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

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

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1677886 ◽

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.

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Effect of different types of cerebral perfusion for acute type A aortic dissection, unilateral versus bilateral

10.21203/rs.3.rs-22196/v2 ◽

2020 ◽

Author(s):

zhengqin liu ◽

Chen Wang ◽

Xiquan Zhang ◽

Shuming Wu ◽

changcun fang ◽

...

Keyword(s):

Aortic Dissection ◽

Lower Incidence ◽

Cerebral Perfusion ◽

Type A ◽

Neurological Complications ◽

Neurological Dysfunction ◽

Acute Type ◽

Type A Aortic Dissection ◽

Neurologic Dysfunction ◽

Ventilation Time

Abstract Background: Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used way for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research was aimed to investigate the clinical effects between u-ACP and b-ACP. Methods: 321 of 356 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP and 197 patients(61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. We also analyzed perioperative variables in order to find the potential associated factors for neurolocial dysfunction (ND). Results: For u-ACP group, 54 patients (43.5%) had postoperative neurological complications including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p=0.016), higher nasopharyngeal temperature (p≦0.000), shorter ventilation time (p=0.018) and lower incidence of hypoxia (p=0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR=1.20, P= 0.028), CPB duration (OR=3.21, P=0.002 ) and type of cerebral perfusion (OR=1.48, P=0.017) were strongly associated with postoperative ND. Conclusions: In our study, we found that b-ACP procedure had shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia and neurological dysfunction compared to u-ACP. Meanwhile, we discovered the incidence of ND was independently associated with there factors, including preoperative neurological dysfunction, CPB time and type of cerebral perfusion.

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

Annals of Palliative Medicine ◽

10.21037/apm-21-1428 ◽

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

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Effect of different types of cerebral perfusion for acute type A aortic dissection undergoing aortic arch procedure, unilateral versus bilateral

BMC Surgery ◽

10.1186/s12893-020-00957-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zhengqin Liu ◽

Chen Wang ◽

Xiquan Zhang ◽

Shuming Wu ◽

Changcun Fang ◽

...

Keyword(s):

Aortic Dissection ◽

Lower Incidence ◽

Cerebral Perfusion ◽

Type A ◽

Neurological Complications ◽

Neurological Dysfunction ◽

Acute Type ◽

Type A Aortic Dissection ◽

Neurologic Dysfunction ◽

Ventilation Time

Abstract Background Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research aimed to investigate the clinical effects of u-ACP and b-ACP. Methods 321 of 356 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP, and 197 patients (61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. Besides, we also analyzed perioperative variables to find the potential associated factors for neurological dysfunction (ND). Results For u-ACP group, 54 patients (43.5%) had postoperative neurological complications, including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications, including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p = 0.016), higher nasopharyngeal temperature (p≦0.000), shorter ventilation time (p = 0.018), and lower incidence of hypoxia (p = 0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR = 1.20, p = 0.028), CPB duration (OR = 3.21, p = 0.002), and type of cerebral perfusion (OR = 1.48, p = 0.017) were strongly associated with postoperative ND. Conclusions In our study, it was observed that b-ACP procedure exhibited shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia, and neurological dysfunction compared to u-ACP. Meanwhile, the incidence of ND was independently associated with three factors: preoperative neurological dysfunction, CPB time, and type of cerebral perfusion.

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Effect of different types of cerebral perfusion for acute type A aortic dissection, unilateral versus bilateral

10.21203/rs.3.rs-22196/v1 ◽

2020 ◽

Author(s):

zhengqin liu ◽

Chen Wang ◽

Xiquan Zhang ◽

Shuming Wu ◽

changcun fang ◽

...

Keyword(s):

Aortic Dissection ◽

Cerebral Perfusion ◽

Type A ◽

Neurological Complications ◽

Neurological Dysfunction ◽

Stepwise Logistic Regression ◽

Acute Type ◽

Clinical Effects ◽

Type A Aortic Dissection ◽

Neurologic Dysfunction

Abstract Background Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used way for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research was aimed to investigate the clinical effects between u-ACP and b-ACP. Methods 321 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP and 197 patients(61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. We also analyzed perioperative variables in order to find the potential associated factors for neurolocial dysfunction (ND). Results For u-ACP group, 54 patients (43.5%) had postoperative neurological complications including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p = 0.016), higher nasopharyngeal temperature (p ≦ 0.000), shorter awakening time (p = 0.030) and lower incidence of hypoxia (p = 0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR = 1.20, P = 0.028), CPB duration (OR = 3.21, P = 0.002 ) and type of cerebral perfusion (OR = 1.48, P = 0.017) were strongly associated with postoperative ND. Conclusions In our study, we found that b-ACP procedure had many advantages compared to u-ACP and we inferred that b-ACP may be more suitable for patients with type A AD undergoing total arch replacement.

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

10.22541/au.163251709.92473248/v1 ◽

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

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Construction and Application of a Model for Predicting the Risk of Delirium in Postoperative Patients With Type a Aortic Dissection

Frontiers in Surgery ◽

10.3389/fsurg.2021.772675 ◽

2021 ◽

Vol 8 ◽

Author(s):

Junfeng He ◽

Qing Ling ◽

Yuhong Chen

Keyword(s):

Acute Kidney Injury ◽

Cardiac Output ◽

Aortic Dissection ◽

Prediction Model ◽

Cardiovascular Surgery ◽

Kidney Injury ◽

Type A ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output ◽

Type A Aortic Dissection

Background: Postoperative delirium (POD), an alteration in a patient's consciousness pattern, can affect the treatment and prognosis of a disease.Objective: To construct a prediction model for delirium in patients with type A aortic dissection after surgery and to validate its effectiveness.Methods: A retrospective cohort design was used to study 438 patients undergoing surgical treatment for type A aortic dissection from April 2019 to June 2020 in tertiary care hospitals. POD (n = 78) and non-delirium groups (n = 360) were compared and analyzed for each index in the perioperative period. A prediction model was established using multifactorial logistic regression, and 30 patients' perioperative data were collected for model validation.Results: Eight predictors were included in this study: smoking, diabetes, previous cardiovascular surgery, ejection fraction (EF), time to aortic block, acute kidney injury, low cardiac output syndrome, and pulmonary complications. The area under the receiver operating characteristic (ROC) curve of the constructed prediction model was 0.98 ± 0.005, and the Youden index was 0.91. The validation results showed 97% sensitivity, 100% specificity, and 93% accuracy. The expression of the model was Z = Smoking assignment* – 2.807 – 6.009*Diabetes assignment – 2.994*Previous cardiovascular surgery assignment – 0.129*Ejection fraction assignment + 0.071*Brain perfusion time assignment – 2.583*Acute kidney injury assignment – 2.916*Low cardiac output syndrome assignment – 3.461*Pulmonary related complications assignment + 20.576.Conclusion: The construction of an effective prediction model for the risk of delirium in patients after type A aortic stratification can help identify patients at high risk of POD early. It also provides a reference for healthcare professionals in the prevention and care of these patients.

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Effect of different types of cerebral perfusion for acute type A aortic dissection undergoing aortic arch procedure, unilateral versus bilateral

10.21203/rs.3.rs-22196/v3 ◽

2020 ◽

Author(s):

Zhengqin Liu ◽

Chen Wang ◽

Xiquan Zhang ◽

Shuming Wu ◽

Changcun Fang ◽

...

Keyword(s):

Aortic Dissection ◽

Lower Incidence ◽

Cerebral Perfusion ◽

Type A ◽

Neurological Complications ◽

Neurological Dysfunction ◽

Acute Type ◽

Type A Aortic Dissection ◽

Neurologic Dysfunction ◽

Ventilation Time

Abstract Background: Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research aimed to investigate the clinical effects of u-ACP and b-ACP. Methods: 321 of 356 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP, and 197 patients (61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. Besides, we also analyzed perioperative variables to find the potential associated factors for neurological dysfunction (ND). Results: For u-ACP group, 54 patients (43.5%) had postoperative neurological complications, including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications, including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p=0.016), higher nasopharyngeal temperature (p≦0.000), shorter ventilation time (p=0.018), and lower incidence of hypoxia (p=0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR=1.20, P= 0.028), CPB duration (OR=3.21, P=0.002), and type of cerebral perfusion (OR=1.48, P=0.017) were strongly associated with postoperative ND. Conclusions: In our study, it was observed that b-ACP procedure exhibited shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia, and neurological dysfunction compared to u-ACP. Meanwhile, the incidence of ND was independently associated with three factors: preoperative neurological dysfunction, CPB time, and type of cerebral perfusion.

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

10.21203/rs.2.21214/v1 ◽

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.

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