scholarly journals Induction of CD73 Prevents Death after Emergency Open Aortic Surgery for a Ruptured Abdominal Aortic Aneurysm – A Randomized, Double-blind, Placebo-controlled Study

2021 ◽  
Author(s):  
Harri Hakovirta ◽  
Juho Jalkanen ◽  
Eija Saimanen ◽  
Tiia Kukkonen ◽  
Pekka Romsi ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Neutralizing Antibodies ◽  
Open Surgery ◽  
Controlled Study ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Double Blind ◽  
Abdominal Aortic ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background: Mortality remains high after emergency open surgery for a ruptured abdominal aortic aneurysm (RAAA). The aim of the present study was to assess, if intravenous (IV) Interferon (IFN) beta-1a improve survival after surgery by up-regulating Cluster of differentiation (CD73). Methods: This is a multi-center phase II double-blind, 2:1 randomized, parallel group comparison of the efficacy and safety of IV IFN beta-1a vs. placebo for the prevention of death after open surgery for an infra-renal RAAA. All study patients presented a confirmed infra-renal RAAA, survived the primary emergency surgery and were treated with IFN beta-1a (10μg) or matching placebo for 6 days after surgery. Major exclusion criteria included irreversible hemorrhagic shock, chronic renal replacement therapy, diagnosed liver cirrhosis, severe congestive heart failure, advanced malignant disease, primary attempt of endovascular aortic repair (EVAR), and per-operative suprarenal clamping over 30 minutes. Main outcome measure was all-cause mortality at day 30 (D30) from initial emergency aortic reconstruction. Results: The study was pre-maturely stopped due to a reported drug-drug interaction and was left under-powered. Out of 40 randomized patients 38 were included in the outcome analyses (27 IFN beta-1a and 11 placebo). There was no statistically significant difference between treatment groups at baseline. However, from surgery more open-abdomen and intestinal ischemia was present in the IFN beta-1a arm. D30 all-cause mortality was 22.2% (6/27) in the IFN beta-1a arm and 18.2% (2/11) in the placebo arm (OR 1.30; 95% CI, 0.21 – 8.19). The most common adverse event relating to the IFN beta-1a was pyrexia (20.7% in the IFN beta-1a arm vs. 9.1% in the placebo arm). High level of serum CD73 associated with survival (P = 0.001) whereas the use of glucocorticoids and the presence of IFN beta neutralizing antibodies associated with a poor CD73 response and survival.Conclusions: Due to the size of the study and several confounding factors a benefit from IFN beta-1a could not be determined. Survival after open RAAA surgery associated strongly with up-regulation of serum CD73. The use of glucocorticoids and IFN beta neutralizing antibodies blocked the up regulation of CD73. Trial registration: ClinicalTrials.gov NCT03119701. Registered 19/04/2017 (retrospectively registered).

scholarly journals Induction of CD73 Prevents Death After Emergency Open Aortic Surgery for a Ruptured Abdominal Aortic Aneurysm – A Randomized, Double-Blind, Placebo-Controlled Study

2021 ◽  
Author(s):  
Harri Hakovirta ◽  
Juho Jalkanen ◽  
Eija Saimanen ◽  
Tiia Kukkonen ◽  
Pekka Romsi ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Open Surgery ◽  
Aortic Surgery ◽  
Common Adverse Event ◽  
Controlled Study ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Double Blind ◽  
Abdominal Aortic ◽  
All Cause Mortality

Abstract Background: Mortality remains high after emergency open surgery for a ruptured abdominal aortic aneurysm (RAAA). The aim of the present study was to assess, if intravenous (IV) Interferon (IFN) beta-1a improve survival after surgery by up-regulating Cluster of differentiation (CD73). Methods: This is a multi-center phase II double-blind, 2:1 randomized, parallel group comparison of the efficacy and safety of IV IFN beta-1a vs. placebo for the prevention of death after open surgery for an infra-renal RAAA. All study patients presented a confirmed infra-renal RAAA, survived the primary emergency surgery and were treated with IFN beta-1a (10μg) or matching placebo for 6 days after surgery. Major exclusion criteria included irreversible hemorrhagic shock, unconsciousness at arrival, chronic renal replacement therapy, diagnosed liver cirrhosis, severe congestive heart failure, advanced malignant disease, primary attempt of endovascular aortic repair (EVAR), and per-operative suprarenal clamping over 30 minutes. Main outcome measure was all-cause mortality at day 30 (D30) from initial emergency aortic reconstruction. Results: Out of 40 randomized patients 38 were included in the outcome analyses (27 active arm and 11 placebo). Treatment groups were comparable by baseline characteristics. D30 all-cause mortality was 22.2% (6/27) in the active arm and 18.2% (2/11) in the placebo arm (OR 1.30; 95% CI, 0.21 – 8.19). The most common adverse event relating to the IFN beta-1a was pyrexia (20.7% in the active arm vs. 9.1% in the placebo arm). High level of serum CD73 associated with survival (P = 0.001) whereas the use of glucocorticoids associated with a poor CD73 response and poor survival in the active arm (P = 0.002).Conclusions: IV IFN beta-1a was well tolerated. Survival after open RAAA surgery associated strongly with up-regulation of serum CD73, but the use of glucocorticoids blocked IFN beta-1a from up-regulating CD73. Trial registration: ClinicalTrials.gov NCT03119701Funding/Support: This study was sponsored by Faron Pharmaceuticals Ltd.

scholarly journals Mortality After Elective and Ruptured Abdominal Aortic Aneurysm Surgical Repair: 12-Year Single-Center Experience of Estonia

2017 ◽  
Vol 107 (2) ◽  
pp. 152-157 ◽  
Author(s):  
J. Lieberg ◽  
L.-L. Pruks ◽  
M. Kals ◽  
K. Paapstel ◽  
A. Aavik ◽  
...  
Keyword(s):  
Risk Factors ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Open Repair ◽  
Mortality Rates ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Abdominal Aortic ◽  
All Cause Mortality ◽  
Aneurysm Repair ◽  
Elective Abdominal Aortic Aneurysm

Background and Aims: Abdominal aortic aneurysm is a degenerative vascular pathology with high mortality due to its rupture, which is why timely treatment is crucial. The current single-center retrospective study was undertaken to analyze short- and long-term all-cause mortality after operative treatment of abdominal aortic aneurysm and to examine the factors that influence outcome. Material and Methods: The data of all abdominal aortic aneurysm patients treated with open repair or endovascular aneurysm repair in 2004–2015 were retrospectively retrieved from the clinical database of Tartu University Hospital. The primary endpoint was 30-day, 90-day, and 5-year all-cause mortality. The secondary endpoint was determination of the risk factors for mortality. Results and Conclusion: Elective abdominal aortic aneurysm repair was performed on 228 patients (mean age 71.8 years), of whom 178 (78%) were treated with open repair and 50 (22%) with endovascular aneurysm repair. A total of 48 patients with ruptured abdominal aortic aneurysm were treated with open repair (mean age 73.8 years) at the Department of Vascular Surgery, Tartu University Hospital, Estonia. Mean follow-up period was 4.2 ± 3.3 years. In patients with elective abdominal aortic aneurysm, 30-day, 90-day, and 5-year all-cause mortality rates were 0.9%, 2.6%, and 32%, respectively. In multivariate analysis, the main predictors for 5-year mortality were preoperative creatinine value and age (p < 0.05). In patients with ruptured abdominal aortic aneurysm, 30-day, 90-day, and 5-year all-cause mortality rates were 22.9%, 33.3%, and 55.1%, respectively. In multivariate analysis, the risk factors for 30-day mortality in ruptured abdominal aortic aneurysm were perioperative hemoglobin and lactate levels (p < 0.05). According to this study, the all-cause mortality rates of elective abdominal aortic aneurysm and ruptured abdominal aortic aneurysm at our hospital were comparable to those at other centers worldwide. Even though some variables were identified as potential predictors of survival, the mortality rates after ruptured abdominal aortic aneurysm remain high. Early diagnosis, timely treatment, and detection of the risk factors for abdominal aortic aneurysm progression would improve survival in patients with abdominal aortic aneurysm.

scholarly journals Treatment Strategies for Improving Surgical Outcomes of Ruptured Abdominal Aortic Aneurysm

2021 ◽  
Author(s):  
Yasumi Maze ◽  
Toshiya Tokui ◽  
Masahiko Murakami ◽  
Teruhisa Kawaguchi ◽  
Ryosai Inoue ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Hospital Mortality ◽  
Surgical Outcomes ◽  
Long Term Results ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Intestinal Necrosis ◽  
Abdominal Aortic ◽  
Significant Difference

Abstract PurposeWe examined the surgical outcomes at our hospital and considered strategies for improving surgical outcomes for ruptured abdominal aortic aneurysm.MethodsWe examined 95 surgical cases of ruptured abdominal aortic aneurysm performed from January 2009 to December 2020.We examined the preoperative characteristics hospital mortality, postoperative complications and long-term results. Results24 were dead in hospital (hospital mortality 25.2%). The majority of the causes of death were hemorrhage/DIC and intestinal necrosis. 10 cases required preoperative aortic clamp by thoracotomy or insertion of intra-aortic balloon occlusion and 8 of them died. 10 cases required open abdominal management and 5 of them died. Examining the long-term results of the open repair group and the EVAR group, there was no significant difference between the two groups. ConclusionsIn order to improve the surgical outcomes of ruptured abdominal aortic aneurysm, it is necessary to start surgery immediately in a situation where hemodynamics is stable. Whether to select open surgery or EVAR as the surgical method should be selected by each hospital so that it can be started immediately. In order to prevent postoperative intestinal necrosis, it is necessary to consider risk factors of acute compartment syndrome and actively introduce open abdominal management.

Sign in / Sign up

Export Citation Format

Share Document