Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients

Chiappini, Bruno; Schepens, Marc A.A.M.; Tan, Erwin; Dell’Amore, Andrea; Morshuis, Wim J.; Dossche, Karl M.; Bergonzini, Marcello; Camurri, Nicola; Reggiani, Maria Letizia Bacchi; Marinelli, Giuseppe; Bartolomeo, Roberto Di

doi:10.1093/eurheartj/ehi024

Cited by 196 publications

(87 citation statements)

References 22 publications

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“…Blanco et al [27] reported an overall in-hospital mortality rate of 66.6% and a mortality rate of 77.7% in patients with neurological symptoms. However, in both studies overall in-hospital mortality rates were clearly higher than reported in most studies (9–36%) [5, 31,51,52,53, 55, 56,58,59,60]. …”

Section: Impact Of Prognosis Due To Initial Neurological Symptomscontrasting

confidence: 60%

“…But recent studies analysing large cohorts of patients have also failed to identify brain malperfusion as an independent risk factor for an adverse outcome after surgical repair [5, 51, 55]. Although Centofanti et al [56] identified coma as a preoperative independent predictor of 30-day mortality in a large, single-center study, coma may not represent a contraindication for resuscitative surgery in hemodynamically stable patients, because the literature addressing this specific issue is scarce.…”

Section: Impact Of Prognosis Due To Initial Neurological Symptomsmentioning

confidence: 99%

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Neurological Symptoms in Aortic Dissection: A Challenge for Neurologists

2008

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Typically, aortic dissection has to be considered in patients with acute thoracic or abdominal pain and accompanying cardiovascular symptoms. Due to these clinical symptoms, neurologists have not been involved in the routine emergency management of aortic dissection. However, transient or permanent neurological symptoms at onset of aortic dissection are not only frequent (17–40% of the patients), but often dramatic and may mask the underlying condition. Especially in pain-free dissection (which occurs in 5–15%) with predominant neurological symptoms diagnosis of aortic dissection can be difficult and delayed. Affecting the outflow of supra-aortal, spinal as well as extremity arteries leads to a variety of neurological symptoms including disturbances of central or peripheral nervous system. Thrombolysis as an emergency stroke therapy without considering aortic dissection may be life-threatening for these patients. Routine chest X-ray and being alert to physical examination findings such as hypotension, asymmetrical pulses or cardiac murmur may reduce risk of delayed diagnosis or misdiagnosis. Neurological symptoms at onset or in the postoperative course of aortic dissection are not necessarily associated with increased mortality.

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Section: Impact Of Prognosis Due To Initial Neurological Symptomscontrasting

confidence: 60%

Section: Impact Of Prognosis Due To Initial Neurological Symptomsmentioning

confidence: 99%

Neurological Symptoms in Aortic Dissection: A Challenge for Neurologists

2008

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“…Stanford A aortic dissection surgery is associated with a high incidence of postoperative hypoxemia compared with other elective cardiac surgical procedures [5,14-16]. During cardiac surgery, both experimental and clinical studies have well documented that open heart surgery with CPB could result in systemic inflammatory response, activation of complements, thrombin, cytokines, endothelin, endotoxins, neutrophils, adhesion molecule, macrophages, multiple inflammatory mediators and impaired immune reaction and organ dysfunction [17-23]. As CPB represents a kind of non-physiological circulation affecting the peripheral tissue perfusion, particularly in the case of prolonged pump time, which might lead to impaired capillary membrane permeability, malperfusion, tissue anoxia and pulmonary complications [24-27].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery

Wang

Xue

Zhu

2013

J Cardiothorac Surg

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BackgroundThe purpose of this study is to identify the risk factors for postoperative hypoxemia in patients with Stanford A aortic dissection surgery and their relation to clinical outcomes.MethodsClinical records of 186 patients with postoperative hypoxemia in Stanford A aortic dissection were analyzed retrospectively. The patients were divided into two groups by postoperative oxygen fraction (PaO2/FiO2):hypoxemia group (N=92) and non-hypoxemia group (N=94).ResultsWe found that the incidence of postoperative hypoxemia was 49.5%. Statistical analysis by t-test and χ2 indicated that acute onset of the aortic dissection (p=0.000), preoperative oxygen fraction (PaO2/FiO2) ≤200 mmHg(p=0.000), body mass index (p=0.008), circulatory arrest (CA) time (p=0.000) and transfusion more than 3000 ml(p=0.000) were significantly associated with postoperative hypoxemia. Multiple logistic regression analysis showed that preoperative hypoxemia, CA time and transfusion more than 3000 ml were independently associated with postoperative hypoxemia in Stanford A aortic dissection.ConclusionOur results suggest that postoperative hypoxemia is a common complication in patients treated by Stanford A aortic dissection surgery. Preoperative oxygen fraction lower than 200 mmHg, longer CA time and transfusion more than 3000 ml are predictors of postoperative hypoxemia in Stanford A aortic dissection.

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“…Dissections involving the ascending aorta (type A; AADA) are routinely treated surgically in the hyperacute and acute state with an operative mortality of around 16.5-25.1% [19,20,21,22]. Furthermore, untreated AADA have an even worse prognosis with about 50% mortality within 48 h [8].…”

Section: Discussionmentioning

confidence: 99%

Prevention of Aortic Dissection Suggests a Diameter Shift to a Lower Aortic Size Threshold for Intervention

et al. 2018

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Background: Multiple studies have quantified the relationship between aortic size and risk of dissection. However, these studies estimated the risk of dissection without accounting for any increase in aortic size from the dissection process itself. Objectives: This study aims to compare aortic size before and after dissection and to evaluate the change in size consequent to the dissection itself. Methods: Fifty-five consecutive patients (29 type A; 26 type B) with aortic dissection and incidental imaging studies prior to dissection were identified and compared to a control group of aneurysm patients (n = 205). The average time between measurement at and prior to dissection was 1.7 ± 1.9 years (1.9 ± 2.0 years mean inter-image time in the control group). A multivariate regression model controlling for growth rate, age, and gender was created to estimate the effect of dissection itself on aortic size. Results: The mean aortic sizes at and prior to dissection were 54.2 ± 7.0 and 45.1 ± 5.7 mm for the ascending aorta, and 47.1 ± 13.8 and 39.5 ± 13.1 mm for the descending aorta, respectively. The multivariable analysis revealed a significant impact of the dissection itself (p < 0.001) and estimated an increase in size of 7.65 mm (ascending aorta) and 6.38 mm (descending aorta). Thus, a proportional estimate of 82.8% (ascending aorta) and 80.8% (descending aorta) of dissections are made at a size lower than the guideline-recommended threshold (55 mm). Conclusions: The aortic diameter increases substantially due to aortic dissection itself and, thus, aortas are being dissected at clinically meaningfully smaller sizes than natural history analyses have previously suggested. These findings have important implications regarding the size at which the risk of dissection is increased.

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Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients

Abstract: Patients' pre-operative co-morbidities and dissection-related complications significantly affect early and late survival and morbidity after surgical treatment of acute type A aortic dissection.

Cited by 196 publications

References 22 publications

Neurological Symptoms in Aortic Dissection: A Challenge for Neurologists

Neurological Symptoms in Aortic Dissection: A Challenge for Neurologists

Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery

Prevention of Aortic Dissection Suggests a Diameter Shift to a Lower Aortic Size Threshold for Intervention

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