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Zhou T, Li JX, Zhang CY, Li YG, Peng J, Wei CL, Chen MH, Zhou HF. Risk factors for one-year mortality following discharge in patients with acute aortic dissection: development and validation of a predictive model in a cross-sectional study. BMC Cardiovasc Disord 2024; 24:129. [PMID: 38424525 PMCID: PMC10903037 DOI: 10.1186/s12872-024-03766-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/03/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE This study was aimed to identify the risk factors that influence the mortality risk in patients with acute aortic dissection (AAD) within one year after discharge, and aimed to construct a predictive model for assessing mortality risk. METHODS The study involved 320 adult patients obtained from the Medical Information Mart for Intensive Care (MIMIC) database. Logistic regression analysis was conducted to identify potential risk factors associated with mortality in AAD patients within one year after discharge and to develop a predictive model. The performance of the predictive model was assessed using the receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). To further validate the findings, patient data from the First Affiliated Hospital of Guangxi Medical University (157 patients) were analyzed. RESULTS Univariate and multivariate logistic regression analyses revealed that gender, length of hospital stay, highest blood urea nitrogen (BUN_max), use of adrenaline, and use of amiodarone were significant risk factors for mortality within one year after discharge (p < 0.05). The constructed model exhibited a consistency index (C-index) and an area under the ROC curve of 0.738. The calibration curve and DCA demonstrated that these indicators had a good degree of agreement and utility. The external validation results of the model also indicated good predictability (AUC = 0.700, p < 0.05). CONCLUSION The personalized scoring prediction model constructed by gender, length of hospital stays, BUN_max levels, as well as the use of adrenaline and amiodarone, can effectively identify AAD patients with high mortality risk within one year after discharge.
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Affiliation(s)
- Ting Zhou
- Cardiothoracic Surgery Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Jing-Xiao Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Chao-Yong Zhang
- The First Affiliated Hospital of Guangxi Medical University Coronary Care Unit, Nanning, Guangxi, P.R. China
| | - Yu-Gui Li
- Department of Cardiac Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Jun Peng
- Department of Cardiac Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Chun-Lou Wei
- Cardiothoracic Surgery Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Meng-Hua Chen
- The Second Affiliated Hospital of Guangxi Medical University Intensive Care Unit, Nanning, Guangxi, P.R. China.
| | - Hua-Fu Zhou
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China.
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2
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Wu SJ, Fan YF, Tsai YC, Sun S, Chien CY, Li JY. Non-prompt surgery for patients with acute type A aortic dissection without pre-operative shock and malperfusion. Front Cardiovasc Med 2022; 9:988179. [PMID: 36545025 PMCID: PMC9760729 DOI: 10.3389/fcvm.2022.988179] [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: 07/07/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Background Acute type A aortic dissection (ATAAD) requires urgent surgical treatment. However, during daily practice, there were some patients with ATAAD sought for medical attention several days after symptoms occurred and some other patients hesitated to receive aortic surgery after the diagnosis of ATAAD was made. This study aims to investigate the surgical outcomes of non-prompt aortic surgery (delayed diagnosis caused by the patient or delayed surgery despite immediate diagnosis) for ATAAD patients. Methods From November 2004 to June 2020, of more than 200 patients with ATAAD patients who underwent aortic surgery at our hospital, there were 30 patients without pre-operative shock and malperfusion who sought for medical attention with symptoms for several days or delayed aortic surgery several days later despite ATAAD was diagnosed. Of the 30 patients (median age 60.9, range 33.4~82.5 years) in the study group, there were 18 patients undergoing surgery when they arrived at our hospital (delayed diagnosis by the patient) and 12 patients receiving surgery days later (delayed surgery despite immediate diagnosis). Patients with prompt surgery after symptom onset (control group) were matched from our database by propensity score matching. The surgical mortality rate and post-operative morbidities were compared between the study group and control group. Results The in-hospital mortality was 3.3% for the study group and 6.7% for the control group (p = non-significant). The incidence of post-operative cerebral permanent neurological defect was 0% for the study group and 13.3% for the control group (p = 0.112). There were three patients receiving aortic re-intervention or re-do aortic surgery during follow-up for the study group and two patients for the control group. Conclusion Prompt surgery for ATAAD is usually a good choice if everything is well prepared. Besides, urgent but non-prompt aortic surgery could also provide acceptable surgical results for ATAAD patients without pre-operative shock and malperfusion who did not seek medical attention or who could not make their minds to undergo surgery immediately after symptom onset. Hospitalization with intensive care is very important for pre-operative preparation and monitoring for the patients who decline prompt aortic surgery.
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Affiliation(s)
- Shye-Jao Wu
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan,MacKay Medical College, New Taipei, Taiwan,*Correspondence: Shye-Jao Wu
| | - Ya-Fen Fan
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Chu Tsai
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shen Sun
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan,MacKay Medical College, New Taipei, Taiwan
| | - Chen-Yen Chien
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan,MacKay Medical College, New Taipei, Taiwan
| | - Jiun-Yi Li
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan,MacKay Medical College, New Taipei, Taiwan
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3
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Eranki A, Merakis M, Williams ML, Flynn CD, Villanueva C, Wilson-Smith A, Lee Y, Mejia R. Outcomes of surgery for acute type A dissection in octogenarians versus non-octogenarians: a systematic review and meta analysis. J Cardiothorac Surg 2022; 17:222. [PMID: 36050776 PMCID: PMC9434858 DOI: 10.1186/s13019-022-01980-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Aditya Eranki
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia.
| | - Michael Merakis
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Michael L Williams
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Campbell D Flynn
- Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Claudia Villanueva
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia
| | - Ashley Wilson-Smith
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Yangsin Lee
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia
| | - Ross Mejia
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia
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4
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Jaén-Torrejimeno I, López-Guerra D, Rojas-Holguín A, De-Armas-Conde N, Blanco-Fernández G. Surgical treatment of liver hydatid cyst in elderly patients: A propensity score-matching retrospective cohort study. Acta Trop 2022; 232:106466. [PMID: 35460646 DOI: 10.1016/j.actatropica.2022.106466] [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: 02/22/2022] [Revised: 03/16/2022] [Accepted: 04/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cystic echinococcosis is a clinically complex chronic parasitic disease and a major socioeconomic problem in endemic areas. The safety of liver resection in elderly patients is often debated among medical professionals. We analyzed the postoperative morbidity and mortality rates of elderly patients who underwent surgery at our unit. METHODS We retrospectively evaluated patients with liver hydatid cysts which were surgically removed at our unit. Patients were divided into two groups: Group 1 (patients < 70 years), and Group 2 (patients ≥ 70 years). Propensity score matching (PSM) and comparative analyses between groups were performed. RESULTS The unmatched cohort consisted of 279 patients (Group 1: 244; Group 2: 35). After PSM, we compared the outcomes for 56 patients from Group 1 to 31 patients from Group 2. A higher rate of severe complications was observed in Group 2 (25.8% vs 5.36%, p = 0.014). No difference was found in the rates of infectious, cardiorespiratory, or hemorrhagic complications between both groups, and in the mortality rate either (0.00% vs 6.45%, p = 0.124). CONCLUSIONS Liver surgery in selected elderly patients is safe and practicable. The low postoperative morbidity rate in these patients is acceptable, albeit higher, due to their comorbidities.
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Affiliation(s)
- Isabel Jaén-Torrejimeno
- Hospital Universitario de Badajoz. Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático. Avda. Elvas sn. 06080 Badajoz. España
| | - Diego López-Guerra
- Universidad de Extremadura. Facultad de Medicina y Ciencias de la Salud. Avda. de Elvas sn. 06006. Badajoz. España; Hospital Universitario de Badajoz. Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático. Avda. Elvas sn. 06080 Badajoz. España
| | - Adela Rojas-Holguín
- Universidad de Extremadura. Facultad de Medicina y Ciencias de la Salud. Avda. de Elvas sn. 06006. Badajoz. España; Hospital Universitario de Badajoz. Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático. Avda. Elvas sn. 06080 Badajoz. España
| | - Noelia De-Armas-Conde
- Hospital Universitario de Badajoz. Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático. Avda. Elvas sn. 06080 Badajoz. España
| | - Gerardo Blanco-Fernández
- Universidad de Extremadura. Facultad de Medicina y Ciencias de la Salud. Avda. de Elvas sn. 06006. Badajoz. España; Hospital Universitario de Badajoz. Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático. Avda. Elvas sn. 06080 Badajoz. España.
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Maze Y, Tokui T, Murakami M, Nakamura B, Inoue R, Hirano R, Hirano K. Clinical outcomes of limited repair and conservative approaches in older patients with acute type A aortic dissection. J Cardiothorac Surg 2022; 17:78. [PMID: 35428343 PMCID: PMC9013093 DOI: 10.1186/s13019-022-01819-5] [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: 07/31/2021] [Accepted: 04/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background Surgical indication and the selection of surgical procedures for acute type A aortic dissection in older patients are controversial; therefore, we aimed to examine the surgical outcomes of acute type A aortic dissection in older patients. Methods From January 2012 through December 2019, 174 patients underwent surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the older (≥ 80 years old) and below-80 (≤ 79 years old) age groups. Additionally, we compared the outcomes between the surgical and conservative treatment groups. Results The primary entry was found in the ascending aorta in 51.6% and 32.8% of the older and below-80 groups, respectively (p = 0.049). Ascending or hemiarch replacement was performed in all older group patients and 57.3% of the below-80 group patients (total arch replacement was performed in the remaining 42.7%; p < 0.001). Hospital mortality rates were similar in both groups. The significant risk factors for hospital mortality were age, preoperative intubation, cardiopulmonary bypass time, and postoperative stroke. The 5-year survival rates were 48.4% ± 10.3% (older group) and 86.7% ± 2.9% (below-80 group; p < 0.001). The rates of freedom from aortic events at 5 years were 86.9% ± 8.7% (older group) and 86.5% ± 3.9% (below-80 group; p = 0.771). The 5-year survival rate of the conservative treatment subgroup was 19.2% ± 8.0% in the older group, which was not significantly different from that of the surgical treatment subgroup (p = 0.103). Conclusion The surgical approach did not achieve a significant survival advantage over conservative treatment and may not always be a reasonable treatment of choice for older patients.
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6
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Chen JW, Sainbayar N, Hsu RB. Outcome of emergency surgery for acute type A aortic dissection in octogenarians. J Card Surg 2022; 37:610-615. [PMID: 34996133 DOI: 10.1111/jocs.16219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emergency surgery for acute type A aortic dissection (AAAD) was usually avoided or denied in octogenarians because of high surgical mortality. Refined surgical techniques and improved postoperative care have led to an improved in-hospital outcome. However, a significant number of operative survivors suffered from postoperative complications and had compromised quality of life. We sought to assess the clinical outcome of emergency surgery using a standard conservative approach in octogenarians with AAAD. METHODS From 2004 to 2021, 123 patients underwent emergency surgery for AAAD by one surgeon using a standard conservative approach with right subclavian artery cannulation, no aortic cross-clamp, selective antegrade cerebral perfusion, moderate systemic hypothermia, reinforced sandwich technique, and a strategy of limited aortic resection. Hospital and late outcomes were assessed in patients with age >80 years. RESULTS Eighteen patients (15%) were octogenarians with seven males (39%) and median age of 82 years (range, 80-89). Hypertension was present in six patients (33%). None had diabetes mellitus, Marfan, or bicuspid aortic valve. Dissection was intramural hematoma in six (33%) and DeBakey type I in 15 patients (83%). Cardiac tamponade with shock was present in seven patients (39%). Ascending aortic grafting was performed in 17 patients, and additional hemiarch replacement in one patient. The hospital mortality rate was 17% (3/18). Fourteen patients (82%) were alive and well at discharge. CONCLUSIONS Emergency surgery for AAAD using a standard conservative approach showed an improved outcome in octogenarians. The majority of patients could return home with an acceptable living.
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Affiliation(s)
- Jeng-Wei Chen
- Department of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nyamsuren Sainbayar
- Department of Cardiovascular Surgery, Third State Central Hospital, Ulan Bator, Mongolia
| | - Ron-Bin Hsu
- Department of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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7
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Angleitner P, Brinster DR, Gleason TG, Harris KM, Evangelista A, Bekeredjian R, Montgomery DG, Sandhu HK, Arnaoutakis GJ, Di Eusanio M, Trimarchi S, Nienaber CA, Isselbacher EM, Eagle KA, Ehrlich MP. Type A Acute Aortic Dissection Presenting With Cerebrovascular Accident at Advanced Age. Semin Thorac Cardiovasc Surg 2021; 34:805-813. [PMID: 34146671 DOI: 10.1053/j.semtcvs.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 01/16/2023]
Abstract
Our aim was to analyze outcomes of patients aged 70 years or above presenting with type A acute aortic dissection (TAAAD) and cerebrovascular accident (CVA). A retrospective analysis of the International Registry of Acute Aortic Dissection (IRAD) was conducted. Patients aged 70 years or above (n = 1449) were stratified according to presence or absence of CVA before surgery (CVA: n = 110, 7.6%). In-hospital outcomes and mortality up to 5 years were analyzed. Additionally, in-hospital outcomes of patients who received medical management were described. No patient presenting with CVA over the age of 87 years underwent surgery. The rates of in-hospital mortality and post-operative CVA were significantly higher in patients presenting with CVA (in-hospital mortality: 32.7% vs 21.7%, P = 0.008; post-operative CVA: 23.4% vs 8.3%, P < 0.001). Presence of CVA was independently associated with significantly increased in-hospital mortality (odds ratio 2.99, 95% confidence interval 1.35 - 6.60, P = 0.007). In survivors of the hospital stay, presenting CVA had no independent influence on mortality up to 5 years (hazard ratio 1.52, 95% confidence interval 0.99 - 2.31, P = 0.54). In medically managed patients, exceedingly high rates of in-hospital mortality (71.4%) and CVA (90.9%) were noted. Patients presenting with TAAAD and CVA at ≥ 70 years of age are at significantly increased risk of in-hospital mortality, although long-term mortality is not affected in hospital survivors. Medical management is associated with poor outcomes. We believe that surgical management should be offered after critical assessment of comorbidities.
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Affiliation(s)
- Philipp Angleitner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
| | - Derek R Brinster
- Department of Cardiothoracic Surgery, Lenox Hill Heart and Lung, Northwell Health System, New York, New York
| | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Raffi Bekeredjian
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | | | - Harleen K Sandhu
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | - George J Arnaoutakis
- Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Marco Di Eusanio
- Cardiac Surgery, Lancisi Cardiovascular Center, Politechnic University of Marche, Ancona, Italy
| | - Santi Trimarchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | | | | | - Kim A Eagle
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Marek P Ehrlich
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Une K, Hidaka Y, Maeda J, Kinoshita H, Kodama H, Sato K. Acute aortic dissection combined with cardiac tamponade in an elderly patient saved by pericardial drainage: A case report. Clin Case Rep 2021; 9:274-277. [PMID: 33489172 PMCID: PMC7813048 DOI: 10.1002/ccr3.3513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 11/19/2022] Open
Abstract
Acute aortic dissection combined with cardiac tamponade is fatal. The radical treatment is an aortic replacement; however, the risk is high. We suggest conservative treatment with pericardial drainage as a treatment option in elderly patients with comorbidities.
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Affiliation(s)
- Kazunobu Une
- Department of Emergency and General medicineJA Onomichi General HospitalOnomichi CityJapan
| | - Yui Hidaka
- Department of Emergency and General medicineJA Onomichi General HospitalOnomichi CityJapan
| | - Junji Maeda
- Department of CardiologyJA Onomichi General HospitalOnomichi CityJapan
| | - Hiroki Kinoshita
- Department of CardiologyJA Onomichi General HospitalOnomichi CityJapan
| | - Hiroshi Kodama
- Department of Cardiovascular SurgeryJA Onomichi General HospitalOnomichi CityJapan
| | - Katsutoshi Sato
- Department of Cardiovascular SurgeryJA Onomichi General HospitalOnomichi CityJapan
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9
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Nakamura K, Orii K, Hanai M, Abe T, Haida H. Management of acute pulmonary embolism after acute aortic dissection surgery. J Cardiol Cases 2020; 22:195-197. [PMID: 33014204 PMCID: PMC7520534 DOI: 10.1016/j.jccase.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022] Open
Abstract
Acute aortic dissection (AAD) continues to be associated with high mortality and morbidity. Pulmonary embolism is also a life-threatening disease. The treatment of these life-threatening diseases remains controversial in case complications arise. Thrombolytic therapy and intensive treatment would be needed to manage these fatal diseases. A 49-year-old man with progressive back pain was admitted to our hospital. Computed tomography (CT) scan revealed type A AAD. Emergency operation for hemiarch replacement was performed. Two weeks postoperatively, the patient’s oxygenation worsened and his d-dimer levels elevated. CT scan revealed a massive thrombus in the bilateral pulmonary arteries. Intensive anticoagulation therapy was started immediately. On postoperative day 27, the patient was weaned from mechanical ventilation, but the false lumen with thrombus was recanalized again. The patient was discharged on postoperative day 75 without resulting in major complications for aortic dissection. The diagnosis of pulmonary embolism concomitant with AAD is difficult. The treatment of pulmonary embolism after AAD is controversial. Our strategy seems to be suitable for acute pulmonary embolism that occurs during the treatment of AAD. ˂Learning objective: The diagnosis of pulmonary embolism concomitant with acute aortic dissection (AAD) is difficult. The treatment of pulmonary embolism after AAD is controversial. Investigating factor XIII levels might help in the early detection of pulmonary embolism.>
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Affiliation(s)
- Ken Nakamura
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya-shi, Saitama, Japan
| | - Kouan Orii
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya-shi, Saitama, Japan
| | - Makoto Hanai
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya-shi, Saitama, Japan
| | - Takayuki Abe
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya-shi, Saitama, Japan
| | - Hirofumi Haida
- Department of Cardiac Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya-shi, Saitama, Japan
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10
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Analysis of Acute Type A Aortic Dissection in Japan Registry of Aortic Dissection (JRAD). Ann Thorac Surg 2020; 110:790-798. [DOI: 10.1016/j.athoracsur.2019.12.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 11/23/2019] [Accepted: 12/19/2019] [Indexed: 11/23/2022]
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11
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Wang Q, Shi X, Zhang H, Dong H, Chen J, Wang X, Shi Y. Effect of high-quality nursing intervention on perioperative blood pressure control and postoperative complications in patients with aortic dissecting aneurysm. Minerva Med 2020; 113:204-206. [PMID: 32407054 DOI: 10.23736/s0026-4806.20.06623-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Qingqing Wang
- Department of Vascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xiaoning Shi
- Department of Vascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Huimin Zhang
- Department of Vascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Hongfen Dong
- Department of Vascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jingjie Chen
- Department of Vascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xiaoyu Wang
- Department of Vascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yunxia Shi
- Department of Vascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China -
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12
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Kachman M, Carter K, Arora VM, Flores A, Meltzer DO, Martin SK. Describing Variability of Inpatient Consultation Practices: Physician, Patient, and Admission Factors. J Hosp Med 2020; 15:e1-e5. [PMID: 32118568 PMCID: PMC7064298 DOI: 10.12788/jhm.3355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 11/20/2022]
Abstract
Appropriate use of consultation can improve patient outcomes, but inappropriate use may cause harm. Factors affecting the variability of inpatient consultation are poorly understood. We aimed to describe physician-, patient-, and admission-level factors influencing the variability of inpatient consultations on general medicine services. We conducted a retrospective study of patients hospitalized from 2011 to 2016 and enrolled in the University of Chicago Hospitalist Project, which included 6,153 admissions of 4,772 patients under 69 attendings. Consultation use varied widely; a 5.7-fold difference existed between the lowest (mean, 0.613) and highest (mean, 3.47) quartiles of use (P <.01). In mixed-effect Poisson regression, consultations decreased over time, with 45% fewer consultations for admissions in 2015 than in 2011 (P <.01). Patients on nonteaching hospitalist teams received 9% more consultations than did those on teaching services (P =.02). Significant variability exists in inpatient consultation use. Further understanding may help to identify groups at high-risk for underuse/overuse and aid in the development of interventions to improve high-value care.
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Affiliation(s)
- Marika Kachman
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Keme Carter
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Andrea Flores
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - David O Meltzer
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Shannon K Martin
- Department of Medicine, University of Chicago, Chicago, Illinois
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