1
|
Elbatarny M, Stevens LM, Dagenais F, Peterson MD, Vervoort D, El-Hamamsy I, Moon M, Al-Atassi T, Chung J, Boodhwani M, Chu MWA, Ouzounian M. Hemiarch versus extended arch repair for acute type A dissection: Results from a multicenter national registry. J Thorac Cardiovasc Surg 2024; 167:935-943.e5. [PMID: 37084820 DOI: 10.1016/j.jtcvs.2023.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/26/2023] [Accepted: 04/08/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE We compared perioperative outcomes of patients with acute type A aortic dissection undergoing hemiarch (HA) versus extended arch (EA) repair with or without descending aortic intervention. METHODS Nine hundred twenty-nine patients underwent acute type A aortic dissection repair (2002-2021, 9 centers) including open distal repair (HA) with or without additional EA repair. EA with intervention on the descending aorta (EAD) included elephant trunk, antegrade thoracic endovascular aortic replacement, or uncovered dissection stent. EA with no descending intervention (EAND), included unstented suture-only methods. Primary outcomes were in-hospital mortality, permanent neurologic deficit, computed tomography malperfusion resolution, and a composite. Multivariable logistic regression was also performed. RESULTS Mean age was 66 ± 18 years, 30% (278 out of 929) were women, and HA was performed more frequently (75% [n = 695]) than EA (25% [n = 234]). EAD techniques included: dissection stent (39 out of 234 [17%]), thoracic endovascular aortic replacement (18 out of 234 [7.7%]), and elephant trunk (87 out of 234 [37%]). In-hospital mortality (EA: n = 49 [21%] and HA: n = 129 [19%]; P = .42), and neurological deficit (EA: n = 43 [18%] and HA: n = 121 [17%]; P = .74) were similar. EA was not independently associated with death (EA vs HA odds ratio, 1.09; 95% CI, 0.77-1.54; P = .63) or neurologic deficit (EA vs HA odds ratio, 0.85; 95% CI, 0.47-1.55; P = .59). Composite adverse events differed significantly (EA vs HA odds ratio, 1.47; 95% CI, 1.16-1.87; P = .001). Malperfusion resolved more frequently after EAD (EAD: n = 32 [80%], EAND: n = 18 [56%], HA: n = 71 [50%]; P = .004), although multivariable analysis was not significant (EAD vs HA odds ratio, 2.17; 95% CI, 0.83-5.66; P = .10). CONCLUSIONS Extended arch interventions pose similar perioperative mortality and neurologic risks as Hemiarch. Descending aortic reinforcement may promote malperfusion restoration. Extended techniques should be approached with caution in acute dissection due to increased risk of adverse events.
Collapse
Affiliation(s)
- Malak Elbatarny
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Louis-Mathieu Stevens
- Department of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal and Research Center, Montreal, Québec, Canada
| | | | - Mark D Peterson
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY
| | - Michael Moon
- Department of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Talal Al-Atassi
- Department of Cardiac Surgery, Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jennifer Chung
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Munir Boodhwani
- Department of Cardiac Surgery, Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael W A Chu
- Department of Cardiac Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
| |
Collapse
|
2
|
Jia S, Wang M, Liu Y, Gong M, Jiang W, Zhang H. Effect of Asymptomatic Common Carotid Artery Dissection on the Prognosis of Patients With Acute Type A Aortic Dissection. J Am Heart Assoc 2024; 13:e031542. [PMID: 38156459 PMCID: PMC10863841 DOI: 10.1161/jaha.123.031542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/09/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Acute type A aortic dissection can extend upwards to involve the common carotid artery. However, whether asymptomatic common carotid artery dissection (CCAD) requires surgical repair remains controversial. This study aimed to explore the effect of asymptomatic CCAD without surgical intervention on the prognosis of patients who underwent surgery for acute type A aortic dissection. METHODS AND RESULTS Between January 2015 and December 2017, 485 patients with no neurological symptoms who underwent surgery for acute type A aortic dissection were enrolled in this retrospective cohort study. The patients were divided into 2 groups based on the exposure factor of CCAD. CCAD was detected in 111 patients (22.9%), and after adjusting baseline data (standardized mean difference <0.1), the 30-day mortality (17.1% versus 6.0%, P<0.001) and incidence of fatal stroke (7.7% versus 1.6%, P=0.001) were significantly higher in the group with CCAD. Univariable and multivariable Cox regression analyses found CCAD as an independent risk factor for 30-day mortality (hazard ratio [HR], 2.8 [95% CI, 1.5-5.2]; P=0.001). At a median follow-up of 6.2 years (interquartile range, 5.6-6.9 years), landmark analysis with a cutoff value of 1 month postoperatively showed a significant increase in mortality in the group with CCAD, especially in the first month (log-rank P=0.002) and no significant difference in survival after the first month postoperatively between the 2 groups (log-rank P=0.955). CONCLUSIONS Asymptomatic CCAD increased the risk of early fatal stroke and death in patients with acute type A aortic dissection after surgery but did not affect midterm survival in patients who survived the early postoperative period.
Collapse
Affiliation(s)
- Songhao Jia
- Department of Cardiac SurgeryBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Maozhou Wang
- Department of Cardiac SurgeryBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Yuyong Liu
- Department of Cardiac SurgeryBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Ming Gong
- Department of Cardiac SurgeryBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Wenjian Jiang
- Department of Cardiac SurgeryBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Hongjia Zhang
- Department of Cardiac SurgeryBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| |
Collapse
|
3
|
Ma L, Chai T, Yang X, Zhuang X, Wu Q, Chen L, Qiu Z. Outcomes of hemi- vs. total arch replacement in acute type A aortic dissection: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:988619. [PMID: 36237909 PMCID: PMC9552831 DOI: 10.3389/fcvm.2022.988619] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background Acute type A aortic dissections (ATAAD) pose a challenge to surgeons due to high mortality, and decision making regarding the appropriate procedure is controversial. This study compared the outcomes of hemiarch and total arch replacement for ATAAD. Methods The PubMed, Web of Science, Embase and Cochrane databases were searched for comparative studies on hemiarch versus total arch replacement that were published before May 1, 2022. Results We included 23 observational studies with a total of 4,576 patients. Combined data analysis showed that early mortality (RR = 0.82; 95% CI: 0.70–0.97; P = 0.02), incidence of postoperative permanent neurological dysfunction (RR = 0.72; 95%CI:0.54∼0.94; P = 0.02), and incidence of renal failure and dialysis (RR = 0.82; 95%CI:0.71∼0.96; P = 0.01) were all lower for hemiarch than for total arch replacement. However, hemiarch replacement had a higher rate of late mortality (RR = 1.37; 95%CI:1.10∼1.71; P = 0.005). There were no statistically significant differences between the two groups in terms of re-operation for bleeding, aortic re-operation, or postoperative pneumonia. Conclusion In this study, hemiarch replacement had better early outcomes but a higher late mortality rate than total arch replacement. Decisions regarding the extent of arch repair should be made according to location and extent of ATAAD and the experience of surgeons to ensure the most favorable prognosis. Systematic review registration: [INPLASY.COM], identifier [INPLASY202250088].
Collapse
Affiliation(s)
- Likang Ma
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China
| | - Tianci Chai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China
| | - Xiaojie Yang
- Department of Thoracic Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Xinghui Zhuang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China
| | - Qingsong Wu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China
- *Correspondence: Liangwan Chen,
| | - Zhihuang Qiu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China
- Zhihuang Qiu,
| |
Collapse
|
4
|
Wang JX, Xue YX, Zhu XY, Chong HS, Chen Z, Zhou Q, Qu JZ, Wang DJ. The impact of age in acute type A aortic dissection: a retrospective study. J Cardiothorac Surg 2022; 17:40. [PMID: 35305695 PMCID: PMC8933992 DOI: 10.1186/s13019-022-01785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background Acute type A aortic dissection (aTAAD) is a lethal disease and age is an important risk factor for outcomes. This retrospective study was to analyze the impact of age stratification in aTAAD, and to provide clues for surgeons when they make choices of therapy strategies.
Methods From January 2011 to December 2019, 1092 aTAAD patients from Nanjing Drum Tower Hospital received surgical therapy. Patients were divided into 7 groups according to every ten-year interval (20–80 s). The differences between the groups were analyzed in terms of the baseline preoperative conditions, surgical methods and postoperative outcomes of patients of different age groups. During a median follow-up term of 17 months, the survival rates were compared among 7 groups through Kaplan–Meier analysis.
Results The median age was 52.0 years old in whole cohort. The multiple comorbidities were more common in old age groups (60 s, 70 s, 80 s), while the 20 s group patients had the highest proportion of Marfan syndrome (28.1%). Preoperative hypotension was highest in 80 s (16.7%, P = 0.038). Young age groups (20–60 s) had a higher rate of root replacement and total arch replacement, which led to a longer duration of operation and hypothermic circulation arrest. The overall mortality was 14.1%, the tendency of mortality was increased with age except 20 s group (33.3% in 80 s, P = 0.016). The postoperative morbidity of gastrointestinal bleeding and bowel ischemia were 16.7% and 11.1% in 80 s group. Conclusions Age is a major impact factor for aTAAD surgery. Old patients presented more comorbidities before surgery, the mortality and complications rate were significantly higher even with less invasive and conservative surgical therapy. But the favorable long-term survival indicated that the simple or less extensive arch repair is the preferred surgery for patients over 70 years old. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01785-y.
Collapse
|
5
|
Xie J, Jing C, Zhang Z, Xu J, Duan Y, Xu D. Digital tongue image analyses for health assessment. MEDICAL REVIEW (BERLIN, GERMANY) 2021; 1:172-198. [PMID: 37724302 PMCID: PMC10388765 DOI: 10.1515/mr-2021-0018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/13/2021] [Indexed: 09/20/2023]
Abstract
Traditional Chinese Medicine (TCM), as an effective alternative medicine, utilizes tongue diagnosis as a major method to assess the patient's health status by examining the tongue's color, shape, and texture. Tongue images can also give the pre-disease indications without any significant disease symptoms, which provides a basis for preventive medicine and lifestyle adjustment. However, traditional tongue diagnosis has limitations, as the process may be subjective and inconsistent. Hence, computer-aided tongue diagnoses have a great potential to provide more consistent and objective health assessments. This paper reviewed the current trends in TCM tongue diagnosis, including tongue image acquisition hardware, tongue segmentation, feature extraction, color correction, tongue classification, and tongue diagnosis system. We also present a case of TCM constitution classification based on tongue images.
Collapse
Affiliation(s)
- Jiacheng Xie
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
- Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO, USA
| | - Congcong Jing
- School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ziyang Zhang
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
- Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO, USA
| | - Jiatuo Xu
- School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ye Duan
- Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO, USA
| | - Dong Xu
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
- Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO, USA
| |
Collapse
|