with suggestive symptoms, especially if there is a history of recent marijuana use.

scholarly journals Risk factors for hypoxemia following surgical repair of acute type A aortic dissection

2016 ◽  
pp. ivw272
Author(s):  
Nan Liu ◽  
Wei Zhang ◽  
Weiguo Ma ◽  
Wei Shang ◽  
Jun Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Surgical Repair ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

scholarly journals Preoperative hematological parameters are inadequate for predicting mortality in Stanford Type A aortic dissection repair

2021 ◽  
Vol 5 (2) ◽  
pp. 01-06
Author(s):  
Selim Durmaz ◽  
◽  
Ömer Faruk Rahman ◽  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Roc Analysis ◽  
Circulatory Arrest ◽  
Hematological Parameters ◽  
Demographic Data ◽  
Type A ◽  
Hospital Death ◽  
Acute Type ◽  
Type A Aortic Dissection

Background: Mortality in acute Type A aortic dissection is still high and unpredictable. We aimed to investigate the validity of preoperative hematological markers and possible risk factors in predicting in-hospital mortality in patients operated with deep hypothermic circulatory arrest method. Methods: 78 consecutive patients who were admitted to the emergency service and operated on were retrospectively analyzed. Risk factors for in-hospital death were investigated to develop a predictive model. Results: There was no difference between patients in terms of the were demographic data of the patients. In the mortality group, only preoperative creatinine levels were found to be higher (p < 0.05). Factors affecting mortality were found as total circulatory arrest (TCA) and cross-clamp (X-clamp) times when intraoperative data were examined (p < 0.05). ROC analysis was performed to determine the power to predict mortality and to determine the cut-off point. In ROC analysis to predict mortality, X-Clamp time > 71 minutes, 68.2% sensitivity and 66.1% specificity, TCA > 44.5 minutes, 72.7% sensitivity and 73.2% specificity were found. In the mortality group, these values were found to be significantly higher than those who were discharged. Conclusion: In the surgical treatment of Type A aortic dissection under deep hypothermia, hematologic biomarkers may be insufficient in estimating the risk for mortality. Keywords: Acute; aortic dissection; biomarker; mortality

scholarly journals Interfacility Transfer of Medicare Beneficiaries With Acute Type A Aortic Dissection and Regionalization of Care in the United States

Circulation ◽  
2019 ◽  
Vol 140 (15) ◽  
pp. 1239-1250 ◽  
Author(s):  
Andrew B. Goldstone ◽  
Peter Chiu ◽  
Michael Baiocchi ◽  
Bharathi Lingala ◽  
Justin Lee ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Operative Mortality ◽  
Type A ◽  
High Volume ◽  
The United States ◽  
Acute Type ◽  
Medicare Beneficiaries ◽  
Type A Aortic Dissection ◽  
High Volume Hospital

Background: The feasibility and effectiveness of delaying surgery to transfer patients with acute type A aortic dissection—a catastrophic disease that requires prompt intervention—to higher-volume aortic surgery hospitals is unknown. We investigated the hypothesis that regionalizing care at high-volume hospitals for acute type A aortic dissections will lower mortality. We further decomposed this hypothesis into subparts, investigating the isolated effect of transfer and the isolated effect of receiving care at a high-volume versus a low-volume facility. Methods: We compared the operative mortality and long-term survival between 16 886 Medicare beneficiaries diagnosed with an acute type A aortic dissection between 1999 and 2014 who (1) were transferred versus not transferred, (2) underwent surgery at high-volume versus low-volume hospitals, and (3) were rerouted versus not rerouted to a high-volume hospital for treatment. We used a preference-based instrumental variable design to address unmeasured confounding and matching to separate the effect of transfer from volume. Results: Between 1999 and 2014, 40.5% of patients with an acute type A aortic dissection were transferred, and 51.9% received surgery at a high-volume hospital. Interfacility transfer was not associated with a change in operative mortality (risk difference, –0.69%; 95% CI, –2.7% to 1.35%) or long-term mortality. Despite delaying surgery, a regionalization policy that transfers patients to high-volume hospitals was associated with a 7.2% (95% CI, 4.1%–10.3%) absolute risk reduction in operative mortality; this association persisted in the long term (hazard ratio, 0.81; 95% CI, 0.75–0.87). The median distance needed to reroute each patient to a high-volume hospital was 50.1 miles (interquartile range, 12.4–105.4 miles). Conclusions: Operative and long-term mortality were substantially reduced in patients with acute type A aortic dissection who were rerouted to high-volume hospitals. Policy makers should evaluate the feasibility and benefits of regionalizing the surgical treatment of acute type A aortic dissection in the United States.

scholarly journals Peri-operative risk factors for in-hospital mortality in acute type A aortic dissection

2019 ◽  
Vol 11 (9) ◽  
pp. 3887-3895
Author(s):  
Miaoyun Wen ◽  
Yongli Han ◽  
Jingkun Ye ◽  
Gengxin Cai ◽  
Wenxin Zeng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Type A ◽  
Operative Risk ◽  
Acute Type ◽  
Type A Aortic Dissection

Influence of Luminal Communication on Aortic Enlargement after Hemiarch Replacement for Acute Type A Aortic Dissection

2019 ◽  
Vol 68 (04) ◽  
pp. 294-300
Author(s):  
Gaku Uchino ◽  
Takeshi Yoshida ◽  
Bunpachi Kakii ◽  
Masato Furui
Keyword(s):  
Risk Factors ◽  
Growth Rate ◽  
Aortic Dissection ◽  
Univariate Analysis ◽  
Type A ◽  
Aortic Diameter ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Independent Risk Factors ◽  
Hemiarch Replacement

Background Aortic enlargement after hemiarch replacement (HAR) for acute type A aortic dissection (AAAD) is a serious problem. We reviewed our experience and analyzed the risk factors for aortic enlargement. Methods During April 2005 to December 2017, 364 patients underwent HAR for AAAD. Seventy-three patients fulfilled the inclusion criteria. We analyzed the change in aortic diameter, aortic growth rate, and major adverse aortic events (MAAEs) and their association with luminal communication of the aortic arch. Results Anastomotic communication, supra-aortic communication (SAC), and distal aortic communication were found in 34 (46.6%), 28 (38.4%), and 20 (27.4%) patients, respectively. The aortic growth rate was high because of the presence of SAC, distal aortic communication, and the number of coexisting aortic communication. Univariate analysis showed that the presence of SAC and an initial aortic diameter > 35 mm at 20 mm distal to the left subclavian artery and at the pulmonary artery bifurcation (PAB) were risk factors for MAAEs. Multivariate analysis showed that SAC and an initial aortic diameter > 35 mm at the PAB were independent risk factors for MAAEs. Conclusion SAC, distal aortic communication, and the number of coexisting aortic communication are significant risk factors for aortic enlargement after HAR for AAAD. SAC and an initial aortic diameter > 35 mm at the PAB are independent risk factors for MAAEs after this procedure.

Surgical outcome of acute type A aortic dissection: analysis of risk factors

2002 ◽  
Vol 74 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Teruhisa Kazui ◽  
Naoki Washiyama ◽  
Abul Hasan Muhammad Bashar ◽  
Hitoshi Terada ◽  
Takayasu Suzuki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Surgical Outcome ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

Perioperative risk factors for mortality in patients with acute type a aortic dissection

2002 ◽  
Vol 74 (6) ◽  
pp. 2034-2039 ◽  
Author(s):  
Anil Z Apaydin ◽  
Suat Buket ◽  
Hakan Posacioglu ◽  
Fatih Islamoglu ◽  
Tanzer Calkavur ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Type A ◽  
Perioperative Risk ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Perioperative Risk Factors
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