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Kim JK, Goh JH, Kim JB, Song JK, Yang DH, Kang JW, Kim SO, Koo HJ. Predictors of Late Adverse Events in Patients with Surgically Treated Type I Aortic Dissection. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00382-4. [PMID: 38719137 DOI: 10.1016/j.ejvs.2024.05.004] [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: 11/11/2023] [Revised: 04/11/2024] [Accepted: 05/01/2024] [Indexed: 06/17/2024]
Abstract
OBJECTIVE Residual aortic dissection (AD) following DeBakey type I AD repair is associated with a high rate of adverse events that need additional intervention or surgery. This study aimed to identify clinical and early post-operative computed tomography (CT) imaging factors associated with adverse events in patients with type I AD after ascending aorta replacement. METHODS This single centre, retrospective cohort study included consecutive patients with type I AD who underwent ascending aorta replacement from January 2011 to December 2017 and post-operative CT within three months. The primary outcome was AD related adverse events, defined as AD related death and re-operation due to aortic aneurysm or impending rupture. The location and size of the primary intimal tears, aortic diameter, and false lumen status were evaluated. Regression analyses were performed to identify factors associated with AD related adverse events. A decision tree model was used to classify patients as high or low risk. RESULTS Of 103 participants (55.43 ± 13.94 years; 49.5% male), 24 (23.3%) experienced AD related adverse events. In multivariable Cox regression analysis, connective tissue disease (hazard ratio [HR] 15.33; p < .001), maximum aortic diameter ≥ 40 mm (HR 4.90; p < .001), and multiple (three or more) intimal tears (HR 7.12; p < .001) were associated with AD related adverse events. The three year cumulative survival free from AD related events was lower in the high risk group with aortic diameter ≥ 40 mm and multiple intimal tears (41.7% vs. 90.9%; p < .001). CONCLUSION Early post-operative CT findings indicating a maximum aortic diameter ≥ 40 mm and multiple intimal tears may predict a higher risk of adverse events. These findings suggest the need for careful monitoring and more vigilant management approaches in these cases.
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Affiliation(s)
- Jin Kyoung Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Jung Hwan Goh
- University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Jae-Kwan Song
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Hyun Jung Koo
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea.
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Kitada Y, Okamura H, Hasui H, Akiyoshi K, Nomura Y, Adachi H. Morphologic prognostic factor for thoracoabdominal aortic dilation after acute type A dissection repair. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae063. [PMID: 38588576 PMCID: PMC11087929 DOI: 10.1093/icvts/ivae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/29/2024] [Accepted: 04/06/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES Risk factors for late-term aortic dilation after acute type A aortic dissection repair have not been well examined. The goal of this study was to determine the relationship between the abdominal aortic true lumen location and thoraco-abdominal aortic dilation after surgical repair for acute type A aortic dissection. METHODS Patients who were preoperatively diagnosed with acute type A aortic dissection between April 2014 and July 2022 were included in this study. We evaluated the renal artery-level dissected aortic morphology and classified the study population into 2 groups: the ventral (those with the true lumen located on the ventral side) and the dorsal (other patients not assigned to the ventral group) groups, based on the location of the true lumen. Aortic dilation was defined as thoraco-abdominal aortic expansion ≥5 mm on 1-year postoperative computed tomography images. RESULTS We examined 49 surgical patients who were assigned to the ventral (n = 22) and dorsal (n = 27) groups. The number of patients with ≥5 mm thoraco-abdominal aortic dilation after the operation was significantly higher in the ventral group than in the dorsal group (90.9% vs 51.9%, P = 0.009). The multivariable logistic regression analysis showed that the ventral type was an independent prognostic factor for thoraco-abdominal aortic dilation after the operation (odds ratio, 6.01; 95% confidence interval, 1.56-23.77; P = 0.009). CONCLUSIONS The location of the true lumen of the abdominal aorta in acute type A aortic dissection may be a prognostic factor for thoraco-abdominal aortic dilation after surgical repair.
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Affiliation(s)
- Yuichiro Kitada
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Homare Okamura
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Hidenari Hasui
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Kei Akiyoshi
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Yohei Nomura
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
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Wang B, Miao M, Shi Q, Xian H, Cao Y, Wang X. Impact of post-implantation syndrome on outcomes in acute type B aortic syndrome patients undergoing endovascular repair. VASA 2024; 53:53-60. [PMID: 37965717 DOI: 10.1024/0301-1526/a001102] [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] [Indexed: 11/16/2023]
Abstract
Background: The aim of this study was to explore the impact of post-implantation syndrome (PIS) on prognosis outcomes in individuals with type B acute aortic syndrome (AAS) undergoing thoracic endovascular aortic repair (TEVAR). Patients and methods: Data from type B AAS individuals who underwent TEVAR from January 2014 to April 2021 were retrospectively reviewed. Study subjects were divided into PIS and non-PIS (nPIS) groups and postoperative clinical outcomes were analyzed. Results: Our study cohort of 74 individuals with type B AAS included 40 aortic dissection (AD), 30 intramural hematoma (IMH), 4 penetrating aortic ulcer (PAU). The incidence of PIS was 14.9%. No statistically significant differences were found in baseline characteristics. The left subclavian artery (LSCA) reconstruction was performed more frequently among the PIS group (45.5% vs 9.5%, p=.008). Major adverse events (MAE) tended to be more frequent in the PIS group, but the difference was not significant (27.3% vs 22.2%, p=.707). At 2-year follow-up, results were comparable between the two groups. Kaplan-Meier analysis showed that PIS was not associated with a higher incidence of mortality, endoleak, new-onset AD, or stroke. A baseline neutrophil-to-lymphocyte ratio (NLR) >10.3 was associated with greater incidence of MAE. In individuals with IMH, better aortic remodeling evaluated by lower total aortic diameter/true lumen diameter (TAD/TLD) was achieved in the nPIS group (1.23±0.10 vs 1.43±0.07, p<.001), and a TAD/TLD ratio >1.32 was associated with significantly more MAE. Cox multivariate regression analysis also showed that a postoperative TAD/TLD ratio >1.32 was an independent risk factor for MAE (OR, 11.36; 95% CI, 1.53-84.26; p=.017). Conclusions: PIS was associated with a trend toward a higher incidence of MAE after TEVAR. In individuals with IMH, a TAD/TLD ratio >1.32 was an independent predictor of postoperative MAE.
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Affiliation(s)
- Bin Wang
- Department of Cardiovascular Surgery, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Miao Miao
- Department of Endocrinology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Qiulin Shi
- Department of Cardiovascular Surgery, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Haiying Xian
- Department of Cardiovascular Surgery, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Yuecheng Cao
- Department of Cardiovascular Surgery, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Xiaoxiang Wang
- Department of Cardiovascular Surgery, Harrison International Peace Hospital, Hengshui, Hebei, China
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Jiang X, Xiang G, Du G, Li X, Wu P, Du X. A hemodynamic analysis of fenestrated physician-modified endograft repair for complicated aortic dissections involving the visceral arteries. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 242:107785. [PMID: 37678097 DOI: 10.1016/j.cmpb.2023.107785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/12/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE The aim of this study is to perform patient-specific hemodynamic simulations of the patients with complicated aortic dissection underwent Physician-modified endograft (PMEG) and evaluate the treatment outcome. METHOD 12 patient-specific models were reconstructed from computed tomography angiography (CTA) data of 6 patients with complicated aortic dissection before and after the PMEG. Hemodynamic simulations were conducted with the same time-varying volumetric flow rate extracted from the literature and 3-element Windkessel model (3 EWM) boundary conditions were applied at the aortic outlet. Hemodynamic indicators such as time-averaged wall shear stress (TAWSS), relative residence time (RRT) and endothelial cell activation potential (ECAP) were obtained to evaluate the postoperative effect of PMEG. RESULTS Comparing with the preoperative models, the flow rates of most visceral arteries were increased in the postoperative models (PSMA = 0.012, PRRA = 0.013, and PLRA = 0.005). Pressure and TAWSS in visceral regions were significantly reduced (PP = 0.003 and PTAWSS = 0.017). With the false lumens (FL) covered by the stent grafts, the average TAWSS level increased in the regions of postoperative abdominal aorta (P = 0.002), and the average RRT and ECAP values decreased significantly (PRRT = 0.02 and PECAP = 0.003). CONCLUSION This study shows that PMEG, as a new technique for the treatment of complicated aortic dissection involving the distal tears in the visceral region, can effectively restore the abnormal blood supply of the visceral arteries, reduce the risk of aortic rupture, the formation of aortic dissection aneurysm (ADA), and thrombosis. This corresponds well with clinical retrospective studies and 1-year follow-up outcomes. The findings of this study are of great significance for the development of PMEG.
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Affiliation(s)
- Xudong Jiang
- Department of Vascular Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, Jiangsu, China; Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu 210008, China
| | - Guangyuan Xiang
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu 210008, China
| | - Guanting Du
- Artificial Organ Technology Laboratory, School of Mechanical and Electrical Engineering, Soochow University, 8 Jixue Road, Suzhou, Jiangsu 21513, China
| | - Xiaoqiang Li
- Department of Vascular Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, Jiangsu, China; Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu 210008, China.
| | - Peng Wu
- Artificial Organ Technology Laboratory, School of Mechanical and Electrical Engineering, Soochow University, 8 Jixue Road, Suzhou, Jiangsu 21513, China.
| | - Xiaolong Du
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu 210008, China.
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Shimamoto T, Komiya T, Matsuo T. Clinical impact of turn-up anastomosis in the treatment of type A acute aortic dissection. Asian Cardiovasc Thorac Ann 2023; 31:759-767. [PMID: 37731318 DOI: 10.1177/02184923231203753] [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] [Indexed: 09/22/2023]
Abstract
BACKGROUND The management of anastomosis and hemostasis of the dissected aorta remains challenging. This study aims to establish an optimal surgical strategy for type A acute aortic dissection by reviewing single-center data using the turn-up anastomosis technique. METHODS Between 2003 and 2015, 264 consecutive patients with type A acute aortic dissection who underwent emergency surgery within 14 days of symptom onset were enrolled. RESULTS The mean age of the patients was 67.7 ± 13.4 years, and 129 were males. The operative time and surgical bleeding were 390.9 ± 144.5 min and 2983.8 ± 3026.5 mL, respectively. In-hospital mortality was observed in 25 patients (9.4%), and 3 (1.1%) experienced uncontrolled bleeding (from the aortic root in two patients and coagulopathy due to dabigatran in one patient). Immediate reopening for bleeding was performed in 20 patients, and bleeding from the aortic anastomosis was observed at three proximal and two distal sites. Proximal re-dissection was observed in 18 patients; in all of which, glue was used, although two re-ruptures of the aortic root were observed among those without glue use. The rates of freedom from all-cause death, aortic death, and aortic events at postoperative 5 years were 78.5 ± 2.7%, 86.8 ± 2.1%, and 74.4 ± 2.9%, respectively. When these values were stratified according to the operative extent, no significant differences were observed. CONCLUSIONS Turn-up anastomosis facilitates short circulatory arrest, short operative time, and stable hemostasis, with few anastomotic complications during surgery for type A acute aortic dissection.
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Affiliation(s)
- Takeshi Shimamoto
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Shizuoka, Japan
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Takehiko Matsuo
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
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Gong X, Lang Q, Qin C, Meng W, Xiao Z. The effect of postoperative anticoagulation on acute aortic dissection: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1173945. [PMID: 37234372 PMCID: PMC10206123 DOI: 10.3389/fcvm.2023.1173945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Background and aim The evolution of the false lumen after the repair of acute aortic dissection has been linked to numerous adverse clinical outcomes, including increased late mortality and a higher risk of reoperation. Despite the widespread use of chronic anticoagulation in patients who have undergone repair for acute aortic dissection, the effects of this therapy on false lumen evolution and its subsequent consequences are yet to be fully understood. This meta-analysis aimed to investigate the impact of postoperative anticoagulation on patients with acute aortic dissection. Methods In PubMed, Cochrane Libraries, Embase, and Web of Science, we performed a systematic review of nonrandomized studies, comparing outcomes with postoperative anticoagulation vs. non-anticoagulation on aortic dissection. We investigated the status of false lumen (FL), aorta-related death, aortic reintervention, and perioperative stroke in aortic dissection patients with anticoagulation and non-anticoagulation. Results After screening 527 articles, seven non-randomized studies were selected, including a total of 2,122 patients with aortic dissection. Out of these patients, 496 received postoperative anticoagulation while 1,626 served as controls. Meta-analyses of 7 studies revealed significantly higher FL patency in Stanford type A aortic dissection (TAAD) postoperative anticoagulation with an OR of 1.82 (95% CI: 1.22 to 2.71; Z = 2.95; I²=0%; P = 0.93). Moreover, there was no statistically significant difference between the two groups in aorta-related death, aortic reintervention, and perioperative stroke with an OR of 1.31 (95% CI: 0.56 to 3.04; Z = 0.62; I² = 0%; P = 0.40), 0.98 (95% CI: 0.66 to 1.47; Z = 0.09; I² = 23%; P = 0.26), 1.73 (95% CI: 0.48 to 6.31; Z = 0.83; I² = 8%; P = 0.35), respectively. Conclusions Postoperative anticoagulation was associated with higher FL patency in Stanford type A aortic dissection patients. However, there was no significant difference between the anticoagulation and non-anticoagulation groups in terms of aorta-related death, aortic reintervention, and perioperative stroke.
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Affiliation(s)
- Xiangfeng Gong
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qianlei Lang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyi Qin
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
- Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Meng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
- Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenghua Xiao
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
- Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, China
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Dong Z, Yang H, Li G, Xu X, Liu H, Gu J, Li M, Gu W, Shao Y, Ni B. Preoperative Predictors of Late Aortic Expansion in Acute Type B Aortic Dissection Treated with TEVAR. J Clin Med 2023; 12:jcm12082826. [PMID: 37109163 PMCID: PMC10141654 DOI: 10.3390/jcm12082826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/10/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND A patent false lumen (FL) in patients with thoracic endovascular aortic repair (TEVAR)-treated type B aortic dissection (TBAD) can cause a significant risk for late aortic expansion (LAE). We hypothesize that preoperative features can predict the occurrence of LAE. METHODS Sufficient preoperative and postoperative follow-up clinical and imaging feature data for patients treated with TEVAR in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2020 were collected. A univariate analysis and multivariable logistic regression analysis were used to find potential risk factors of LAE. RESULTS Ninety-six patients were finally included in this study. The mean age was 54.5 ± 11.7 years and 85 (88.5%) were male. LAE occurred in 15 (15.6%) of 96 patients after TEVAR. Two preoperative factors showed strong associations with LAE according to the multivariable logistic regression analysis: preoperative partial thrombosis of the FL (OR = 10.989 [2.295-48.403]; p = 0.002) and the maximum descending aortic diameter (OR = 1.385 [1.100-1.743] per mm increase; p = 0.006). CONCLUSIONS Preoperative partial thrombosis of the FL and an increase in the maximum aortic diameter are strongly associated with late aortic expansion. Additional interventions of the FL may help to improve the prognosis of patients with the high risk of late aortic expansion.
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Affiliation(s)
- Zhiqiang Dong
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - He Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Gang Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Xinyang Xu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Hong Liu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Jiaxi Gu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Minghui Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Weidong Gu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Yongfeng Shao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Buqing Ni
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
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Prognostic Value of the Systemic Immune Inflammation Index after Thoracic Endovascular Aortic Repair in Patients with Type B Aortic Dissection. DISEASE MARKERS 2023; 2023:2126882. [PMID: 36845014 PMCID: PMC9957628 DOI: 10.1155/2023/2126882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 02/19/2023]
Abstract
The study aimed at investigating the association between postoperative inflammatory scores and aorta-related adverse events (AAEs) after thoracic endovascular aortic repair (TEVAR) for patients with type B aortic dissection (TBAD). This single-centre, retrospective cohort included all patients who underwent TEVAR for TBAD between November 2016 and November 2020 at a university hospital. The risk factors for AAEs were analyzed by Cox proportional hazards model regression. Prediction accuracy was assessed using the area under the receiver operating characteristic curves. This study included 186 patients with a mean age of 58.5 years and a median follow-up period of 26 months. A total of 68 patients developed AAEs. Age and postoperative systemic immune inflammation index (SII) (>2893) were associated with post-TEVAR AAEs (hazard ratio (HR) 1.03, p = 0.003; HR 1.88, p = 0.043, respectively). Increased postoperative SII and age are independent risk factors for AAE post-TEVAR in patients with TBAD.
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Tang Z, Liu H, Shao Y. Efficacy of CRP in combination with D-dimer in predicting adverse postoperative outcomes of patients with acute Stanford type A aortic dissection. J Cardiothorac Surg 2022; 17:71. [PMID: 35410359 PMCID: PMC8996412 DOI: 10.1186/s13019-022-01818-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 03/11/2022] [Indexed: 01/20/2023] Open
Abstract
Abstract
Purpose
The present study evaluated the efficacy of C-reactive protein (CRP) and D-dimer and the combination of them as prognostic indicators for patients with acute type A aortic dissection (ATAAD).
Methods
This is a retrospective cohort study. From January 2019 to December 2021, patients with ATAAD admitted to the emergency medicine center of our hospital within 24 h after symptoms (chest pain, back pain, abdominal pain and so on) onset were enrolled in our study. Serum concentration of CRP and D-dimer were measured during hospitalization. Logistic regression was used to evaluate the association between these two biomarkers and in-hospital adverse outcomes (IAO) by adjusting confounding factors. Predictive efficacy was assessed by area under the curve (AUC) of receiver operating characteristic curve.
Results
A total of 199 patients with ATAAD were finally enrolled. They were categorized as Non-IAO group (n = 146) and IAO group (n = 53) according to postoperative outcomes. After controlling for potentially confounding variables, we found categorized variables that admission CRP > 54.28 mg/L, admission D-dimer > 8.45 mg/L and peak D-dimer > 24.89 mg/L were independent predictors of in-hospital adverse outcomes. Multiple Logistic regression analysis revealed that the odd ratios were 2.9 for admission D-dimer > 8.45 [95% Confidence Interval (CI) 1.11–7.5, p = 0.03], 4.9 for admission CRP > 54.28 (95% CI 1.6–14.9, p = 0.005) and 5.7 for peak D-dimer > 24.89 (95% CI 2.49–13, p < 0.001). The predictive accuracy of the combination of three categorized variables (AUC: 0.867, 95% CI 0.813–0.921, p < 0.001) was superior to that of any other one alone.
Conclusion
Admission D-dimer > 8.45 mg/L, peak D-dimer > 24.89 mg/L and admission CRP > 54.28 mg/L are independent predictors of in-hospital adverse outcomes in patients with ATAAD. Combination of these three markers will improve the predictive efficacy.
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Lescan M, Mustafi M, Wilhelm V, Keller M, Schlensak C, Rosenberger P, Magunia H. The impact of dissection membrane motility on mid-term aortic remodelling after thoracic endovascular repair. Eur J Cardiothorac Surg 2022; 61:869-876. [PMID: 34747437 DOI: 10.1093/ejcts/ezab444] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess preoperative dissection flap motility and to evaluate its impact on the aortic remodelling and the development of distal stent-induced new entry after thoracic endovascular aneurysm repair (TEVAR)/frozen elephant trunk (FET). METHODS Patients with primary or residual type B dissections were included in a retrospective study with transoesophageal echocardiography analysis of the preoperative dissection flap motility assessed by the true lumen (TL) strain. Three-dimensional computing tomography centreline reconstructions before TEVAR/FET and during the follow-up were conducted to measure aortic remodelling: false lumen thrombosis, TL expansion and aortic diameters at 10 and 20 cm downstream the left subclavian artery, at the coeliac trunk and in the infrarenal aorta. All continuous variables are reported as median with first and third quartiles. RESULTS Fifty-six consecutive patients were treated with TEVAR (n = 45) or FET (n = 11) in the acute (n = 16), subacute (n = 16) and chronic (n = 24) dissection phase. At a median follow-up of 6 (3-12) months, they showed a favourable TL expansion in the descending aorta, significantly higher in the acute [+9 mm (5-12); P < 0.001] and subacute groups [+5 mm (3-8); P = 0.039] than in the chronic group [+2 mm (0-5)]. The dissection flap motility parameter TL strain was superior in the acute (P = 0.006) and subacute (P = 0.035) groups in comparison to the chronic group. The motile flap [TL strain >22.5% (median)] was associated with a higher TL expansion rate in the thoracic aorta (P = 0.009) and a comparable distal stent-induced new entry incidence (overall: 16%) in comparison to the immobile flap (P = 0.89). CONCLUSIONS The intraoperative assessment and the inclusion of the dissection flap motility parameters in the decision-making during TEVAR/FET may refine the distal endograft sizing for an improved remodelling of the TL.
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Affiliation(s)
- Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Migdat Mustafi
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Viktoria Wilhelm
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Marius Keller
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Harry Magunia
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
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Fatma K, Carine GC, Marine G, Philippe P, Valérie D. Numerical modeling of residual type B aortic dissection: longitudinal analysis of favorable and unfavorable evolution. Med Biol Eng Comput 2022; 60:769-783. [PMID: 35076858 DOI: 10.1007/s11517-021-02480-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022]
Abstract
Residual type B aortic dissection was numerically investigated to highlight the contribution of biomechanical parameters to the pathology's evolution. Patient-specific geometries from cases involving both favorable and unfavorable evolution were modeled to assess their hemodynamic features. This original approach was supported by a longitudinal study confirming the association between morphological changes, hemodynamic features, adverse clinical outcomes, and CT-angioscan observations on the same patient. Comparing one patient with unfavorable evolution with one with favorable one, we identify potential biomechanical indicators predictive of unfavorable evolution: (i) a patent false lumen with a flow rate above 50% of inlet flow rate; (ii) high wall shear stress above 18 Pa at entry tears, and above 10 Pa at some regions of the false lumen wall; (iii) low time-averaged wall shear stress in distal false lumen below 0.5 Pa; (iv) vortical structure dynamics. Although these comparisons could only be conducted on 2 patients and need to be confirmed by a larger number of cases, our findings point to these hemodynamic markers as possible candidates for early evaluation of the pathology's evolution towards an unfavorable scenario. Graphical Abstract Correlation between hemodynamics index and thrombus initiation for unfavorable case. ET2 and ET3 are entry tear numbers 2 and 3 respectively. WSS is wall shear stress. TAWSS is time average shear stress.
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Affiliation(s)
- Khannous Fatma
- Aix Marseille Univ, CNRS, IRPHE-UMR7342, Ecole Centrale, Marseille, France
| | | | - Gaudry Marine
- Aix Marseille Univ, CNRS, IRPHE-UMR7342, Ecole Centrale, Marseille, France
- Aix Marseille Univ, APHM, Timone Hospital, Department of Vascular Surgery, Marseille, France
| | - Piquet Philippe
- Aix Marseille Univ, APHM, Timone Hospital, Department of Vascular Surgery, Marseille, France
| | - Deplano Valérie
- Aix Marseille Univ, CNRS, IRPHE-UMR7342, Ecole Centrale, Marseille, France.
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An KR, de Mestral C, Tam DY, Qiu F, Ouzounian M, Lindsay TF, Wijeysundera HC, Chung JCY. Surveillance Imaging Following Acute Type A Aortic Dissection. J Am Coll Cardiol 2021; 78:1863-1871. [PMID: 34696957 DOI: 10.1016/j.jacc.2021.08.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Survivors of acute type A aortic dissection (ATAAD) repair remain at risk for long-term complications. Guidelines recommend postoperative imaging surveillance, but adherence is uncertain. OBJECTIVES The aim of this study was to define the real-world frequency of postoperative imaging and characterize long-term outcomes of ATAAD. METHODS Population-based administrative health databases for Ontario, Canada, were linked to identify patients who underwent ATAAD repair and survived at least 90 days. Guideline-directed imaging surveillance (GDIS) was defined as undergoing a computed tomographic or magnetic resonance imaging scan at 6 and 12 months postoperatively and then annually thereafter. Multivariable time-to-event analysis explored the associations between GDIS and all-cause mortality and reintervention. RESULTS A total of 888 patients who survived urgent ATAAD repair between April 1, 2005, and March 31, 2018, were included. Median follow-up after ATAAD repair was 5.2 years (interquartile range: 2.4-7.9 years). A total of 14% patients received GDIS throughout follow-up. At 6 years, 3.9% of patients had received GDIS. The mortality rate was 4% at 1 year, 14% at 5 years, and 29% at 10 years. Incidence of aortic reintervention was 3% at 1 year, 9% at 5 years, and 17% at 10 years; the majority of these were urgent (68%), and they carried a 9% 30-day mortality rate. Greater adherence to GDIS was associated with mortality (hazard ratio: 1.08; 95% confidence interval: 1.05-1.11) and reintervention (hazard ratio: 1.04; 95% confidence interval: 1.01-1.07). CONCLUSIONS Adherence to GDIS following ATAAD repair is poor, while long-term mortality and reinterventions remain substantial. Further research is needed to determine if guidelines should be modified.
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Affiliation(s)
- Kevin R An
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. https://twitter.com/KevinAnMD
| | - Charles de Mestral
- Division of Vascular Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Maral Ouzounian
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. https://twitter.com/OuzounianMD
| | - Thomas F Lindsay
- Division of Vascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. https://twitter.com/hwijeysundera
| | - Jennifer C-Y Chung
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Lin TW, Tsai MT, Wu HY, Wang YC, Hu YN, Kan CD, Roan JN, Luo CY. Outcomes of acute type A aortic dissection operations performed by early-career cardiovascular surgeons. JTCVS OPEN 2021; 6:1-10. [PMID: 36003577 PMCID: PMC9390692 DOI: 10.1016/j.xjon.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 12/03/2022]
Abstract
Objective Surgical outcomes of acute type A aortic dissection have been recognized to be associated with the surgical volume of individual hospitals and surgeons. In this study, we aimed to investigate the results and learning curves of acute type A aortic dissection operations performed by early-career cardiovascular surgeons. Methods A total of 248 surgical repairs of acute type A aortic dissections were conducted at a tertiary medical center between 2010 and 2018. By using the cumulative sum test, cardiovascular surgeons in their early career were identified, and their performances were assessed. The outcomes of patients who were operated by early-career cardiovascular surgeons were compared with those by experienced or senior surgeons. Results During the study period, 202 (81.5%) of the 248 acute type A aortic dissection operations were performed primarily by the 4 newly appointed attending cardiovascular surgeons. In cumulative sum curves, all surgeons exhibited a steady performance throughout the study period. On the basis of our institutional result of acute type A aortic dissection operation, early career was defined as performing fewer than 32 acute type A aortic dissection operations. The 30-day mortality rates of acute type A aortic dissection operations performed by early-career surgeons were equivalent to those performed by experienced/senior surgeons (10.9% vs 12.5%, P = .844). There was also no difference in mid-term overall survival and aortic event-free survival between the 2 groups (P = .638 and P = .574, respectively). Conclusions In a center with a well-established program, cardiovascular surgeons could accomplish surgical repair of acute type A aortic dissection with adequate early- and mid-term results from the initiation of their careers.
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Endovascular Treatment of Post Type A Chronic Aortic Arch Dissection With a Branched Endograft: Early Results From a Retrospective International Multicenter Study. Ann Surg 2021; 273:997-1003. [PMID: 30973389 DOI: 10.1097/sla.0000000000003310] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the outcome of endovascular aortic arch repair for chronic dissection with a custom-made branched endograft. BACKGROUND Acute type A aortic dissections are often treated with prosthetic replacement of the ascending aorta. During follow-up, repair of an aneurysmal evolution of the false lumen distal to the ascending prosthesis can be a challenge both for the surgeon and the patient. METHODS We conducted a multicenter, retrospective study of consecutive patients from 14 vascular units treated with a custom-made, inner-branched device (Cook Medical, Bloomington, IN) for chronic aortic arch dissection. Rates of in-hospital mortality and stroke, technical success, early and late complications, reinterventions, and mortality during follow-up were evaluated. RESULTS Seventy consecutive patients were treated between 2011 and 2018. All patients were considered unfit for conventional surgery. In-hospital combined mortality and stroke rate was 4% (n = 3), including 1 minor stroke, 1 major stroke causing death, and 1 death following multiorgan failure. Technical success rate was 94.3%. Twelve (17.1%) patients required early reinterventions: 8 for vascular access complication, 2 for endoleak correction, and 2 for pericardial effusion drainage. Median follow-up was 301 (138-642) days. During follow-up, 20 (29%) patients underwent secondary interventions: 9 endoleak corrections, 1 open repair for prosthetic kink, and 10 distal extensions of the graft to the thoracic or thoracoabdominal aorta. Eight patients (11%) died during follow-up because of nonaortic-related cause in 7 cases. CONCLUSIONS Endovascular treatment of aortic arch chronic dissections with a branched endograft is associated with low mortality and stroke rates but has a high reintervention rate. Further follow-up is required to confirm the benefits of this novel approach.
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Santamaria V, Schirone L, Vinciguerra M, De Bellis A, Greco E. Predictors for outcome in type A aortic dissection: A focus on false lumen. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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16
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Zhu H, Zhang L, Liang T, Li Y, Zhou J, Jing Z. Elevated preoperative neutrophil-to-lymphocyte ratio predicts early adverse outcomes in uncomplicated type B aortic dissection undergoing TEVAR. BMC Cardiovasc Disord 2021; 21:95. [PMID: 33593284 PMCID: PMC7885432 DOI: 10.1186/s12872-021-01904-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Thoracic aortic endovascular repair (TEVAR) of uncomplicated type B aortic dissection (uTBAD) has favorable long-term outcomes but higher early adverse events compared with the optimal medical treatment. Recently, clinical evidence concerning vascular surgery indicates that elevated preoperative systemic inflammatory response predicts adverse clinical events. The aim of our study was to evaluate the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and early outcomes of uTBAD patients undergoing TEVAR. RESULTS 216 patients diagnosed with uTBAD were included in this retrospective study between January 2015 and December 2018. The median (IQR) follow-up period was 21 (15-33) months. An early adverse event was defined as occurring within 2 years after the procedure. Median patient age was 60 (IQR, 48-68) years and 78.7 % were male. Early adverse events occurred in 24 patients (11.1 %). In the multivariable analysis, preoperative NLR (HR per SD, 1.98; 95 % CI, 1.14-3.44; P = 0.015) was associated with 2-year adverse events. CONCLUSIONS NLR is an independent predictive factor of early adverse events in uTBAD patients undergoing TEVAR.
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Affiliation(s)
- Hongqiao Zhu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Taiping Liang
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Yiming Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China.
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Roselli EE. Commentary: Embracing the future by bracing the arch. J Thorac Cardiovasc Surg 2020; 163:576-577. [DOI: 10.1016/j.jtcvs.2020.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
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Relationship of Platelet Counts and Inflammatory Markers to 30-Day Mortality Risk in Patients with Acute Type A Aortic Dissection. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1057496. [PMID: 32382526 PMCID: PMC7191390 DOI: 10.1155/2020/1057496] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/17/2022]
Abstract
Markers of prothrombotic state and inflammation are associated with the prognosis of patients with acute type A aortic dissection (AAAD). However, it is unclear that the relationship between these biomarkers and their combined impact on risk stratification. The present study evaluated the prognostic value of platelet counts, lymphocyte to neutrophil ratio (LNR), and lymphocyte to monocyte ratio (LMR), alone and in combination. A retrospective analysis of clinical data of 744 AAAD patients was conducted to identify whether these biomarkers were related to the 30-day mortality risk. A Kaplan-Meier analysis and log-rank test were used to compare survival between groups. A Cox hazard regression multivariable analysis was performed for 30-day mortality. Individual biomarker (platelet count, LNR, or LMR) was unable to predict 30-day mortality. However, combinations of all three biomarkers provided additive predictive value over either marker alone, the receiver operating characteristic (ROC) model had a prediction probability of 0.739 when platelet counts, LNR, and LMR were included. Cox hazard regression multivariable analysis showed that combinations of all three biomarkers were the strongest predictor of 30-day mortality (p < 0.021). Combined with these three easily measurable biomarkers at admission, they could help identify AAAD patients with a high risk of 30-day mortality.
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Gao Z, Pei X, He C, Wang Y, Lu J, Jin M, Cheng W. Oxygenation impairment in patients with acute aortic dissection is associated with disorders of coagulation and fibrinolysis: a prospective observational study. J Thorac Dis 2019; 11:1190-1201. [PMID: 31179061 DOI: 10.21037/jtd.2019.04.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Stanford type-A acute aortic dissection (AAD) is typically accompanied by oxygenation impairment before surgery. In addition, inflammation, coagulation and fibrinolysis also impair blood oxygenation. However, our understanding of the concentration of these factors in bronchoalveolar lavage fluid (BALF) has not been reported. The objective of the study was to investigate the impact of preoperative acute lung injury (ALI) on postoperative oxygenation impairment and to explore the effect of coagulation and fibrinolysis in blood and BALF. Methods This investigation utilized a prospective observational study design, which was registered at www.clinicaltrials.gov (identifier NCT01894334). The study included 53 patients undergoing surgery for Stanford type-A AAD at an academic hospital in China between October 2013 and July 2014. Preoperative ALI was identified according to the oxygenation index calculated by the PaO2/FiO2 ratio. The subjects were divided into the ALI group (oxygenation index ≤300 mmHg) or the control group (oxygenation index >300 mmHg). The primary outcome was patient oxygenation index, while secondary outcomes were concentrations of tissue factor (TF), tissue factor pathway inhibitor (TFPI), and plasminogen activator inhibitor-1 (PAI-1) in serum and BALF. Results The incidence of preoperative ALI for Stanford type-A AAD patients was 41.5%. Stanford type-A AAD patients with preoperative ALI had a lower postoperative oxygenation index (104.6±31.7 vs. 248.7±48.0 mmHg, P<0.001), higher concentrations of TF in serum and BALF (F=133.67, P<0.001; F=68.14, P<0.001), higher concentrations of TFPI in serum and BALF (F=31.98, P<0.001; F=45.58, P<0.001), and higher concentrations of PAI-1 in serum and BALF (F=213.88, P<0.001; F=107.95, P<0.001) when compared with those without preoperative ALI. Type-A AAD patients also showed a greater loss of blood (1,524±458 vs. 1,175±327 mL, P=0.040), longer mechanical ventilation time in the ICU (27.24±8.37 vs. 17.33±7.36 h, P<0.001), longer total stay in the ICU (42.27±10.85 vs. 33.45±9.05 h, P=0.002), and longer total hospital stay (17.77±5.00 vs. 13.48±3.97 days, P=0.001). Multivariate linear regression analysis indicated that preoperative PAI-1 in BALF, and TF in both serum and BALF were significantly associated with preoperative oxygenation impairment in patients with Stanford type-A AAD. Conclusions Preoperative ALI caused more serious postoperative oxygenation impairment for Stanford type-A AAD, and coagulation and fibrinolysis appear to play critical roles in this process. Preoperative PAI-1 in BALF and TF in both serum and BALF were significant factors related to the occurrence of preoperative oxygenation impairment for Stanford type-A AAD.
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Affiliation(s)
- Zhifeng Gao
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China.,Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Xin Pei
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Chen He
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Yuefeng Wang
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Jiakai Lu
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Mu Jin
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Weiping Cheng
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
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Bozso SJ, Nagendran J, MacArthur RG, Chu MW, Kiaii B, El-Hamamsy I, Cartier R, Shahriari A, Moon MC. Dissected Aorta Repair Through Stent Implantation trial: Canadian results. J Thorac Cardiovasc Surg 2019; 157:1763-1771. [DOI: 10.1016/j.jtcvs.2018.09.120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/08/2018] [Accepted: 09/04/2018] [Indexed: 11/15/2022]
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Intentional Targeted False Lumen Occlusion after Aortic Dissection: A Systematic Review of the Literature. Ann Vasc Surg 2019; 56:317-329. [DOI: 10.1016/j.avsg.2018.08.086] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022]
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Matalanis G, Ip S. A new paradigm in the management of acute type A aortic dissection: Total aortic repair. J Thorac Cardiovasc Surg 2019; 157:3-11. [DOI: 10.1016/j.jtcvs.2018.08.118] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/06/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
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Kodama H, Takahashi S, Okazaki T, Morita S, Go S, Watanabe M, Yamane Y, Katayama K, Kurosaki T, Sueda T. Association between false lumen segmental arteries and spinal cord ischemia in type A acute aortic dissection. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 61:226-233. [PMID: 30465415 DOI: 10.23736/s0021-9509.18.10639-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Spinal cord ischemia (SCI) and paraplegia are complications of surgery for type A acute aortic dissection (TAAAD). Since the segmental arteries play a key role in SCI, this study evaluated the association between SCI and false lumen segmental arteries (FLSAs: segmental arteries originating from the false lumen). METHODS The study included 101 consecutive TAAAD patients (mean age, 66±13; range, 34-89 years) who underwent surgery from January 2011 to April 2017. The diagnosis of TAAAD and the number of FSLAs were determined by preoperative computed tomography (CT). Patients were divided into two groups according to the number of FLSAs at the Th9-L2 level: Group A (N.=13), ≥8 FLSAs; and group B (N.=88), ≤7 FLSAs. Preoperative, perioperative, and postoperative findings were compared between the groups, and risk factors for SCI were evaluated. RESULTS The frequency of preoperative paralysis was significantly higher in Group A than Group B (P=.0070). The overall incidence of postoperative SCI was 8% (8/101) and significantly higher in Group A than Group B (5/13 [45%] vs. 3/88 (4%), P<0.0001). Hospital mortality was 8% (8/101) and significantly higher in Group A than Group B (3/13 [23%] vs. 5/88 [6%], P=.0302). Multivariate analysis showed that the independent risk factors for SCI were ≥8 FLSAs at Th9-L2 (odds ratio [OR], 20.4; 95% confidence interval [95% CI], 3.34-124.9, P=0.0011) and diabetes mellitus (OR, 22.3; 95% CI, 1.69-294.5; P=0.0184). CONCLUSIONS In patients who underwent surgery for TAAAD, ≥8 FLSAs at the Th9-L2 levels on preoperative CT was a risk factor for SCI.
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Affiliation(s)
- Hiroshi Kodama
- Department of Cardiovascular Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University School of Medicine, Hiroshima, Japan -
| | - Takanobu Okazaki
- Department of Cardiovascular Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Shohei Morita
- Department of Cardiovascular Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Seimei Go
- Department of Cardiovascular Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Masazumi Watanabe
- Department of Cardiovascular Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Yoshitaka Yamane
- Department of Cardiovascular Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Keijiro Katayama
- Department of Cardiovascular Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Tatsuya Kurosaki
- Department of Cardiovascular Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Taijiro Sueda
- Department of Cardiovascular Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
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Girardi LN. Is a more extensive operation justified for acute type A dissection repair? J Thorac Cardiovasc Surg 2018; 157:12-13. [PMID: 30396732 DOI: 10.1016/j.jtcvs.2018.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
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Shimamoto T, Komiya T, Tsuneyoshi H. Fate of uncomplicated acute type B aortic dissection and impact of concurrent aortic dilatation on remote aortic events. J Thorac Cardiovasc Surg 2018; 157:854-863. [PMID: 30201125 DOI: 10.1016/j.jtcvs.2018.05.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 04/08/2018] [Accepted: 05/13/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to describe the reliable prognostic factors of mortality and subsequent aortic events during the follow-up of uncomplicated type B acute aortic dissection. METHODS From January 2004 to December 2014, 255 patients with uncomplicated type B acute aortic dissection were admitted to our hospital. Cox proportional hazards analysis was performed to identify risk factors for all-cause mortality, aorta-related mortality, and aortic events. RESULTS In-hospital mortality was observed in 7 patients (2.7%). The rates of 5-year freedom from all-cause mortality, aorta-related mortality, and aortic events were 79.4% ± 2.9%, 93.3% ± 2.0%, and 71.7% ± 3.4%, respectively. The rate of 5-year freedom from aortic events was significantly lower among those with a patent false lumen (P = .006). Age and descending aorta diameter were independent risk factors of all-cause and aorta-related mortality (hazard ratio [HR], 1.08 and 1.13; 95% confidence interval [CI], 1.04-1.10 and 1.03-1.24; P = .0001 and .007, respectively). Independent risk factors for aortic events were descending aorta diameter, false lumen thickness, and dilatation of abdominal aorta (HR, 1.06; 95% CI, 1.02-1.12; P = .006; HR, 1.07; 95% CI, 1.04-1.11; P = .00002; HR, 2.01; CI, 1.20-3.38; P = .008). CONCLUSIONS In uncomplicated type B acute aortic dissection, the age and dilatation of the thoracic aorta were associated with a higher risk of death, whereas false lumen thickness and concurrent abdominal aortic dilatation augment the risk for aortic events.
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Affiliation(s)
- Takeshi Shimamoto
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan.
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
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Itagaki R, Kimura N, Mieno M, Hori D, Itoh S, Akiyoshi K, Yuri K, Tanno K, Kawahito K, Yamaguchi A. Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D-Dimer Concentration. J Am Heart Assoc 2018; 7:JAHA.118.009144. [PMID: 29987123 PMCID: PMC6064831 DOI: 10.1161/jaha.118.009144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Clinical characteristics and treatment outcomes of acute type A aortic dissection with D‐dimer elevation have not been clarified. Methods and Results D‐dimer was measured preoperatively within 24 hours of symptom onset in 262 patients with acute type A aortic dissection. The median (and interquartile range) admission D‐dimer concentration in our total patient group was 26.7 (8.3–85.9) μg/mL. Median (interquartile range) D‐dimer concentrations were 5.0 (2.6–18.0) μg/mL for complete false lumen thrombosis (n=33), 60.9 (19.4–160.4) μg/mL for partial thrombosis (n=81), 26.5 (10.0–70.6) μg/mL for a patent false lumen (n=131), and 8.7 (3.2–26.9) μg/mL for ulcerlike projection (n=17) (P<0.01). With a D‐dimer concentration of ≤8.3 μg/mL representing the lower quartile, we then investigated predictors of a low D‐dimer level. Multivariate analysis showed dissection limited to the ascending aorta (P<0.01; odds ratio, 9.81) or descending aorta (P<0.01; odds ratio, 7.68), a completely thrombosed false lumen (P<0.01; odds ratio, 4.02), and absence of brain ischemia (P=0.013; odds ratio, 4.74) to be predictors of the lower D‐dimer concentration. Compared with patients with a low D‐dimer concentration (≤8.3 μg/mL, n=66), patients with a D‐dimer concentration >8.3 μg/mL (n=196) had a reduced preoperative platelet count and increased operation time and transfusion volume. In‐hospital mortality was elevated in this group (1.5% versus 11.2%; P=0.031), although 7‐year survival did not differ for hospital survivors (lower versus higher, 93.1% versus 79.1%; P=0.21). Conclusions D‐dimer concentrations are strongly influenced by the extent of dissection and false lumen status. Operative risks are increased in patients with a relatively high D‐dimer concentration.
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Affiliation(s)
- Ryo Itagaki
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan
| | - Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Satoshi Itoh
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kei Akiyoshi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keisuke Tanno
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koji Kawahito
- Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Rohlffs F, Spanos K, Tsilimparis N, Debus ES, Kölbel T. Techniques and outcomes of false lumen embolization in chronic type B aortic dissection. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 59:784-788. [PMID: 29943961 DOI: 10.23736/s0021-9509.18.10638-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endovascular strategies have been increasingly used for the treatment of chronic type B aortic dissection (cTBAD) offering better outcomes in terms of mortality and morbidity compared to open surgical repair. Aortic remodeling after standard TEVAR is less likely in cTBAD due to rigidity of the dissection membrane. Another limitation of endovascular therapy is continued retrograde false lumen perfusion with back-flow from distal entry tears. Treatment strategies in cTBAD should aim at false lumen thrombosis. There are many approaches to achieve this goal of false lumen thrombosis, but concepts as open surgery or fenestrated and branched endovascular repair are limited by either high technical and logistic demands to the surgeon or high rates of mortality and morbidity. False lumen embolization techniques offer less invasive treatment strategies with promising early results. The main strategies for false lumen embolization include the "cork in the bottle neck" technique, the Candy-Plug technique or the Knickerbocker-technique. This article describes technical aspects and early results of these new endovascular techniques of false lumen embolization in chronic aortic dissection.
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Affiliation(s)
- Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany -
| | - Konstantinos Spanos
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Eike S Debus
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Matalanis G, Ip S. Total aortic repair for acute type A aortic dissection: a new paradigm. J Vis Surg 2018; 4:79. [PMID: 29780725 DOI: 10.21037/jovs.2018.04.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/23/2018] [Indexed: 01/16/2023]
Abstract
The currently accepted guidelines of open surgical repair for acute type A aortic dissection (ATAAD) include the resection of the primary entry tear, replacement of the ascending aorta and "hemi-arch" with an open distal anastomosis, and aortic valve resuspension and some form of obliteration of the aortic root false lumen. The principal aim being protection against aortic rupture, aortic regurgitation, and coronary ischemia and restoration of antegrade preferential true lumen perfusion. Proponents argue that this operation is tailored to be in the armamentarium of most cardiac surgeons and deliver the lowest early operative risk, while leaving the infrequent long-term sequelae to be dealt with electively by experienced aortic centres. While a superficially compelling argument, the actual outcomes suggest that it falls significantly short of achieving its noble goals on both acute and chronic counts. This led us to develop a seemingly more radical but in practise safe paradigm, which aims to achieve total aortic healing in the acute phase.
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Affiliation(s)
- George Matalanis
- Department of Cardiac Surgery, Austin Hospital, Heidelberg, Australia
| | - Shoane Ip
- Department of Cardiac Surgery, Austin Hospital, Heidelberg, Australia
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Bonci G, Steigner ML, Hanley M, Braun AR, Desjardins B, Gaba RC, Gage KL, Matsumura JS, Roselli EE, Sella DM, Strax R, Verma N, Weiss CR, Dill KE. ACR Appropriateness Criteria® Thoracic Aorta Interventional Planning and Follow-Up. J Am Coll Radiol 2017; 14:S570-S583. [DOI: 10.1016/j.jacr.2017.08.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
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Dohle DS, Jakob H, Schucht R, Janosi RA, Schlosser T, El Gabry M, Wendt D, Thielmann M, Tsagakis K. The impact of entries and exits on false lumen thrombosis and aortic remodelling†. Eur J Cardiothorac Surg 2017; 52:508-515. [DOI: 10.1093/ejcts/ezx236] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 05/07/2017] [Indexed: 01/16/2023] Open
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Lin TW, Tsai MT, Hu YN, Lin WH, Wang WM, Luo CY, Roan JN. Postoperative Extracorporeal Membrane Oxygenation Support for Acute Type A Aortic Dissection. Ann Thorac Surg 2017; 104:827-833. [PMID: 28267980 DOI: 10.1016/j.athoracsur.2017.01.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 01/08/2017] [Accepted: 01/10/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Few studies have investigated the use of postoperative extracorporeal membrane oxygenation (ECMO) in acute type A aortic dissection (aTAAD). We identified aTAAD surgical patients at risk of ECMO implantation postoperatively and analyzed the prognosis of these patients. METHODS We retrospectively reviewed 162 consecutive aTAAD patients undergoing operations from January 2008 to December 2015. Patient data were analyzed for risk factors leading to an ECMO requirement. Short-term and long-term outcomes in patients who did and did not require ECMO were compared. RESULTS Postoperative ECMO was required in 20 patients (12.3%), and in-hospital mortality was higher in the ECMO group (65.0% vs 8.5%, p < 0.001). Factors predicting postoperative ECMO were preoperative hemodynamic instability (p = 0.049), aortic cross-clamp time (p = 0.036), and postoperative peak creatinine kinase-MB (p = 0.002). ECMO survivors presented at a younger age (p = 0.036) and had a less postoperative blood transfusion (p = 0.034) than ECMO nonsurvivors. The postdischarge survival rate was equivalent in patients with or without ECMO support. CONCLUSIONS Although postoperative ECMO is an important predictor of in-hospital death, this pilot study showed that aTAAD patients supported with postoperative ECMO who survive to hospital discharge have a long-term survival comparable to patients who did not receive ECMO.
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Affiliation(s)
- Ting-Wei Lin
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Ta Tsai
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ning Hu
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Hung Lin
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ming Wang
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chwan-Yau Luo
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jun-Neng Roan
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Pan XD, Li B, Ma WG, Zheng J, Liu YM, Zhu JM, Huang LJ, Sun LZ. Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection. J Thorac Dis 2017; 9:529-536. [PMID: 28449459 DOI: 10.21037/jtd.2017.03.04] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In patients with type A dissection, residual dissection and new distal entry tears following the frozen elephant trunk (FET) procedure adversely affect long-term prognosis. Management include open and endovascular repair, while clinical experience is limited. We evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) in management of residual intimal tear or distal new entry tear following FET in patients with type A aortic dissection (TAAD). METHODS Between May 2003 and April 2013, we performed FET and total arch replacement for 1,003 patients with TAAD. Among these, 23 patients (2.3%) required TEVAR for distal new entry (n=2) or residual intimal tear (n=21) at a mean of 2.0±1.6 years after FET. Mean age was 50.1±11.5 years. Marfan syndrome was seen in 2 patients (8.7%). RESULTS Procedural success was 100%. The distal landing zone was above the 11th thoracic vertebra (T11) in 86.9% (20/23). Neither death nor any paraplegia or stroke occurred early after TEVAR. Follow-up was complete in 100% averaging 2.8±1.7 years (0.3-6.4). One non-Marfan patient died of distal aortic rupture at 4 months after TEVAR. No late stroke or paraplegia occurred. Survival was 95.7% (95% CI, 72.9-99.4%) at 3 and 5 years, respectively. CTA detected false lumen obliteration by thrombus around the endograft in the descending aorta in 91.3% (21/23) of patients. CONCLUSIONS These early and midterm outcomes show the efficacy of TEVAR in obliterating the residual intimal tear or distal new entry after FET in patients with TAAD. TEVAR may be an alternative approach to distal new entry or residual intimal tear following FET for patients with TAAD.
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Affiliation(s)
- Xu-Dong Pan
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Bin Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Jun Zheng
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Yong-Min Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Jun-Ming Zhu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Lian-Jun Huang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
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Tanaka A, Ishii H, Suzuki S, Ota T, Oshima H, Usui A, Komori K, Murohara T. Influence of False Lumen Status on the Prognosis of Acute Type A Aortic Dissection without Urgent Surgical Treatment. J Atheroscler Thromb 2017; 24:169-175. [PMID: 27466158 PMCID: PMC5305677 DOI: 10.5551/jat.35675] [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] [Indexed: 11/11/2022] Open
Abstract
AIM Recently, much attention has been focused on partial thrombosis of the false lumen in patients with acute aortic dissection. However, its effect on clinical outcomes in these patients, especially in case of acute type A aortic dissection, has not been clearly elucidated. This study evaluated the influence of the false lumen status, including partial thrombosis, on short-term clinical outcomes in acute type A aortic dissection patients without urgent surgical treatment. METHODS Sixty-two patients (29 males, mean age 73±13 years) with acute type A aortic dissection who did not receive urgent surgical treatment at four hospitals were enrolled. Patients were divided into three groups based on the false lumen status on enhanced computed tomography image (complete thrombosis, n=28; partial thrombosis, n=27; patent, n=7). Patients with partial thrombosis were further divided into two groups (thrombus-dominant, n=15; flow-dominant, n=12). RESULTS The short-term mortality rate (in-hospital and 30-day) was significantly higher in patients with a patent false lumen, while no significant difference was seen between the other two groups. Patients with flow-dominant partial thrombosis had significantly higher short-term mortality rate than those with thrombus-dominant partial thrombosis (in-hospital, p=0.001 and 30-day, p<0.001). CONCLUSIONS The short-term mortality rate in acute type A aortic dissection patients without urgent surgical treatment was lower in patients with partial thrombosis of the false lumen than in those with a patent false lumen. Furthermore, patients with flow-dominant partial thrombosis had higher mortality rate than those with thrombus-dominant partial thrombosis.
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Affiliation(s)
- Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Choo SJ, Kim JB. Editorial on the article entitled "the impact of intimal tear location and partial false lumen thrombosis in acute type b aortic dissection". J Thorac Dis 2016; 8:E1331-E1332. [PMID: 27867619 DOI: 10.21037/jtd.2016.10.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Mean platelet volume to platelet count ratio predicts in-hospital complications and long-term mortality in type A acute aortic dissection. Blood Coagul Fibrinolysis 2016; 27:653-9. [DOI: 10.1097/mbc.0000000000000449] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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36
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Tanaka A, Sandhu HK, Estrera AL. Descending endografts for type A dissections: con. Ann Cardiothorac Surg 2016; 5:227-32. [PMID: 27386411 DOI: 10.21037/acs.2016.04.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An important goal of surgical repair of type A aortic dissection is to resect the intimal tear. Studies on the fate of residual dissection after acute type A aortic dissection repair in the past decade have driven surgeons to seek procedures to avoid distal reoperation. Aggressive surgical approach with total arch replacement in acute type A dissection has demonstrated lower incidence of distal reoperation and slower aortic growth rate compared to less aggressive ascending/hemiarch repair. Recently, successful results of thoracic endovascular aortic repair (TEVAR) in type B aortic dissection have encouraged surgeons to further attack acute type A aortic dissection with hybrid approach: antegrade endografting in the descending thoracic true lumen as an adjunct to hemiarch or total arch repair. However, is the hybrid approach with simultaneous descending endografting justified in all the acute type A aortic dissection cases? The outcomes of the hybrid approach reported by the several groups have demonstrated 80-100% of false lumen thrombus formation in the proximal descending aorta (stented segment); however, the complete obliteration of the false lumen is only 17-50%. The incidence of distal reoperation/reintervention after hybrid approach is as high as 14% and an adjunctive procedure is often performed. Moreover, there are concerns about additional risks associated with the hybrid procedures, such as spinal cord injury (SCI), stent graft induced new entry and stroke. The data on this new approach are still very limited. Hence, further study is warranted to prove its safety and durability.
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Affiliation(s)
- Akiko Tanaka
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann Hospital, Houston, TX, USA
| | - Harleen K Sandhu
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann Hospital, Houston, TX, USA
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann Hospital, Houston, TX, USA
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Settepani F, Cappai A, Basciu A, Barbone A, Citterio E, Ornaghi D, Tarelli G. Hybrid Versus Conventional Treatment of Acute Type A Aortic Dissection. J Card Surg 2015. [DOI: 10.1111/jocs.12598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Fabrizio Settepani
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Antioco Cappai
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Alessio Basciu
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Alessandro Barbone
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Enrico Citterio
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Diego Ornaghi
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
| | - Giuseppe Tarelli
- Department of Cardiac Surgery; Humanitas Clinical and Research Center; Rozzano, Milano Italy
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38
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Li DZ, Li XM, Sun HP, Yang YN, Ma YT, Qu YY, Ma X, Liu F. A novel simplified thrombo-inflammatory prognostic score for predicting in-hospital complications and long-term mortality in patients with type A acute aortic dissection: a prospective cohort study. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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40
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Kimura N, Itoh S, Yuri K, Adachi K, Matsumoto H, Yamaguchi A, Adachi H. Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg 2015; 149:S91-8.e1. [DOI: 10.1016/j.jtcvs.2014.08.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/02/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
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Coselli JS, Green SY, Zarda S, Nalty CC, Price MD, Hughes MS, Preventza O, de la Cruz KI, LeMaire SA. Outcomes of open distal aortic aneurysm repair in patients with chronic DeBakey type I dissection. J Thorac Cardiovasc Surg 2014; 148:2986-93.e1-2. [DOI: 10.1016/j.jtcvs.2014.07.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 11/25/2022]
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Esposito G, Cappabianca G, Bichi S, Cricco A, Albano G, Anzuini A. Hybrid repair of type A acute aortic dissections with the Lupiae technique: ten-year results. J Thorac Cardiovasc Surg 2014; 149:S99-104. [PMID: 25256081 DOI: 10.1016/j.jtcvs.2014.07.099] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/14/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Replacing the ascending aorta and the arch in patients with type A acute aortic dissection achieves good short-term results, but several patients are left with distal intimal tears or a patent false lumen in the descending aorta. In this series, we report the 10-year experience with the Lupiae technique, a hybrid aortic repair technique for patients with type A acute aortic dissection. METHODS From 2003 to 2013, 89 patients with type A acute aortic dissections underwent replacement of the ascending aorta, the arch, and the rerouting of the neck vessels on the ascending aorta, creating a proximal Dacron landing zone for a completion with thoracic endovascular aortic repair if necessary. RESULTS In-hospital mortality was 8.9%. In 16 patients, the false lumen healed spontaneously, whereas the remaining 65 patients underwent thoracic endovascular aortic repair. One patient died after thoracic endovascular aortic repair. Eighty patients were followed up. Complete thrombosis of the false lumen was obtained in 93.8% of patients. The median follow-up was 46 ± 35 months. Overall 8-year survival was 93.7% ± 5%, 100% for patients with spontaneously healed residual false lumen after just type A acute aortic dissection repair and 92.3% ± 7.7% for patients who underwent thoracic endovascular aortic repair after type A acute aortic dissection repair. In 10 years, 1 patient underwent a reoperation on the distal aorta (1.25%). CONCLUSIONS The availability of a Dacron landing zone on the distal ascending aorta after type A acute aortic dissection repair allows the exclusion, with a thoracic endovascular aortic repair, of any residual intimal tear refilling a patent false lumen. This approach seems to be associated with a high probability of false lumen thrombosis and low rates of reoperations on the distal aorta.
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Affiliation(s)
- Giampiero Esposito
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | | | - Samuele Bichi
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonio Cricco
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Giovanni Albano
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Angelo Anzuini
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
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