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Akita S, Tokuda Y, Kato W, Tanaka K, Mutsuga M. Risk factors for proximal and distal aortic events after type A acute aortic dissection. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02077-z. [PMID: 39287769 DOI: 10.1007/s11748-024-02077-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 08/27/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVES Type A acute aortic dissection (TAAAD) is a life-threatening condition often requiring emergency surgery, with approximately 30% of patients needing reoperation. This study aimed to identify predictors of long-term aortic events from early postoperative computed tomography (CT) examinations. METHODS A total of 336 cases underwent TAAAD surgery at two institutions between 2002 and 2018. Of these, 302 patients received CT examinations immediately after initial TAAAD surgery. Predictors of aortic events were evaluated from these early postoperative CT exams. Aortic events were defined as any events involving aortic-related death, open surgery, reoperation, endovascular stenting, or thoracic aorta diameter enlargement to ≥ 55 mm. RESULTS Excluding 34 in-hospital deaths (10.1%; 34/336), the 1-, 5-, and 10-year actuarial survival rates after primary TAAAD surgery were 98.2%, 88.6%, and 81.7%, respectively. Over a mean follow-up period of 7.4 ± 5.1 years, 67 aortic events (proximal: 19, distal: 45, both: 3) were observed. Freedom from proximal aortic events was 98.6%, 93.9%, and 85.2% at 1, 5, and 10 years, respectively. Proximal anastomosis new entry was identified as a significant risk factor for aortic events, with a 92% vs. 42% incidence at 10 years (p < 0.001). Freedom from distal aortic events was 99.6%, 84.5%, and 67.2% at 1, 5, and 10 years, respectively. A false/true area ratio greater than 1 and distal anastomosis new entry were significant risk factors for aortic events (low-risk group: 83.3% vs. high-risk group: 42.3% at 10 years, p < 0.001). CONCLUSIONS Detailed analysis of early postoperative CT scans following primary TAAAD surgery may help identify predictors of subsequent aortic events, potentially improving long-term patient management and outcomes.
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Affiliation(s)
- Sho Akita
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, 466-8560, Japan.
- Department of Cardiovascular Surgery, Nagoya Daini Redcross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650, Japan.
| | - Yoshiyuki Tokuda
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, 466-8560, Japan
| | - Wataru Kato
- Department of Cardiovascular Surgery, Nagoya Daini Redcross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650, Japan
| | - Keisuke Tanaka
- Department of Cardiovascular Surgery, Nagoya Daini Redcross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Syowa-ku, Nagoya City, Aichi, 466-8560, Japan
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Carbone A, Palladino R, Franzese M, Castaldo R, Ranieri B, Crisci G, Izzo R, Esposito G, Cittadini A, Schreurs B, van Kimmenade RRJ, Bossone E. Health-related quality of life in patients with aortic dissection: An unmet need. Curr Probl Cardiol 2024; 49:102138. [PMID: 38295010 DOI: 10.1016/j.cpcardiol.2023.102138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/14/2023] [Indexed: 02/02/2024]
Abstract
Knowledge about the Health-related Quality of Life (HR-QoL) after Type A (TA-AAD) and Type B acute aortic dissection (TB-AAD) is still insufficient. Through this systematic review, including 22 studies (16 for TA-AAD and 6 TB-AAD -1998-2023), the entire literature on HR-QoL after surgical and/or endovascular and/or medical interventions has been investigated. In TA-AAD patients, despite overall SF-36 score was similar to the standard population, with > 80 years patients displaying a better emotional domain, the SF-12 was significant lower to controls in physical and mental well-being domains. Exercise-based cardiac rehabilitation improved HR-QoL. In TB-AAD, vitality and mental health SF-36 scores improved after thoracic endovascular aortic repair (TEVAR); long-term QoL was similar in the open surgery group compared to TEVAR. Overall, HR-QoL after AAD seems adequate irrespective of age or sex, except for some specific domains. Physical exercise and cardiac rehabilitation may improve HR-QoL in these patients. PROSPERO registry ID: CRD42023421130.
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Affiliation(s)
- Andreina Carbone
- Cardiology Unit, University Hospital "Luigi Vanvitelli", Naples, Italy
| | - Raffaele Palladino
- Department of Public Health, University "Federico II" of Naples, Naples, Italy
| | - Monica Franzese
- Cardiology Unit, University Hospital "Luigi Vanvitelli", Naples, Italy
| | | | | | - Giulia Crisci
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Bibi Schreurs
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Eduardo Bossone
- Department of Public Health, University "Federico II" of Naples, Naples, Italy.
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Hanna L, Jha R, Sounderajah V, Markar S, Gibbs R. Patient Reported Outcome Measures Used to Assess Quality of Life in Aortic Dissection: a Systematic Scoping Review using COSMIN Methodology. Eur J Vasc Endovasc Surg 2023; 66:343-350. [PMID: 37391013 DOI: 10.1016/j.ejvs.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/25/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To systematically identify all patient reported outcome measures (PROMs) (quality of life [QOL] instruments or other instrument/methodology) that have been used to date in aortic dissection (AD) and to explore how well these instruments evaluate QOL according to the Consensus based Standards for the selection of health Measurement Instruments (COSMIN) methodology or guideline. DATA SOURCES Embase, MEDLINE, PsycINFO, CINAHL, and Cochrane Library were search on 1st July 2022. REVIEW METHODS This scoping review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) and the COSMIN guidelines for performing systematic reviews of validated PROMs. Studies that reported on any aspect or domain of QOL using a PROM or other instrument or methodology on AD were included. Data synthesis, including psychometric property analysis and risk of bias assessment were performed according to COSMIN guidelines. RESULTS Forty-five studies, published between 1994 and 2021 reporting on 5 874 patients (mean age 63 years, 70.6% male), were included. A total of 39 PROMs were used, and three studies used semi-structured interviews. The majority (69%) of studies were in patients with type A aortic dissection (TAAD). The most common PROM used was the SF-36 (51%). Six studies evaluated one or more psychometric properties of a PROM. Only one of these studies was specifically designed as a validation study. No study reported on content validity. Internal consistency was the most evaluated psychometric property. No study evaluated all the psychometric properties according to COSMIN methodology. The methodological quality used to assess these PROMs was judged to be adequate or very good. CONCLUSION This review highlights the heterogeneity of PROMs or methods used to determine QOL in AD patients. The lack of research regarding a comprehensive evaluation of the psychometric properties of a PROM used in AD highlights the need for the development and validation of a dissection specific PROM. [PROSPERO registration no. CRD42022310477].
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Affiliation(s)
- Lydia Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.
| | - Rama Jha
- School of Medicine, Imperial College London, London, UK
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, London, UK; Institute of Global Health Innovation, Imperial College London, London, UK
| | - Sheraz Markar
- Department of Surgery and Cancer, Imperial College London, London, UK; Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Richard Gibbs
- Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
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4
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Eranki A, Wilson-Smith A, Williams ML, Saxena A, Mejia R. Quality of life following surgical repair of acute type A aortic dissection: a systematic review. J Cardiothorac Surg 2022; 17:118. [PMID: 35578309 PMCID: PMC9112611 DOI: 10.1186/s13019-022-01875-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background The outcomes of surgery for acute Stanford Type A aortic dissection (ATAAD) extend beyond mortality and morbidity. The aim of this systematic review was to summarise the literature surrounding health related quality of life (HR-QOL) following ATAAD, compare the outcomes to the standardised population, and to assess the impact of advanced age on HRQOL outcomes following surgery. Methods A systematic review of studies after January 2000 was performed to identify HR-QOL in patients following surgery for ATAAD. Electronic searches of three databases were performed and clinical studies extracted by two independent reviewers. Strict inclusion and exclusion criteria were applied. Quality appraisal was conducted utilizing predefined criteria on pilot forms. HR-QOL results were synthesized through a narrative review of included studies. Results There was significant attrition in HR-QOL of patients following surgery for ATAAD. Outcomes fared worse when compared to an age adjusted normative population. Of note, elderly patients were physically vulnerable, whereas younger populations may be more mentally vulnerable to postoperative sequalae. The included studies were quite heterogeneous in their study designs, methods, HR-QOL measures reported and follow up time-frames which limited direct comparison between studies. Conclusion HR-QOL outcomes are adversely affected when compared to preoperative status and physical health demonstrates significant attrition over time. HR-QOL outcomes are worse off when compared to an age matched general population. In terms of age, advancing age is associated with worse physical component scores but emotional health may fare better than younger patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01875-x.
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Affiliation(s)
- Aditya Eranki
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, 2305, Australia.
| | - Ashley Wilson-Smith
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, 2305, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Michael L Williams
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, 2305, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Akshat Saxena
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Ross Mejia
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, 2305, Australia
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5
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Smolock CJ, Xiang F, Roselli EE, Blackstone EH, Svensson LG, Artis AS, Liu H, Tong MZ. Health-Related Quality of Life After Extensive Aortic Replacement. Semin Thorac Cardiovasc Surg 2021; 34:793-801. [PMID: 34271093 DOI: 10.1053/j.semtcvs.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 01/16/2023]
Abstract
To assess and compare patient-reported long-term health-related quality of life (HRQoL) after combined proximal aortic (arch ± ascending, root) and distal aortic (descending thoracic ± abdominal) replacement using open vs multimodal/endovascular (hybrid) approaches. From 2010 to 2016, 146 adults underwent single- or multi-stage aortic arch plus descending thoracic aorta replacement, 31 open and 115 hybrid. The 2 surgical approach groups had similar preoperative characteristics and extent of surgery. Cross-sectional follow-up revealed 49 deaths (7 open, 42 hybrid). Of the 97 survivors, 72 (74%) responded to the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 survey (18 open, 54 hybrid) a median 6.2 years (15th, 85th percentiles: 3.1, 7.9) after their last aortic surgery. Predictors of HRQoL scores were identified by random forest regression. Overall physical HRQoL T-score was lower than that of population norms (46 vs 50, P < 0.0001); mental HRQoL T-score was similar (50 vs 50, P > 0.9). Neither T-score was significantly different according to surgical approach (P ≥ 0.3). Greater number of postoperative complications and history of chronic obstructive pulmonary disease were the most important predictors of lower physical HRQoL, and prior myocardial infarction was the most important predictor of lower mental HRQoL. Although extensive aortic replacement had a small long-term effect on patient-reported physical HRQoL, both physical and mental HRQoL can be preserved in survivors with both surgical approaches. Surgeons should recommend the approach they believe will yield the best long-term survival, but lifelong follow-up is crucial, and patients should understand that they may require multiple operations.
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Affiliation(s)
| | - Fei Xiang
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Cardiac Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Amanda S Artis
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Huan Liu
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Michael Z Tong
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
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Sbarouni E, Georgiadou P, Manavi M, Analitis A, Beletsioti C, Niakas D, Iliodromitis E, Voudris V. Long-term outcomes and quality of life following acute type A aortic dissection. Hellenic J Cardiol 2021; 62:463-465. [PMID: 33524616 DOI: 10.1016/j.hjc.2021.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 01/13/2021] [Accepted: 01/25/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Eftihia Sbarouni
- Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Marina Manavi
- Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Antonis Analitis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Greece
| | | | - Dimitrios Niakas
- Μedical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Iliodromitis
- Μedical School, National and Kapodistrian University of Athens, Athens, Greece; Attikon University Hospital, Department of Cardiology, Greece
| | - Vassilis Voudris
- Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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7
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Lin CY, Lee KT, Ni MY, Tseng CN, Lee HA, Su IL, Ho HP, Tsai FC. Impact of reduced left ventricular function on repairing acute type A aortic dissection: Outcome and risk factors analysis from a single institutional experience. Medicine (Baltimore) 2018; 97:e12165. [PMID: 30170461 PMCID: PMC6392594 DOI: 10.1097/md.0000000000012165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Preoperative left ventricular dysfunction is a risk factor for postoperative mortality and morbidity in cardiovascular surgeries with cardiopulmonary bypass, including thoracic aortic surgery. Using a retrospective study design, this study aimed to clarify the short- and mid-term outcomes of patients who underwent acute type A aortic dissection (ATAAD) repair with reduced left ventricular function.Between July 2007 and February 2018, a total of 510 adult patients underwent surgical repair of ATAAD in a single institution. The patients were classified as having left ventricular ejection fraction (LVEF) <50% (low EF group, n = 86, 16.9%) and LVEF ≥50% (normal group, n = 424, 83.1%) according to transesophageal echocardiographic assessment at the operating room. Preoperative demographics, surgical information, and postoperative complication were compared between the two groups. Three-year survival was analyzed using the Kaplan-Meier actuarial method. Serial echocardiographic evaluations were performed at 1, 2, and 3 years postoperation.Demographics, comorbidities, and surgical procedures were generally homogenous between the 2 groups, except for a lower rate of aortic arch replacement in the low EF group. The averaged LVEFs were 44.3 ± 2.5% and 65.8 ± 6.6% among the low EF and normal groups, respectively. The patients with low EF had higher in-hospital mortality (23.3% versus 13.9%, P = .025) compared with the normal group. Multivariate analysis revealed that intraoperative myocardial failure requiring extracorporeal membrane oxygenation support was an in-hospital mortality predictor (odds ratio, 16.99; 95% confidence interval, 1.23-234.32; P = .034), as was preoperative serum creatinine >1.5 mg/dL. For patients who survived to discharge, the 3-year cumulative survival rates were 77.8% and 82.1% in the low EF and normal groups, respectively (P = .522). The serial echocardiograms revealed no postoperative deterioration of LVEF during the 3-year follow-up.Even with a more conservative aortic repair procedure, the patients with preoperative left ventricular dysfunction are at higher surgical risk for in-hospital mortality. However, once such patients are able to survive to discharge, the midterm outcome can still be promising.
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Affiliation(s)
- Chun-Yu Lin
- Department of Cardiothoracic and Vascular Surgery
| | | | - Ming-Yang Ni
- Department of Anesthesiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | | | - Hsiu-An Lee
- Department of Cardiothoracic and Vascular Surgery
| | - I-Li Su
- Department of Cardiothoracic and Vascular Surgery
| | - Heng-Psan Ho
- Department of Cardiothoracic and Vascular Surgery
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8
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Jarral OA, Kidher E, Patel VM, Nguyen B, Pepper J, Athanasiou T. Quality of life after intervention on the thoracic aorta. Eur J Cardiothorac Surg 2015; 49:369-89. [DOI: 10.1093/ejcts/ezv119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/24/2015] [Indexed: 12/24/2022] Open
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Guo S, Sun Y, Ji B, Liu J, Wang G, Zheng Z. Similar Cerebral Protective Effectiveness of Antegrade and Retrograde Cerebral Perfusion During Deep Hypothermic Circulatory Arrest in Aortic Surgery: A Meta-Analysis of 7023 Patients. Artif Organs 2015; 39:300-8. [PMID: 25735404 DOI: 10.1111/aor.12376] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Shasha Guo
- Department of Cardiopulmonary Bypass; State Key Laboratory of Cardiovascular Medicine; Fuwai Hospital; National Center for Cardiovascular Disease; Chinese Academy of Medical Science; Peking Union Medical College; Beijing China
| | - Yanhua Sun
- Department of Cardiopulmonary Bypass; State Key Laboratory of Cardiovascular Medicine; Fuwai Hospital; National Center for Cardiovascular Disease; Chinese Academy of Medical Science; Peking Union Medical College; Beijing China
| | - Bingyang Ji
- Department of Cardiopulmonary Bypass; State Key Laboratory of Cardiovascular Medicine; Fuwai Hospital; National Center for Cardiovascular Disease; Chinese Academy of Medical Science; Peking Union Medical College; Beijing China
| | - Jinping Liu
- Department of Cardiopulmonary Bypass; State Key Laboratory of Cardiovascular Medicine; Fuwai Hospital; National Center for Cardiovascular Disease; Chinese Academy of Medical Science; Peking Union Medical College; Beijing China
| | - Guyan Wang
- Department of Anesthesiology; State Key Laboratory of Cardiovascular Medicine; Fuwai Hospital; National Center for Cardiovascular Disease; Chinese Academy of Medical Science; Peking Union Medical College; Beijing China
| | - Zhe Zheng
- Department of Cardiovascular Surgery; State Key Laboratory of Cardiovascular Medicine; Fuwai Hospital; National Center for Cardiovascular Disease; Chinese Academy of Medical Science; Peking Union Medical College; Beijing China
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10
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Russo CF, Mariscalco G, Colli A, Santè P, Nicolini F, Miceli A, De Chiara B, Beghi C, Gerosa G, Glauber M, Gherli T, Nappi G, Murzi M, Molardi A, Merlanti B, Vizzardi E, Bonadei I, Coletti G, Carrozzini M, Gelsomino S, Caiazzo A, Lorusso R. Italian multicentre study on type A acute aortic dissection: a 33-year follow-up†. Eur J Cardiothorac Surg 2015; 49:125-31. [PMID: 25721818 DOI: 10.1093/ejcts/ezv048] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/14/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Despite substantial progress in surgical techniques and perioperative management, the treatment and long-term follow-up of type A acute aortic dissection (AAD) still remain a major challenge. The objective of this retrospective, multicentre study was to assess in a large series of patients the early and long-term results after surgery for type A AAD. METHODS We analysed the preoperative, intraoperative and postoperative conditions of 1.148 consecutive patients surgically treated in seven large referral centres from 1981 to 2013. We applied to each patient three different multi-parameter risk profiles (preadmission risk, admission risk and post-surgery risk) in order to compare risk factors and outcome. Long-term Kaplan-Meier survival was evaluated. RESULTS The median age was 64 years and the male population was predominant (66%). Identified diagnosis of collagen disease was present in 9%, and Marfan syndrome in 5%. Bicuspid aortic valve was present in 69 patients (6%). Previous cardiac surgery was identified in 10% of the patients. During surgery, the native aortic valve was preserved in 72% of the cases, including leaflet resuspension in 23% and David operation in 1.2%. Considering aortic valve replacement (AVR: 28%), bioprosthesis implantation was performed in 14.7% of the subjects. Neurological impairment at discharge was shown in 23% of the cases among which 21% of patients had new neurological impairment versus preoperative conditions. The overall 30-day mortality rate was 25.7%. All risk profiles remained independently associated with in-hospital mortality. During the available follow-up of hospital survivors (median: 70 months, interquartile range: 34-113, maximum: 396), cardiac-related death occurred in 7.9% of the subjects. The cumulative survival rate for cardiac death was 95.3% at 5 years, 92.8% at 10 years and 52.8% at 20 years. Severe aortic regurgitation (AR) (grade 3-4) at the time of surgery showed to be a significant risk factor for reintervention during the follow-up (P < 0.001). Among risk profiles, only the preadmission risk was independently associated with late mortality after multivariate analysis. Unexpectedly, there was no difference in freedom from cardiac death between patients with and without AVR. CONCLUSIONS Although surgery for type A has remained challenging over more than three decades, there is a positive trend in terms of hospital mortality and long-term follow-up. About 90% of patients were free from reoperation in the long term, although late AR remains a critical issue, suggesting that a thorough debate on surgical options, assessment and results of a conservative approach should be considered.
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Affiliation(s)
- Claudio F Russo
- Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan, Italy
| | - Giovanni Mariscalco
- Department of Heart and Vessels, Cardiac Surgery Unit-Ospedale di Circolo, Varese, Italy
| | - Andrea Colli
- Cardiac Surgery, Università of Padova Medical School, Padova, Italy
| | - Pasquale Santè
- II Università of Napoli Medical School, Ospedale Monaldi, Napoli, Italy
| | | | | | | | - Cesare Beghi
- Department of Heart and Vessels, Cardiac Surgery Unit-Ospedale di Circolo, Varese, Italy
| | - Gino Gerosa
- Cardiac Surgery, Università of Padova Medical School, Padova, Italy
| | | | - Tiziano Gherli
- Cardiac Surgery, Università of Parma Medical School, Parma, Italy
| | - Gianantonio Nappi
- II Università of Napoli Medical School, Ospedale Monaldi, Napoli, Italy
| | | | - Alberto Molardi
- Cardiac Surgery, Università of Parma Medical School, Parma, Italy
| | - Bruno Merlanti
- Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan, Italy
| | | | | | | | | | | | - Antonio Caiazzo
- II Università of Napoli Medical School, Ospedale Monaldi, Napoli, Italy
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11
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Yang WJ, Duan QJ, Cheng HF, Dong AQ. A case study of pulmonary embolism from the right atrial shunt after acute type a aortic dissection surgery. J Cardiothorac Surg 2014; 9:180. [PMID: 25403894 PMCID: PMC4236451 DOI: 10.1186/s13019-014-0180-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/30/2014] [Indexed: 11/30/2022] Open
Abstract
This is one case report of a 46-year-old Chinese male with type A acute aortic dissection. It is an emergent surgery including Bentall procedure, interposition graft replacement of aortic arch, stented descending aorta with the modified right atrial shunt technique. In the early post operation period, the patient was complicated with pulmonary embolism. Pulmanary arteriography showed that the right main pulmonary embolism without an extrinsic compression. After the anticoagulant therapy, the patient was well recovered and discharged from hospital 1 month later. The origin of pulmonary embolism in the patient was believed to be the thrombosis in the shunt fistula. The right atrial shunt-related complications haven't been reported for more than thirty years. Pulmonary embolism could be a severe complication after the right atrial shunt in acute type A aortic dissection.
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Affiliation(s)
- Wei J Yang
- Department of cardiovascular surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, No, 88 Jiefang road, Hangzhou, China.
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12
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Conway BD, Stamou SC, Kouchoukos NT, Lobdell KW, Khabbaz KR, Murphy E, Hagberg RC. Improved clinical outcomes and survival following repair of acute type A aortic dissection in the current era. Interact Cardiovasc Thorac Surg 2014; 19:971-6. [DOI: 10.1093/icvts/ivu268] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Kurisu K, Baba H, Nakashima H, Kajiwara T, Hisahara M, Joo K, Ochiai Y. Tricuspid regurgitation resulting from acute type A aortic dissection. Ann Thorac Surg 2014; 98:e5-6. [PMID: 24996748 DOI: 10.1016/j.athoracsur.2014.04.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 02/17/2014] [Accepted: 04/04/2014] [Indexed: 11/19/2022]
Abstract
Proximal extension of acute type A aortic dissection can affect the aortic valve but seldom affects the tricuspid valve. We report the case of an octogenarian who underwent successful surgical repair of an aortic dissection that was accompanied by tricuspid regurgitation. We believe that the tricuspid regurgitation was attributable to displacement of the valve resulting from aortic dissection.
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Affiliation(s)
- Kazuhiro Kurisu
- Department of Cardiovascular Surgery, Kyushu Kosei Nenkin Hospital, Kitakyushu, Japan.
| | - Hironori Baba
- Department of Cardiovascular Surgery, Kyushu Kosei Nenkin Hospital, Kitakyushu, Japan
| | - Hidehiko Nakashima
- Department of Cardiovascular Surgery, Kyushu Kosei Nenkin Hospital, Kitakyushu, Japan
| | - Takashi Kajiwara
- Department of Cardiovascular Surgery, Kyushu Kosei Nenkin Hospital, Kitakyushu, Japan
| | - Manabu Hisahara
- Department of Cardiovascular Surgery, Kyushu Kosei Nenkin Hospital, Kitakyushu, Japan
| | - Kunihiko Joo
- Department of Cardiovascular Surgery, Kyushu Kosei Nenkin Hospital, Kitakyushu, Japan
| | - Yoshie Ochiai
- Department of Cardiovascular Surgery, Kyushu Kosei Nenkin Hospital, Kitakyushu, Japan
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Bing F, Rodière M, Martinelli T, Monnin-Bares V, Chavanon O, Bach V, Baguet JP, Ferretti GR, Thony F. Type A Acute Aortic Dissection. Vasc Endovascular Surg 2014; 48:239-45. [DOI: 10.1177/1538574413518611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To understand why the false channel (FC) remains patent after surgery of type A acute aortic dissection (TAAAD). Materials and Methods: Postoperative contrast-enhanced computed tomography scans of 129 patients operated for TAAAD were analyzed, and a color-Doppler ultrasound examination (CDUS) of the supra-aortic vessels (SAVs) was performed in 12 patients. Results: The FC remained patent in 107 (82.9%) patients. The entry site was situated near the distal anastomosis in 43 (40.2%) patients and far from it in 44 (41.1%) patients. In 10 (9.35%) patients, an entry site was observed only in the SAVs. In 10 (9.35%) patients, no entry site was seen. Of the 12 patients explored with CDUS, a retrograde filling of the FC was observed in 11 patients. Conclusion: The frequent postoperative circulating aortic FC can be explained by the persistence of the primary entry tear, the presence of iatrogenic tears, and/or a retrograde filling in the SAVs.
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Melby SJ, Zierer A, Damiano RJ, Moon MR. Importance of Blood Pressure Control After Repair of Acute Type A Aortic Dissection: 25-Year Follow-Up in 252 Patients. J Clin Hypertens (Greenwich) 2012; 15:63-8. [DOI: 10.1111/jch.12024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Cho JR, Shin S, Kim JS, Ko YG, Hong MK, Jang Y, Seung KB, Park HS, Tahk SJ, Lim DS, Jeon DW, Chae IH, Kim DK, Yoon J, Jeong MH, Choi D. Clinical characteristics of acute aortic syndrome in korean patients: from the korean multi-center registry of acute aortic syndrome. Korean Circ J 2012; 42:528-37. [PMID: 22977448 PMCID: PMC3438262 DOI: 10.4070/kcj.2012.42.8.528] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 12/20/2011] [Accepted: 02/25/2012] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Acute aortic syndrome (AAS) is a heterogeneous group of disorders that often present with severe chest or back pain. It includes acute aortic dissection (AD), intramural hematoma (IMH), dissecting aneurysm, and penetrating aortic ulcer (PAU). The clinical picture of AAS and its prognosis have not been studied in a large number of Korean patients. Therefore, we organized a multi-center registry to identify the clinical characteristics and treatment patterns, as well as long-term outcomes in Korean patients with AAS. Subjects and Methods Five-hundred twenty-eight patients, who had been diagnosed with AAS, were enrolled into this registry from 10 centers. On a retrospective basis, we collected demographic, laboratory, imaging data, as well as follow-up clinical outcomes by reviewing medical records from individual centers. All the data were collected in core lab and analyzed in detail. Results The mean patient age was 60.1±14.5 years; the male-to-female ratio was M : F=297 : 231. The prevalent risk factors for AAS included hypertension (361, 68.4%) and diabetes (52, 11.1%). The components of AAS that are included in this study are acute AD (446, 84.5%), IMH (57, 10.7%), and PAU (11, 2.1%). By type of AAS, patients diagnosed with Stanford A were 45.6% of enrolled patients, whereas those with Stanford B were 54.4% of enrolled patients. Among nearly half of the patients were treated with medicine (55.7%) alone, whereas 40.0% underwent surgery and 4.3% underwent endovascular treatment. Overall, the in-hospital event rate was 21.2% and the in-hospital death rate was 8.1%. The mean follow-up duration was 42.8 months and there showed 22.9% of total event and 10.1% of death during this period. Conclusion By organizing a multi-center registry of AAS, we could identify the characteristics of AAS in real-world Korean patients. Further, prospective study is warranted with a larger number of patients.
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Affiliation(s)
- Jung Rae Cho
- Cardiology Division, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Tsai HS, Tsai FC, Chen YC, Wu LS, Chen SW, Chu JJ, Lin PJ, Chu PH. Impact of acute kidney injury on one-year survival after surgery for aortic dissection. Ann Thorac Surg 2012; 94:1407-12. [PMID: 22939248 DOI: 10.1016/j.athoracsur.2012.05.104] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 05/21/2012] [Accepted: 05/25/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND Surgical treatment is an option for both type A aortic dissection and complicated type B aortic dissection. Acute kidney injury (AKI) influences the disease course after surgery. Our hypothesis was that AKI should be an important prognostic factor for aortic dissection after surgical treatment. METHODS Between July 2005 and October 2010, 268 patients (mean age 53 ± 14 years; range, 16 to 88) underwent open surgery for aortic dissection. We reviewed the clinical presentations, surgical variables, and postoperative outcomes to identify the risk factors of death. The 256 patients were divided into groups, with and without AKI, within 24 hours after operation according to the RIFLE (acronym for risk, injury, failure, loss, end stage) criteria. RESULTS The in-hospital mortality rate was 17.9%, the 1-year mortality rate was 18.7%, and the major adverse cardiac events rate within 1 year was 29.9%. In multivariate analysis, patients more than 70 years of age (hazard ratio [HR] 2.390, p = 0.029), cardiogenic shock (HR 2.895, p = 0.005), preoperative ventilator use (HR 4.137, p = 0.018), operation at midnight (HR 2.295, p = 0.028), longer bypass time (HR 1.007, p < 0.001), and AKI (HR 2.552, p = 0.041) were clinical predictors of mortality. Kaplan-Meier analysis showed that the survival rate was strongly correlated with the severity of AKI by the RIFLE criteria. The independent predictors of AKI included hypertension (odds ratio 2.340, p = 0.027), sepsis (odds ratio 2.594, p = 0.043), and lower limb malperfusion (odds ratio 4.558, p = 0.022). CONCLUSIONS Our study provides outcomes of postoperative aortic dissection. We found that AKI was a predictor of 1-year mortality by using the RIFLE criteria. Factors associated with increased 1-year mortality and AKI should be taken into consideration for surgery and postoperative care.
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Affiliation(s)
- Hsing-Shan Tsai
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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Kirsch M, Legras A, Bruzzi M, Louis N. Fate of the distal aorta after surgical repair of acute DeBakey type I aortic dissection: A review. Arch Cardiovasc Dis 2011; 104:125-30. [DOI: 10.1016/j.acvd.2010.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 11/15/2010] [Accepted: 11/16/2010] [Indexed: 11/27/2022]
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Knobloch K, Dehn I, Khaladj N. Interhospital transfer by HEMS and outcomes in aortic dissections. Air Med J 2010; 29:262. [PMID: 21055633 DOI: 10.1016/j.amj.2010.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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20
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Jeremy RW. Thoracic aortic dissection - beyond the acute problem. Heart Lung Circ 2010; 19:641-3. [PMID: 20951338 DOI: 10.1016/s1443-9506(10)01480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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