Long-Term Outcome and Quality of Life in Aortic Type A Dissection Survivors

The Long-Term Outcome and Quality of Life after Replacement of the Ascending Aorta

(1) Background: Despite optimal surgical therapy, replacement of the ascending aorta leads to a significant reduction in the quality of life (QoL). However, an optimal result includes maintaining and improving the QoL. The aim of our study was to evaluate the long-term outcome and the QoL in patients with aneurysms in the ascending aorta; (2) Methods: Between 2014 and 2020, 121 consecutive patients who underwent replacement of the ascending aorta were included in this study. Acute aortic pathologies were excluded. A standard short form (SF)-36 questionnaire was sent to the 112 survivors. According to the surgical procedure, patients were divided into two groups (A: supracoronary replacement of the aorta, n = 35 and B: Wheat-, David- or Bentall-procedures, n = 86). The QoL was compared within these groups and to the normal population, including myocardial infarction (MI), coronary artery disease (CAD) and cancer (CAN) patients; (3) Results: 83 patients were males (68.6%) with a mean age of 62.0 ± 12.5 years. Early postoperative outcomes showed comparable results between groups A and B, with a higher re-thoracotomy rate in B (A: 0.0% vs. B: 22.1%, p = 0.002). The 30-day mortality was zero. Overall, mortality during the follow-up was 7.4%. The SF-36 showed a significant decay in both the Physical (PCS) and Mental Component Summary (MCS) in comparison to the normal population (PCS: 41.1 vs. 48.4, p < 0.001; MCS: 42.1 vs. 50.9, p < 0.001) but without significant difference between both groups. Compared to the MI and CAD patients, significantly higher PCS but lower MCS scores were detected (p < 0.05); (4) Conclusions: Replacement of the ascending aorta shows low risk regarding the operative and postoperative outcomes with satisfying long-term results in the QoL. The extent of the surgical procedure does not influence the postoperative QoL.

Social support and self-efficacy multiply mediate the relationship between medical coping style and resilience in patients with type A aortic dissection

Background

Previous research has shown that medical coping modes are associated with resilience in cardiovascular disease patients. However, postoperatively, the mechanism underlying this association in Stanford type A aortic dissection patients is poorly understood.

Objective

This study investigated the mediating effects of social support and self-efficacy on the relationship between medical coping modes and resilience in Stanford type A aortic dissection patients postoperatively.

Methods

We assessed 125 patients after surgery for Stanford type A aortic dissection using the Medical Coping Modes Questionnaire, the General Self-Efficacy Scale, the Social Support Rating Scale, and the Connor-Davidson Resilience Scale. Structural equation modeling with AMOS (v.24) was used to test the hypothesized model with multiple mediators. Both direct and mediational effects (through social support and self-efficacy) of medical coping modes on resilience outcomes were examined.

Results

The mean Connor-Davidson Resilience Scale score was 63.78 ± 12.29. Confrontation, social support, and self-efficacy correlated with resilience (r = 0.40, 0.23, 0.72, respectively; all p < 0.01). In multiple mediation models, social support independently (effect = 0.11; 95% confidence interval [CI], 0.04-0.27) and social support and self-efficacy serially (effect = 0.06; 95% CI, 0.02-0.14) mediated the association of confrontation with resilience maintenance, accounting for 57.89 and 10.53% of the total effect, respectively.

Conclusion

Social support and self-efficacy were multiple mediators of the relationship between confrontation and resilience. Interventions designed to facilitate confrontation and subsequently increase social support and self-efficacy may be useful to increase resilience in Stanford type A aortic dissection patients.

The relationship between quality of life and health promotion behavior in patients with type B aortic dissection: a cross-sectional study

BACKGROUND

To understand the current situation of health promotion behavior and quality of life among aortic dissection survivors and the correlation between them.

METHODS

Sociodemographic characteristics were collected. T-test and variance analysis were applied for univariate analysis. Quality of life was measured using the SF-36 Questionnaire, and health-promoting behaviors were measured using the aortic dissection health promotion behavior questionnaire. The association between type B aortic dissection survivors' health promotion behavior and health status questionnaire (SF-36) scores was determined through Pearson's correlation coefficients. This association was analyzed through multivariable regression analysis.

RESULTS

A total of 131 type B aortic dissection survivors were evaluated through the self-developed aortic dissection patient health promotion behavior scale and health status questionnaire (SF-36). Results showed that the health promotion behavior of Stanford B aortic dissection survivors (85.05 ± 11.28) correlated with their Mental Component Summary (MCS) (55.23 ± 30.72; r = 0.359, P < 0.01). The model showed 39.00% variance shared between behavior motivation and MCS (R² = 0.390, F = 13.189, P < 0.01).

CONCLUSION

Type B aortic dissection survivors in Zunyi, China had a lower quality of life. Medical staff can formulate intervention measures from behavioral motivation to improve the quality of life of aortic dissection survivors.

Outcomes of surgery for acute type A dissection in octogenarians versus non-octogenarians: a systematic review and meta analysis

INTRODUCTION

Acute Type A Aortic Dissection (ATAAD) is a cardiothoracic emergency that requires urgent intervention. Elderly status, particularly age over 80, is an independent risk factor for mortality and morbidity. The mid-term outcomes of this age group are also unknown. This systematic review and meta-analysis of observational studies was therefore performed to analyse short- and mid-term mortality and morbidity in octogenarians following surgery for ATAAD.

METHODS

A systematic review was conducted for studies published since January 2000. The primary endpoint was short-term mortality, either reported as 30-day mortality or in-hospital mortality and medium-term (five year) survival. Secondary endpoints were rates of postoperative complications, namely stroke, acute renal failure (ARF), re-exploration and intensive care unit (ICU) length of stay (LOS).

RESULTS

A total of 16 retrospective studies, with a total of 16, 641 patients were included in the systematic review and meta-analysis. Pooled analysis demonstrated that octogenarian cohorts are at significantly higher risk of short-term mortality than non-octogenarians (OR 1.93; 95% CI 1.33-2.81; P < 0.001). Actuarial survival was significantly lower in the octogenarian cohort, with a five-year survival in the octogenarian cohort of 54% compared to 76% in the non-octogenarian cohort (P < 0.001). There were no significant differences between the cohorts in terms of secondary outcomes: stroke, ARF, re-exploration or ICU LOS.

CONCLUSION

Octogenarians are twice as likely to die in the short-term following surgery for ATAAD and demonstrate a significantly lower five-year actuarial survival. Patients and family members should be well informed of the risks of surgery and suitable octogenarians selected for surgery.

Quality of life following surgical repair of acute type A aortic dissection: a systematic review

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.

Quality of life: modified triple-branched stent graft implantation versus frozen elephant trunk technique

Objective

To compare the effects of modified triple-branched stent implantation and frozen elephant trunk technique on the quality of life (QoL) of acute Stanford Type A aortic dissection (AAAD) patients at different follow-up times.

Methods

Data from 175 AAAD survivors was collected which were divided into two groups according to different surgical techniques: (group A): modified triple-branched stent graft implantation; (group B): frozen elephant trunk. The SF-36 were used to assess the QoL at discharge (AD), the third postoperative month (POM3), and the twelfth postoperative month (POM12).

Results

(1) The total scores at each time of both groups showed lower than the normal level; Group A scored higher than group B at some time points in terms of some items (role physical, role emotion and mental health; all P = 0.000), and some items at POM3 or POM12 scored higher than at discharge (role physical, social function; both P = 0.000). (2) There were less patients with heavy self-perceived burden in group A than group B at discharge (P = 0.032) and patients with heavy self-perceived burden decreased over time. (3) Young postoperative AAD patients (P = 0.002) in group B (P = 0.005) with heavy self-perceived burden (P = 0.000), acute renal failure (P = 0.008), long LOS (P = 0.026) and blood loss (> 1000 mL/24 h) (P = 0.039) seemed to get a worse QoL.

Conclusion

The impact on QoL of the modified triple-branched stent graft implantation technique seemed to be better than those of frozen elephant trunk surgery in role physical, role emotion and mental health.

Low postoperative blood platelet count may be a risk factor for 3-year mortality in patients with acute type A aortic dissection

Background

Mortality and complications remain high after acute type A aortic dissection (ATAAD) open surgery and are associated with coagulation dysfunction. Platelets play an important role in the process of coagulation. This study explored the relationship between postoperative platelet counts and 3-year mortality after operation in patients with ATAAD undergoing open aortic repair surgery.

Methods

Patients with ATAAD who underwent Total Arch Replacement and Frozen Elephant Trunk in Fuwai Hospital from 2011 to 2015 were selected for this study. The perioperative data were collected and sorted through the electronic clinical case system. Multivariate Logistic regression was used to analyze the risk factors for death within three years after surgery.

Results

A total of 495 patients were included in the analysis. After correction for confounding factors, decreased postoperative platelet count remained an independent factor that was associated with lower mortality (OR = 0.918, 95% CI 0.853–0.988, P = 0.023).

Conclusions

The study indicated that decreased postoperative platelet count may lead to increased 3-year mortality, in patients with ATAAD who underwent open aortic repair surgery.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13019-021-01623-7.

Clinical outcomes and quality of life in patients with acute and subacute type B aortic dissection after thoracic endovascular aortic repair

Objective

Thoracic endovascular aortic repair (TEVAR) is considered the mini-invasive treatment of choice for patients with Stanford type B aortic dissection (TBAD). This study aimed to investigate the clinical outcomes and quality of life (QoL) in patients with acute and subacute TBAD after TEVAR.

Methods

From January 2014 until July 2016, 22 acute patients (Group A) and 18 subacute patients received TEVAR (Group B), and 13 patients were managed non-operatively (Group C). The Medical Outcomes Study Short Form-36 was used to assess QoL preoperatively and after TEVAR. Operative techniques and complications were retrospectively analyzed.

Results

The role emotion, vitality, and mental health domains scored well preoperatively. Except for role emotion, vitality, and mental health, the remaining domains significantly improved after TEVAR. There was no significant difference in QoL metrics between Groups A and B. In Group C, bodily pain and social functioning domains were improved, and role emotion was decreased, with no improvement in the remaining domains. The 3-year survival rates were 95.5%, 100%, and 85.7% for Groups A, B, and C, respectively.

Conclusions

TEVAR may be safe and effective in patients with acute and subacute TBAD with similar and favorable clinical and QoL metrics.

Midterm cerebral outcomes of Stanford type A aortic dissection in patients who underwent novel triple-branched stent graft implantation combined with intraoperative monitoring of regional cerebral oxygen saturation

Objective

The aim of this study was to evaluate the cerebral outcomes of patients underwent novel triple‐branched stent graft implantation combined with the intraoperative monitoring of regional cerebral oxygen saturation.

Methods

One hundred thirty‐seven consecutive patients who underwent the surgery of triple‐branched stent graft implantation in our department were enrolled in this retrospective case‐control study. The patients in group A received brain protection based on the intraoperative monitoring of regional cerebral oxygen saturation and the patients in group B received conventional brain protection. The general clinical data, the types of corrective surgeries, the intraoperative situations, the postoperative complications, and the midterm outcomes of the patients were analyzed.

Results

The incidence of postoperative cerebral dysfunction in the patients of group A was significantly lower than that in the patients in group B (3.2% vs 14.9%, P = .020). We found significant differences in the incubation times (30.3 ± 22.1 vs 42.3 ± 27.9 hours, P = .014), the lengths of intensive care unit stay (58.0 ± 54.3 vs 79.7 ± 55.5 hours, P = .004), and the hospital stays (19.3 ± 6.7 vs 24.9 ± 17.3 days, P = .045). A descending trend in the mortality rates was observed between the patients in the two groups based on the 20 months of observation; however, this trend was not statistically significant (1.6% vs 6.8%, P = .218).

Conclusions

The novel triple‐branched stent graft implantation procedure combined with intraoperative monitoring of the regional cerebral oxygen saturation was an effective treatment for Stanford type A aortic dissection, with a relatively low incidence of postoperative cerebral dysfunction.

A machine learning model to classify aortic dissection patients in the early diagnosis phase

Aortic dissection is one of the most clinical-challenging and life-threatening cardiovascular diseases associated with high morbidity and mortality. Aortic dissection requires fast diagnosis and timely therapy. Any delay or misdiagnosis can cause severe consequence to aortic dissection patients with even higher mortality. To better help physicians identify the potential dissection within the scope of all misdiagnosed patients, this paper describes a method which is developed with data mining methods for aortic dissection patient classification and prediction in the phase of early diagnosis. Various machine learning algorithms were used to build the models which were all trained and tested on the patient dataset with cross validation. Among them, Bayesian Network model achieved the best performance by predicting at a precision rate of 84.55% with Area Under the Curve (AUC) value of 0.857. On this basis, the Bayesian Network model can help physicians better with early diagnosis of aortic dissection in clinical practice. Beyond this study, more data from diverse regions and the internal pathology can be crucial to further build a universal model with broader predictive power.

Do early postoperative CT findings following type A aortic dissection repair predict early clinical outcome?

PURPOSE

The purposes of this study are to determine the prevalence of specific postoperative CT findings following Stanford type A aortic dissection repair in the early postoperative period and to determine if these postoperative findings are predictive of adverse clinical outcome.

METHODS

Patients who underwent type A dissection repair between January 2012 and December 2014 were identified from our institutional cardiac surgery database. Postoperative CT exams within 1 month of surgery were retrospectively reviewed to determine sizes and attenuation of mediastinal, pericardial, and pleural fluid, and the presence or absence of pneumomediastinum, pneumothorax, or lung consolidation. Poor early clinical outcome was defined as length of stay (LOS) > 14 days. Student's t test and chi-square test were used to determine the relationship between postoperative CT features and early clinical outcome.

RESULTS

Thirty-nine patients (24 M, 15 F, mean age 58.5 ± 13.7 years) underwent type A dissection repair and mean LOS was 17.3 ± 21.2 days. A subset of 19 patients underwent postoperative CTs within 30 days of surgery, and there was no significant relationship between LOS and sizes and attenuation of mediastinal, pericardial, and pleural fluid, and the presence or absence of pneumomediastinum, pneumothorax, or lung consolidation.

CONCLUSIONS

CT features such as mediastinal, pericardial, and pleural fluid were ubiquitous in the early postoperative period. There was no consistent CT feature or threshold that could reliably differentiate between "normal postoperative findings" and early postoperative complications.