scholarly journals Low postoperative blood platelet count may be a risk factor for mortality in patients with acute type A aortic dissection

2021 ◽  
Author(s):  
Guangyu Liu ◽  
Hongbai Wang ◽  
Qipeng Luo ◽  
Liang Cao ◽  
Lijing Yang ◽  
...  
Keyword(s):  
Platelet Count ◽  
Aortic Dissection ◽  
Postoperative Mortality ◽  
Type A ◽  
Blood Platelet ◽  
Acute Type ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Aortic Repair ◽  
Open Aortic Repair

Abstract Background Mortality and complications remain high after Acute Type A Aortic Dissection (ATAAD) open surgery, which is associated with coagulation dysfunction. Platelets play an important role in the process of coagulation. This study was to explore the relationship between postoperative platelet counts and postoperative mortality in patients with ATAAD after open aortic repair surgery.Methods Patients with ATAAD who underwent Total Arch Replacement and Frozen Elephant Trunk in Fuwai Hospital from 2011 to 2015 were selected in this study. The perioperative data were collected and sorted through the electronic clinical case system. Multivariate Logistic regression was used to analyze the risk factors for death within three years after surgery.Results A total of 495 patients were included in the analysis. After correction with the confounding factors, postoperative platelets count remained as an independent factor that was associated with lower mortality (OR = 0.918, 95%CI 0.853-0.988, P = 0.023).Conclusions The study indicated that decreased postoperative platelet count may lead to increased mortality, in patients with ATAAD underwent open aortic repair surgery.

scholarly journals Low postoperative blood platelet count may be a risk factor for 3-year mortality in patients with acute type A aortic dissection

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Guangyu Liu ◽  
Hongbai Wang ◽  
Qipeng Luo ◽  
Liang Cao ◽  
Lijing Yang ◽  
...  
Keyword(s):  
Platelet Count ◽  
Aortic Dissection ◽  
Type A ◽  
Blood Platelet ◽  
Acute Type ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Aortic Repair ◽  
Case System ◽  
Open Aortic Repair

Abstract Background Mortality and complications remain high after acute type A aortic dissection (ATAAD) open surgery and are associated with coagulation dysfunction. Platelets play an important role in the process of coagulation. This study explored the relationship between postoperative platelet counts and 3-year mortality after operation in patients with ATAAD undergoing open aortic repair surgery. Methods Patients with ATAAD who underwent Total Arch Replacement and Frozen Elephant Trunk in Fuwai Hospital from 2011 to 2015 were selected for this study. The perioperative data were collected and sorted through the electronic clinical case system. Multivariate Logistic regression was used to analyze the risk factors for death within three years after surgery. Results A total of 495 patients were included in the analysis. After correction for confounding factors, decreased postoperative platelet count remained an independent factor that was associated with lower mortality (OR = 0.918, 95% CI 0.853–0.988, P = 0.023). Conclusions The study indicated that decreased postoperative platelet count may lead to increased 3-year mortality, in patients with ATAAD who underwent open aortic repair surgery.

scholarly journals Endovascular Fenestration/Stenting First Followed by Delayed Open Aortic Repair for Acute Type A Aortic Dissection With Malperfusion Syndrome

Circulation ◽  
2018 ◽  
Vol 138 (19) ◽  
pp. 2091-2103 ◽  
Author(s):  
Bo Yang ◽  
Carlo Maria Rosati ◽  
Elizabeth L. Norton ◽  
Karen M. Kim ◽  
Minhaj S. Khaja ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aortic Repair ◽  
Open Aortic Repair ◽  
Malperfusion Syndrome

scholarly journals Alternative management of proximal aortic dissection: concept and application

2021 ◽  
Author(s):  
Xun Yuan ◽  
Andreas Mitsis ◽  
David Mozalbat ◽  
Christoph A. Nienaber
Keyword(s):  
Aortic Dissection ◽  
Case Reports ◽  
Type A ◽  
Ascending Aorta ◽  
Recent Experience ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aortic Repair ◽  
Small Series ◽  
Open Aortic Repair

AbstractOpen surgery remains the mainstay of treatment for acute type A aortic dissection and should be offered to most patients. However, there are elderly patients in which surgical treatment may be deemed extremely high risk or futile. Endovascular treatment approaches have been applied to a small number of these patients and data are limited to case reports and small series. The application of endovascular therapies to ascending aorta is currently limited by anatomical and technical challenges posed by the dynamic motion of the ascending aorta and the proximity of vital structures to intended landing zones (aortic valve, coronary arteries, and supra-aortic branches) and lack of specially designed endografts to address these issues. While thoracic endovascular aortic repair (TEVAR) has replaced open aortic repair for a suitable lesion in distal aortic dissection, some selected patients with type A aortic dissection at high surgical may be candidates. Hence, there is potential because, in proximal (Stanford type A) dissections, 10–30% of patients are not accepted for surgery, and 30–50% are technically amenable for TEVAR. Recent experience has shown that carefully selected patients with favorable anatomical characteristics may be subject to endovascular stent-graft treatment as a last resort with mixed results. Technical improvement is necessary to offer. satisfactory endovascular options in non-surgical candidates.

Surgical outcomes of total arch replacement with modified elephant trunk technique in type A aortic dissection: insights from single-center experience

2022 ◽  
pp. 021849232110701
Author(s):  
Jian Li ◽  
Yueyun Zhou ◽  
Wei Qin ◽  
Cunhua Su ◽  
Fuhua Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Total Arch Replacement ◽  
Hospital Death ◽  
Acute Type ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Visceral Malperfusion ◽  
Cerebral Malperfusion

Background Total arch replacement with modified elephant trunk technique plays an important role in treating acute type A aortic dissection in China. We aim to summarize the therapeutic effects of this procedure in our center over a 17-year period. Methods Consecutive patients treated at our hospital due to type A aortic dissection from January 2004 to January 2021 were studied. Relevant data of these patients undergoing total arch replacement with modified elephant trunk technique were collected and analyzed. Results A total of 589 patients were included with a mean age of 53.1 ± 12.2 years. The mean of cardiopulmonary bypass, cross-clamping, and selected cerebral perfusion time were 199.6 ± 41.9, 119.0 ± 27.2, and 25.1 ± 5.0 min, respectively. In-hospital death occurred in 46 patients. Multivariate analysis identified four significant risk factors for in-hospital mortality: preexisting renal hypoperfusion (OR 5.43; 95% CI 1.31 – 22.44; P = 0.020), cerebral malperfusion (OR 11.87; 95% CI 4.13 – 34.12; P < 0.001), visceral malperfusion (OR 4.27; 95% CI 1.01 – 18.14; P = 0.049), and cross-clamp time ≥ 130 min (OR 3.26; 95% CI 1.72 – 6.19; P < 0.001). The 5, 10, and 15 years survival rates were 86.4%, 82.6%, and 70.2%, respectively. Conclusions Total arch replacement with modified elephant trunk technique is an effective treatment for acute type A aortic dissection with satisfactory perioperative results. Patients with preexisting renal hypoperfusion, cerebral malperfusion, visceral malperfusion, and long cross-clamp time are at a higher risk of in-hospital death.

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