scholarly journals Characteristics and outcomes of Stanford type A aortic dissection patients with post-operation severe hyperbilirubinemia: a retrospective cohort study

2020 ◽  
Author(s):  
Xiaolan Chen ◽  
Ming Bai ◽  
Lijuan Zhao ◽  
Yangping Li ◽  
Yan Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Type A ◽  
Older Age ◽  
Type A Aortic Dissection ◽  
Post Operation ◽  
Independent Risk Factors ◽  
Severe Hyperbilirubinemia

Abstract Objective Hyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the report on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients is limited. Therefore, the purpose of our present study is to assess the characteristics and outcomes of AAD patients with post-operation severe hyperbilirubinemia.Methods Patients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints.Results Of the 2210 screened patients, 271 (12.3%) were included. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. In-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9%, 33.9%, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age ( P < 0.033), AKI stage 3 ( P < 0.001), the total amount of blood transfusion after surgery ( P = 0.019), mean arterial pressure (MAP) in the first postoperative day ( P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) after surgery ( P = 0.02), and the peak total bilirubin (TB) concentration ( P = 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 μmol/l. Older age, high preoperative serum creatinine (SCr) concentration, and prolonged cardiopulmonary bypass (CPB) time were identified as the independent risk factors of AKI. High preoperative SCr concentration was identified as the only independent risk factor of the requirement of CRRT.Conclusions Post-operation severe hyperbilirubinemia is a common clinical presentation in AAD surgery patients. Post-operation severe hyperbilirubinemia AAD patients with older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB had higher risk of in-hospital mortality.

scholarly journals Characteristics and outcomes of Stanford type A aortic dissection patients with post-operation severe hyperbilirubinemia: a retrospective cohort study

2020 ◽  
Author(s):  
Xiaolan Chen ◽  
Ming Bai ◽  
Lijuan Zhao ◽  
Yangping Li ◽  
Yan Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Type A ◽  
Type A Aortic Dissection ◽  
Post Operation ◽  
Severe Hyperbilirubinemia

Abstract Background Hyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the report on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients is limited. Methods Patients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints. Results 271 (12.3%) patients were included. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. In-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9%, 33.9%, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age (P < 0.033), AKI stage 3 (P < 0.001), the amount of blood transfusion after surgery (P = 0.019), mean arterial pressure (MAP) in the first postoperative day (P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) (P = 0.02), and the peak total bilirubin (TB) concentration (P = 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 µmol/l. Survival analysis showed significantly decreased survival for patients who developed severe, rather than mild, hyperbilirubinemia. Conclusions Post-operation severe hyperbilirubinemia is a common clinical presentation in AAD surgery patients. Post-operation severe hyperbilirubinemia AAD patients with older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB had higher risk of in-hospital mortality.

scholarly journals Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study

2020 ◽  
Author(s):  
Xiaolan Chen ◽  
Ming Bai ◽  
Lijuan Zhao ◽  
Yangping Li ◽  
Yan Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Multivariate Logistic Regression Analysis ◽  
Type A ◽  
Term Survival ◽  
Type A Aortic Dissection ◽  
Post Operation

Abstract Background: Hyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the reports on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients were limited. Methods: Patients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints. Results: After screening, 271 patients were included in our present study. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. The in-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9%, 33.9%, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age (P < 0.033), AKI stage 3 (P < 0.001), the amount of blood transfusion after surgery (P = 0.019), mean arterial pressure (MAP) in the first postoperative day (P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) (P = 0.02), and the peak total bilirubin (TB) concentration (P = 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 μmol/L. Patients with post-operation TB ≥ 121 μmol/L was associated with worse long-term survival as well. Conclusions: Severe post-operation hyperbilirubinemia is a common clinical situation in patients had AAD repair. In AAD patients with severe post-operation hyperbilirubinemia, older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB lead to increase in-hospital mortality.

scholarly journals Incidence- and In-hospital Mortality-Related Risk Factors of Acute Kidney Injury Requiring Continuous Renal Replacement Therapy in Patients Undergoing Surgery for Acute Type a Aortic Dissection

2021 ◽  
Vol 8 ◽  
Author(s):  
Xuelian Chen ◽  
Jiaojiao Zhou ◽  
Miao Fang ◽  
Jia Yang ◽  
Xin Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Replacement Therapy ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Independent Risk Factors

Background: Few studies on the risk factors for postoperative continuous renal replacement therapy (CRRT) in a homogeneous population of patients with acute type A aortic dissection (AAAD). This retrospective analysis aimed to investigate the risk factors for CRRT and in-hospital mortality in the patients undergoing AAAD surgery and to discuss the perioperative comorbidities and short-term outcomes.Methods: The study collected electronic medical records and laboratory data from 432 patients undergoing surgery for AAAD between March 2009 and June 2021. All the patients were divided into CRRT and non-CRRT groups; those in the CRRT group were divided into the survivor and non-survivor groups. The univariable and multivariable analyses were used to identify the independent risk factors for CRRT and in-hospital mortality.Results: The proportion of requiring CRRT and in-hospital mortality in the patients with CRRT was 14.6 and 46.0%, respectively. Baseline serum creatinine (SCr) [odds ratio (OR), 1.006], cystatin C (OR, 1.438), lung infection (OR, 2.292), second thoracotomy (OR, 5.185), diabetes mellitus (OR, 6.868), AKI stage 2–3 (OR, 22.901) were the independent risk factors for receiving CRRT. In-hospital mortality in the CRRT group (46%) was 4.6 times higher than in the non-CRRT group (10%). In the non-survivor (n = 29) and survivor (n = 34) groups, New York Heart Association (NYHA) class III-IV (OR, 10.272, P = 0.019), lactic acidosis (OR, 10.224, P = 0.019) were the independent risk factors for in-hospital mortality in patients receiving CRRT.Conclusion: There was a high rate of CRRT requirement and high in-hospital mortality after AAAD surgery. The risk factors for CRRT and in-hospital mortality in the patients undergoing AAAD surgery were determined to help identify the high-risk patients and make appropriate clinical decisions. Further randomized controlled studies are urgently needed to establish the risk factors for CRRT and in-hospital mortality.

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.

scholarly journals Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Jing Zhou ◽  
Jieyi Pan ◽  
Yuheng Yu ◽  
Weixiang Huang ◽  
Yan Lai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Independent Risk Factors

scholarly journals Perioperative risk factors predict one-year mortality in patients with acute type-A aortic dissection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yanwei Yang ◽  
Jiayi Xue ◽  
Huixian Li ◽  
Jiaqi Tong ◽  
Mu Jin
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Aortic Dissection ◽  
Serum Creatinine ◽  
Type A ◽  
Perioperative Risk ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Perioperative Risk Factors ◽  
One Year

Abstract Objective The goal of this study was to analyze perioperative risk factors to predict one- year mortality after operation for acute type A aortic dissection (AAD). Methods A total of 121 consecutive patients undergoing Stanford type A AAD surgery in Beijing Anzhen Hospital were enrolled. Preoperative clinical and laboratory data from patients were collected. Results Multivariable Cox regression analysis showed that significant factors associated with increased one-year mortality were elder age (year) (hazard ratio (HR) 1.0985; 95% confidence interval (CI) 1.0334–1.1677), intraoperative blood transfusion ≥2000 mL (HR 8.8081; 95% CI 2.3319–33.2709), a higher level of serum creatinine (μmol/L) at postoperative one day (HR 1.0122; 95% CI 1.0035–1.0190) and oxygenation index (OI) < 200 (mmHg) at the end of surgery (HR 5.7575; 95% CI 1.1695–28.3458). Conclusion In this study, perioperative risk factors to predict one-year prognosis are age, intraoperative blood transfusion ≥2000 mL, postoperative OI < 200 mmHg and level of postoperative serum creatinine. The results aid in the comprehension of surgical outcomes and assist in the optimization of treatment strategies for those with perioperative risk factors to decrease one-year mortality.

scholarly journals Risk factors of hepatic dysfunction after total arch repair of acute type A aortic dissection with modified triple-branched stent graft implantation

2021 ◽  
Author(s):  
Linfeng Xie ◽  
Debin Jiang ◽  
zhihuang qiu ◽  
Qingsong Wu ◽  
Jun Xiao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Stent Graft ◽  
Hepatic Dysfunction ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Independent Risk Factors ◽  
Stent Graft Implantation ◽  
Graft Implantation

Abstract Background: Hepatic dysfunction (HD) is a serious complication after cardiovascular surgery. However, risk factors of developing hepatic dysfunction after acute type A aortic dissection (AAAD) are largely unclear. Methods: The clinical data of 227 patients with AAAD repaired by modified triple-branched stent graft implantation from January 2018 to January 2020 were collected retrospectively, including preoperative , surgical and postoperative information. Logistics regression was used to explore the potential risk factors of HD. Results: In the early stage after operation, a total of 57 patients were complicated with HD, accounting for 25.11%. The hospital mortality rate in these patients with HD was 19.30%, while the rate in patients without HD was only 6.5%. We found that preoperative body mass index (BMI)>30kg/㎡(OR: 7.054, 95%CI: 1.798-27.678, P=0.005), preoperative renal insufficiency(OR:7.575,95%CI:2.923-19.629, P=0.000),preoperative moderate/severe pericardial effusion(OR: 16.409, 95%CI: 2.81-93.444, P=0.002) and cardiopulmonary bypass time>180min (OR: 7.190, 95%CI: 3.113-16.608, P＝0.000) were independent risk factors for HD after AAAD repaired by modified triple-branched stent graft implantation. Conclusions: Preoperative BMI>30kg/㎡, preoperative renal insufficiency, preoperative moderate/severe pericardial effusion and cardiopulmonary bypass time>180min are independent risk factors for HD after total arch repair with modified triple-branched stent graft implantation in AAAD patients. And the occurrence of HD after operation would prolong the time of mechanical ventilation and the hospitalization time of ICU, and significantly increase the in-hospital mortality of patients. Keywords: risk factors,acute type A aortic dissection,hepatic dysfunction, modified triple-branched stent graft implantation, total arch repair

scholarly journals Analysis of Risk Factors of Postoperative Neurological Complications in Patients with Stanford Type A Aortic Dissection Undergoing Sun’s Procedure

2021 ◽  
Vol 5 (6) ◽  
pp. 93-101
Author(s):  
Hui Zhang ◽  
Ruicheng Zhang ◽  
Hua Zhang ◽  
Feng Li ◽  
Jianming Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Type A ◽  
Neurological Complications ◽  
Neurological Dysfunction ◽  
Multivariate Logistic Regression ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Type A Aortic Dissection ◽  
Independent Risk Factors

Objective: This study analyzed the risk factors of neurological complications in patients with Stanford type A aortic dissection after Sun’s procedure in a single-center with the purpose of improving the effects. Methods: From January 2019 to December 2020, the clinical data of 480 patients with Stanford type A aortic dissection, who were treated by Sun’s procedure in our center were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the risk factors of postoperative neurological complications. According to whether there were neurological complications after surgery, they were divided into two groups: the group with complications (n=70) and the group without complications (n=410). The clinical data of the two groups were collected and compared. Results: There were 70 cases of patients with postoperative neurological complications in 480 cases. The incidence rates of temporary neurological dysfunction (TND) and permanent neurological dysfunction (PND) was 11.5% (55/480) and 3.1% (15/480), respectively. Univariate analysis showed that the age (? 70 years), stroke history, femoral artery intubation and cardiopulmonary bypass (CPB) time were associated with postoperative PND (p < 0.05). Renal dysfunction, emergency surgery, postoperative hypernatremia, postoperative hyperglycemia, postoperative hypoxemia, postoperative low cardiac output syndrome, and assisted time of suction influenced the occurrence of postoperative TND (p < 0.05). Multivariate logistic regression analysis showed that age (? 70 years), stroke history, femoral artery intubation and CPB time were independent risk factors for PND. Renal dysfunction, emergency surgery, postoperative hypernatremia, postoperative hyperglycemia, postoperative hypoxemia, postoperative low cardiac output syndrome, and aspiration time were independent risk factors for TND. Compared with the two groups, the hospitalization time and ICU time of the patients in the neurological complications group were significantly prolonged, and the mortality rate was significantly increased (p < 0.05). Conclusion: There are many risk factors for neurological complications in patients with Stanford type A aortic dissection after surgery. With the improvement of surgical techniques, optimization of cerebral perfusion, and interventions for risk factors, Sun’s procedure remains the preferred treatment for Stanford type A aortic dissection.

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