Physical activities and surgical outcomes in elderly patients with acute type A aortic dissection

Objective: Although elderly patients undergoing surgery for acute type A aortic dissection (ATAAD) is increasing, their physical activities are not fully understood. We report the physical activities and surgical outcomes in the elderly patients who underwent ATAAD. Methods: From 2009 to 2019, 103 consecutive patients underwent surgery for ATAAD at our institution. Surgical outcomes along with pre- and postoperative physical activities in 52 elderly patients (≥70 years old) were compared with those in 51 younger patients (<70 years old). Postoperative walking difficulty was defined as taking ≥30 days to regain the ability to walk 200 m postoperatively or as the inability to walk at discharge. Results: It took longer for elderly patients to regain the ability to walk 100 or 200 m postoperatively. ROC analysis revealed the AUC of the duration for walking 200 m postoperatively as a prognostic indicator for late deaths was 0.878, with the highest accuracy at 30 days (sensitivity = 83.3%, specificity = 91.8%). Hospital mortality within 30 days was 3.8%, and 1-, 3-, and 5-years survival rates were 92%, 84.7%, 84.7%, respectively, for elderly patients, with no significant differences between groups. Cox proportional hazard analysis showed postoperative walking difficulty was an independent risk factor for late mortality in all cohorts (P = 0.017). Conclusions: Elderly patients undergoing surgical ATAAD repair showed acceptable surgical outcomes. However, they were more likely to decrease their physical activities postoperatively. Postoperative difficulty in walking was an independent risk factor for the late mortality in patients with ATAAD.

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Physical activities and surgical outcomes in elderly patients with acute type A aortic dissection

Journal of Cardiac Surgery ◽

10.1111/jocs.15617 ◽

2021 ◽

Author(s):

Yasushi Tashima ◽

Yurie Toyoshima ◽

Kota Chiba ◽

Noriyuki Nakamura ◽

Koichi Adachi ◽

...

Keyword(s):

Aortic Dissection ◽

Elderly Patients ◽

Surgical Outcomes ◽

Type A ◽

Physical Activities ◽

Acute Type ◽

Type A Aortic Dissection

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Surgical Outcomes of Acute Type A Aortic Dissection in Elderly Patients

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2014.01.045 ◽

2014 ◽

Vol 97 (5) ◽

pp. 1576-1581 ◽

Cited By ~ 12

Author(s):

Kazunori Komatsu ◽

Tamaki Takano ◽

Takamitsu Terasaki ◽

Yuko Wada ◽

Tatsuichiro Seto ◽

...

Keyword(s):

Aortic Dissection ◽

Elderly Patients ◽

Surgical Outcomes ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Is extended arch replacement for acute type a aortic dissection an additional risk factor for mortality?

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(03)00726-4 ◽

2003 ◽

Vol 76 (4) ◽

pp. 1209-1214 ◽

Cited By ~ 37

Author(s):

M.Erwin S.H Tan ◽

Karl M.E Dossche ◽

Wim J Morshuis ◽

Johannes C Kelder ◽

Frans G.J Waanders ◽

...

Keyword(s):

Risk Factor ◽

Aortic Dissection ◽

Type A ◽

Additional Risk Factor ◽

Acute Type ◽

Additional Risk ◽

Type A Aortic Dissection

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Metabolic Syndrome and Its Components Are Associated With Hypoxemia After Surgery for Acute Type A Aortic Dissection: an Observational Study

10.21203/rs.3.rs-900428/v1 ◽

2021 ◽

Author(s):

Like Zhang ◽

Lei Zhang ◽

Zengren Zhao ◽

Yun Liu ◽

Juzeng Wang ◽

...

Keyword(s):

Metabolic Syndrome ◽

Regression Analysis ◽

Risk Factor ◽

Aortic Dissection ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Receiver Operating

Abstract Background: The aim of this study was to explore whether or to what extent metabolic syndrome (METs) and its components were associated with hypoxemia in acute type A aortic dissection (ATAAD) patients after surgery.Methods: This study involved 271 inpatients who underwent surgery. Demographic and clinical data were collected. Subgroup analysis, mixed model regression analysis, and receiver operating characteristic (ROC) curve analysis were performed, and a scoring system was evaluated.Results: The 271 inpatients were assigned to the hypoxemia group (n = 48) or no hypoxemia group (n = 223) regardless of METs status. Compared to the no hypoxemia group, the hypoxemia group had a higher incidence of METs. Hypoxemia was present in 0%, 3.7%, 19.8%, 51.5%, 90.0% and 100% in the groups of individuals who met the diagnostic criteria of MetS 0, 1, 2, 3, 4 and 5 times, respectively. In the multivariable logistic regression analysis, BMI quartile was still a risk factor for hypoxemia after adjustment for other risk factors. After adjustment for potential confounding factors, METs was an independent risk factor for hypoxemia in several models. After assigning a score for each METs component present, the AUCs were 0.852 (95% CI: 0.789–0.914) in all patients, 0.728 (95% CI: 0.573–0.882) in patients with METs and 0.744 (95% CI: 0.636–0.853) in patients without METs according to receiver operating characteristic analysis.Conclusions: METs, especially body mass index, confers a greater risk of hypoxemia in ATAAD after surgery.

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Supracoronary aortic replacement for acute type A aortic dissection: A risk-factor for developing a late aortic root aneurysm?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332431 ◽

2013 ◽

Vol 61 (S 01) ◽

Author(s):

J Brickwedel ◽

M Coutandin ◽

AM Bernhardt ◽

H Reichenspurner ◽

C Detter

Keyword(s):

Risk Factor ◽

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Aortic Root Aneurysm ◽

Aortic Replacement

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Skeletal muscle quality affects patient outcomes in acute type A aortic dissection

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa008 ◽

2020 ◽

Vol 30 (5) ◽

pp. 739-745

Author(s):

Toshihito Gomibuchi ◽

Tatsuichiro Seto ◽

Shuji Chino ◽

Toru Mikoshiba ◽

Masaki Komatsu ◽

...

Keyword(s):

Skeletal Muscle ◽

Risk Factor ◽

Aortic Dissection ◽

Muscle Mass ◽

Daily Living ◽

Psoas Muscle ◽

Muscle Quality ◽

Acute Type ◽

Type A Aortic Dissection ◽

The Mean

Abstract OBJECTIVES Although skeletal muscle quantity is linked to surgical outcomes, quality remains unexamined. In this study, we evaluated whether skeletal muscle quality and quantity could predict surgical outcomes in acute type A aortic dissection (ATAAD). METHODS Skeletal muscle quality and quantity were evaluated using computed tomography (CT) values and the psoas muscle mass index, respectively. From May 2004 to December 2017, 324 ATAAD patients underwent aortic replacement after CT scans and psoas muscle mass index measurements. Patients were grouped into intramuscular fat (IMF; n = 55) and non-IMF (n = 269) deposition groups. RESULTS The mean ages of the patients were 72.3 ± 9.7 and 66.8 ± 12.1 years (P = 0.002), and hospital mortality rates were 3.6% (2/55) and 7.4% (20/269; P = 0.393) for IMF and non-IMF deposition groups, respectively. IMF deposition was a risk factor for a deterioration in activities of daily living at discharge by multivariable analysis [odds ratio 0.33, 95% confidence interval (CI) 0.16–0.69; P = 0.003]. The mean follow-up was 43.9 ± 36.8 months. The 5-year survival was significantly worse for the IMF deposition group (IMF 73.8% vs non-IMF 88.2%; P = 0.010). The multivariable Cox proportional hazard analysis showed that IMF deposition significantly predicted poor survival (hazard ratio 3.26, 95% CI 1.47–7.24; P = 0.004), unlike psoas muscle mass index and age. CONCLUSIONS Skeletal muscle quality, defined by IMF deposition, was an independent predictor of overall survival and postoperative activities of daily living dependence risk in patients undergoing surgery for ATAAD. Thus, IMF deposition may be an additional risk factor for estimating late outcomes of ATAAD surgery.

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Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection

Journal of Thoracic and Cardiovascular Surgery ◽

10.1067/mtc.2002.119702 ◽

2002 ◽

Vol 123 (2) ◽

pp. 318-325 ◽

Cited By ~ 115

Author(s):

Matthias Kirsch ◽

Céline Soustelle ◽

Rémi Houël ◽

Marie Line Hillion ◽

Daniel Loisance

Keyword(s):

Factor Analysis ◽

Risk Factor ◽

Aortic Dissection ◽

Type A ◽

Risk Factor Analysis ◽

Acute Type ◽

Type A Aortic Dissection

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Clinical Outcomes of Limited Repair And Conservative Approaches In Older Patients With Acute Type A Aortic Dissection

10.21203/rs.3.rs-772479/v1 ◽

2021 ◽

Author(s):

Yasumi Maze ◽

Toshiya Tokui ◽

Masahiko Murakami ◽

Bun Nakamura ◽

Ryosai Inoue ◽

...

Keyword(s):

Conservative Treatment ◽

Aortic Dissection ◽

Hospital Mortality ◽

Surgical Outcomes ◽

Older Patients ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Treatment Groups ◽

Significant Difference

Abstract Background: Surgical indication and the selection of surgical procedures for acute type A aortic dissection in older patients are controversial; therefore, we examined the surgical outcomes in older patients.Methods: From January 2012 through December 2019, 174 patients surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the older (≥80 years old) and below-80 (≤79 years old) age groups. Additionally, we compared the surgical and conservative treatment groups.Results: The primary entry was found in the ascending aorta in 51.6% and 32.8% of the older and below-80 groups, respectively (p = 0.049). Ascending or hemiarch replacement was performed in all older group cases and 57.3% of the below-80 group cases (total arch replacement was performed in the remaining 42.7%; p < 0.001). Hospital mortality rates were similar in both groups. The significant risk factors for hospital mortality were age, preoperative intubation, cardiopulmonary bypass time, and postoperative stroke. The 5-year survival rates were 48.4% ± 10.3% (older group) and 86.7% ± 2.9% (below-80 group; p < 0.001). The rates of freedom from aortic events at 5 years were 86.9% ± 8.7% (older group) and 86.5% ± 3.9% (below-80 group; p = 0.771). The 5-year survival rate of the conservative treatment group was 19.2% ± 8.0% in the older group. There was no significant difference between the surgical treatment groups (p = 0.103).Conclusion: The surgical approach did not achieve a significant survival advantage over conservative treatment and may not always be the reasonable treatment of choice for older patients.

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