Comparison of Risk Scores for the Prediction of Outcomes after Surgery for Acute Type A Aortic Dissection

2019 ◽  
pp. 1-4
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Operative Mortality ◽  
External Validation ◽  
Type A ◽  
Risk Scores ◽  
Acute Type ◽  
Risk Models ◽  
Type A Aortic Dissection ◽  
Malperfusion Syndrome

We compared the performance of four existing risk models and a newly developed risk score for type A acute aortic dissection surgery. In 327 consecutives with type A aortic dissection surgery patients during 2003/03-2017/03 at our centre, operative mortality occurred in 65 (19.9%). Independent predictors of operative mortality were critical pre-operative state and malperfusion syndrome, and a novel additive “CritMal” Score was constructed from this. C-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.60 (0.52-0.67), EuroSCORE II 0.64 (0.57-0.72), Rampoldi 0.68 (0.59-0.76), Leontyev 0.56 (0.48-0.64), and CritMal 0.72 (0.64-0.80) respectively. This is the first study externally assessing surgical scores for aortic dissection surgery, with modest accuracy for all and moderate for CritMal. There is room for improvement of these risk models, and further refinements and external validation are warranted for clinical application.

Operative Strategies and Outcomes in Type a Aortic Dissection after the Enactment of a Multidisciplinary Aortic Surgery Team

2015 ◽  
Vol 10 (6) ◽  
pp. 410-415 ◽  
Author(s):  
Jared P. Beller ◽  
Joshua A. Scheinerman ◽  
Leora B. Balsam ◽  
Patricia Ursomanno ◽  
Abe DeAnda
Keyword(s):  
Aortic Dissection ◽  
Patient Outcomes ◽  
Acute Aortic Dissection ◽  
Operative Mortality ◽  
Aortic Surgery ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
International Registry ◽  
Operative Strategies

Objective The purpose of this study was to compare operative strategies and patient outcomes in acute type A aortic dissection (ATAAD) repairs before and after the implementation of a multi-disciplinary aortic surgery team. Methods Between May 2005 and July 2014, 101 patients underwent ATAAD repair at our institution. A dedicated multidisciplinary aortic surgery team (experienced aortic surgeon, perfusionists, cardiac anesthesiologists, nurses, and radiologists) was formed in 2010. We retrospectively compared ATAAD repair outcomes in patients before (2005–2009, N = 39) and after (2010–2014, N = 62) implementation of our program. Expected operative mortality was calculated using the International Registry of Acute Aortic Dissection preoperative predictive model. Results This study demonstrated a significant reduction in operative mortality after implementation of the aortic surgery program (30.8% vs. 9.7%; P = 0.014). There was also an increase in the complexity of surgical technique and perfusion strategies with fewer postoperative complications related to respiratory (P < 0.0001) and renal failure (P = 0.034). Baseline demographics were similar, and there was no statistically significant difference in International Registry of Acute Aortic Dissection predictive variables between the 2 groups. However, there was a 3.5-fold reduction in the observed-to-expected (O/E) operative mortality ratio. There was a 50% increase in volume with a significant number of patients being admitted directly to our aortic center for ATAAD repair, thus avoiding delay in operation related to transfers from a secondary hospital. Conclusions Patient outcomes are improved when the surgical treatment of ATAAD is managed by a high-volume multidisciplinary aortic surgery team.

scholarly journals Surgical Treatment of Acute Type A Aortic Dissection with 18-Litre Bleeding

Aorta ◽  
2021 ◽  
Vol 09 (01) ◽  
pp. 030-032
Author(s):  
Sergey Y. Boldyrev ◽  
Kirill O. Barbukhatty ◽  
Vladimir A. Porhanov
Keyword(s):  
Surgical Treatment ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Type I ◽  
Acute Type ◽  
Drug Induced ◽  
Type A Aortic Dissection ◽  
Mortality And Morbidity ◽  
Perioperative Bleeding

AbstractSurgical treatment of Type-A acute aortic dissection is associated with high mortality and morbidity. One of the reasons is perioperative bleeding, which may lead to worse outcomes. We present a case of successful treatment of a patient with 18-litre perioperative blood loss in DeBakey Type-I acute aortic dissection with drug-induced hypocoagulation and malperfusion of a lower extremity.

scholarly journals Impacts of eosinophil percentage on prognosis acute type A aortic dissection patients

2021 ◽  
Author(s):  
Yue Shao ◽  
Liu Ye ◽  
Hao-ming Shi ◽  
Xin-mei Wang ◽  
Jun Luo ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Aortic Dissection ◽  
Multivariate Regression ◽  
Medical Information ◽  
External Validation ◽  
Inflammatory Cells ◽  
Type A ◽  
Multivariate Regression Analysis ◽  
Acute Type ◽  
Type A Aortic Dissection

Abstract Background Eosinophils are pro-inflammatory cells involved in thrombosis and have been proposed as a prognosis marker in acute ischemic stroke and ST-elevation myocardial Infarction. Here, we sought to clarify the prognostic value of eosinophil percentage (EOS%) in patients with acute type A aortic dissection (AAAD). Methods We examined 183 consecutive AAAD patients. Based on the optimum cut-off value of EOS% determined by X-tile software, patients were classified into the low EOS% (EOS%≤0.1) and high EOS% groups (EOS%>0.1). We performed multivariate regression analysis and Kaplan-Meier (KM) survival curves to assess the association between EOS% and mortality. Eosinophil accumulation in aortic dissection intraluminal thrombus was confirmed using hematoxylin–eosin (H&E) staining. An external cohort from Medical Information Mart for Intensive Care IV was performed to validate the results. Results Relative to surviving patients, those who died during hospitalization had significantly lower EOS% (p=0.001) but significantly higher WBC (p=0.002) and neutrophil (p=0.001) counts. Multivariate regression analysis identified EOS% as an independent predictor of in-hospital and 1-year mortality. KM curves revealed that 1-year cumulative mortality was significantly higher in the low EOS% group, although it was mainly attributed to the higher 30-day mortality. H&E staining revealed massive infiltration of eosinophils in all 20 thrombus specimens. The external validation confirmed that relative to survivors, patients with in-hospital (p=0.010) had significantly lower EOS%. Moreover, multivariate regression analyses identified that decreased EOS% was independently significantly associated with in-hospital mortality. Conclusions Low EOS% is significantly related to increased mortality rates in AAAD patients.

Impact of GERAADA Score in Patients With Acute Type A Aortic Dissection

2021 ◽  
Author(s):  
Kayo Sugiyama ◽  
Hirotaka Watanuki ◽  
Masato Tochii ◽  
Yasuhiro Futamura ◽  
Yuka Kitagawa ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Postoperative Results ◽  
Entire Study ◽  
Type A Aortic Dissection ◽  
Actual Mortality ◽  
Aortic Dissection Type A

Abstract Background Despite continuous developments and advances in the perioperative management of patients suffering from acute aortic dissection type A (AADA), the associated postoperative morbidity and mortality remain high and strongly depend on the preoperative clinical status. The associated postoperative mortality is still hard to predict prior to the surgical procedure. The so-called German Registry of Acute Aortic Dissection Type A (GERAADA) score uses very basic and easily retrievable parameters and was specifically designed for predicting the 30-day mortality rate in patients undergoing surgery for AADA. This study evaluated impact of the GERAADA score in the authors’ institutional results. MethodsAmong 101 acute type A aortic dissection patients treated at our hospital during August 2015–March 2021, the GERAADA was calculated individually and retrospectively. Predicted and actual mortalities were assessed, and independent predicted factors were searched. The primary endpoint was defined as comparison of GERAADA scores and early mortality, and the secondary endpoints were defined as comparison of GERAADA scores and other postoperative results, and comparison of preoperative factors and postoperative results regardless to GERAADA scores.ResultsWhile the overall 30-day mortality for the entire study cohort calculated by the GERAADA score was 14.3 (8.1-77.6) %, the actual mortality rate was 6%. However, the GERAADA score was significantly high in some postoperative complications and showed significant correlation with some peri- and post-operative factors. In addition, factors not belonging to GERAADA score such as time from onset to arrival at the hospital, time from onset to arrival at the operation room, spouse presence, and hemodialysis were significantly associated with 30-day mortality.ConclusionsAlthough the actual mortality was lower than predicted, GERAADA score may impact on the postoperative course. In addition, it would be desirable to add parameters such as the time from onset to arrival, family background, and hemodialysis for further accuracy.

scholarly journals Interfacility Transfer of Medicare Beneficiaries With Acute Type A Aortic Dissection and Regionalization of Care in the United States

Circulation ◽  
2019 ◽  
Vol 140 (15) ◽  
pp. 1239-1250 ◽  
Author(s):  
Andrew B. Goldstone ◽  
Peter Chiu ◽  
Michael Baiocchi ◽  
Bharathi Lingala ◽  
Justin Lee ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Operative Mortality ◽  
Type A ◽  
High Volume ◽  
The United States ◽  
Acute Type ◽  
Medicare Beneficiaries ◽  
Type A Aortic Dissection ◽  
High Volume Hospital

Background: The feasibility and effectiveness of delaying surgery to transfer patients with acute type A aortic dissection—a catastrophic disease that requires prompt intervention—to higher-volume aortic surgery hospitals is unknown. We investigated the hypothesis that regionalizing care at high-volume hospitals for acute type A aortic dissections will lower mortality. We further decomposed this hypothesis into subparts, investigating the isolated effect of transfer and the isolated effect of receiving care at a high-volume versus a low-volume facility. Methods: We compared the operative mortality and long-term survival between 16 886 Medicare beneficiaries diagnosed with an acute type A aortic dissection between 1999 and 2014 who (1) were transferred versus not transferred, (2) underwent surgery at high-volume versus low-volume hospitals, and (3) were rerouted versus not rerouted to a high-volume hospital for treatment. We used a preference-based instrumental variable design to address unmeasured confounding and matching to separate the effect of transfer from volume. Results: Between 1999 and 2014, 40.5% of patients with an acute type A aortic dissection were transferred, and 51.9% received surgery at a high-volume hospital. Interfacility transfer was not associated with a change in operative mortality (risk difference, –0.69%; 95% CI, –2.7% to 1.35%) or long-term mortality. Despite delaying surgery, a regionalization policy that transfers patients to high-volume hospitals was associated with a 7.2% (95% CI, 4.1%–10.3%) absolute risk reduction in operative mortality; this association persisted in the long term (hazard ratio, 0.81; 95% CI, 0.75–0.87). The median distance needed to reroute each patient to a high-volume hospital was 50.1 miles (interquartile range, 12.4–105.4 miles). Conclusions: Operative and long-term mortality were substantially reduced in patients with acute type A aortic dissection who were rerouted to high-volume hospitals. Policy makers should evaluate the feasibility and benefits of regionalizing the surgical treatment of acute type A aortic dissection in the United States.

scholarly journals Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: A 20-year experience

2019 ◽  
Vol 158 (3) ◽  
pp. 675-687.e4 ◽  
Author(s):  
Bo Yang ◽  
Elizabeth L. Norton ◽  
Carlo Maria Rosati ◽  
Xiaoting Wu ◽  
Karen M. Kim ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Malperfusion Syndrome

scholarly journals Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience

2005 ◽  
Vol 129 (1) ◽  
pp. 112-122 ◽  
Author(s):  
Santi Trimarchi ◽  
Christoph A. Nienaber ◽  
Vincenzo Rampoldi ◽  
Truls Myrmel ◽  
Toru Suzuki ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
International Registry ◽  
Results Of Surgery
Sign in / Sign up

Export Citation Format

Share Document