Hyperlactemia Predicts Surgical Mortality in Patients Presenting With Acute Stanford Type-A Aortic Dissection

Bennett, Jeremy M.; Wise, Eric S.; Hocking, Kyle M.; Brophy, Colleen M.; Eagle, Susan

doi:10.1053/j.jvca.2016.03.133

Cited by 35 publications

(47 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two previous studies have reported that hypercalcemia in AAAD indicates an increased risk of post-operative mortality (26,35). They considered that lactic acidosis, as a surrogate for systemic malperfusion, represents a novel, accurate, and easily obtainable predictor to estimate mortality.…”

Section: Discussionmentioning

confidence: 99%

The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

Zhou

Hao

et al. 2020

Front. Med.

View full text Add to dashboard Cite

Background: Acute kidney injury (AKI) is a common complication of cardiac surgery, which could lead to increased morbidity and mortality. Acute type A aortic dissection (AAAD) is a life-threatening cardiac disease and can be closely related to post-operative AKI. However, data on the incidence of AKI defined by the newest Kidney Disease: Improving Global Outcomes (KDIGO) criteria and in-hospital mortality of a homogeneous population who underwent AAAD are limited. We aimed to investigate the incidence of AKI defined by the KDIGO criteria and the risk factors associated with the outcomes among AAAD-induced AKI patients. Methods: We reviewed 335 patients who underwent surgical treatment for AAAD between March 2009 and June 2016. We screened the patients' AKI status and analyzed probably risk factors of AKI and in-hospital mortality. Independent-sample t-test or Chi-square test was performed to identify differences between AKI and non-AKI groups and survivors with AKI and non-survivors with AKI, respectively. The logistic regression model was applied to identify independent risk factors. Results: AKI occurred in 71.94% of AAAD patients, including 85 stage 1 (35.26%), 77 stage 2 (31.95%), and 79 stage 3 (32.78%) patients. The in-hospital mortality rate was 21.16%. Logistic regression analysis showed that the body mass index, chronic kidney disease, chronic liver disease, cardiopulmonary bypass duration, red blood cell transfusion, and hypoproteinemia were the independent significant risk factors of the occurrence of post-operative AKI. The risk factors associated with in-hospital mortality among AAAD-induced AKI patients included AKI stage (odds ratio (OR), 3.322), deep hypothermic circulatory arrest (OR, 2.586), lactic acidosis (OR, 3.407), and continuous renal replacement therapy (OR, 3.156). Li et al. AKI After AAAD Surgery Conclusion: For AAAD patients undergoing surgery, AKI was a common complication, and it increased patients' mortality risk. Therefore, identifying the risk factors of AKI and preventing post-operative AKI are important for improving the post-operative outcomes of AAAD patients.

show abstract

Section: Discussionmentioning

confidence: 99%

The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

Zhou

Hao

et al. 2020

Front. Med.

View full text Add to dashboard Cite

show abstract

“…mortality in patients undergoing surgery for type A aortic dissection. 13,14,16,18,21 In a study of 96 patients with malperfusion and acute type A aortic dissection, Grimm and colleagues 13 noted variable mortality depending on organ malperfusion (7% extremity, 10% renal, 20% brain, and 100% intestinal); however, base deficit or acidosis was not measured. 13 In a recent study of 144 patients with type A aortic dissection, Bennett and colleagues 21 correlated preoperative lactic acidosis and operative mortality.…”

Section: Discussionmentioning

confidence: 99%

The profound impact of combined severe acidosis and malperfusion on operative mortality in the surgical treatment of type A aortic dissection

Lawton

Moon

Liu

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

“…The merit of the Penn classification has been to unify the concepts of global (cardiogenic shock) and local ischemia (malperfusion) [6,19]. Most studies agree with the severe impact on early and late mortality in Penn nonA patients [7,8,14,15,18].…”

Section: Discussionmentioning

confidence: 99%

“…There are no studies determining the most sensitive marker for preoperative malperfusion. Lactic acid levels above 6 mmol/L [14], as well as base deficit greater than −10 mEq/L [15], have very recently been proposed as cutoff points for an unfavorable outcome, however none of these markers have been analyzed in conjunction with one another, as well as with preoperative pH.…”

Section: Introductionmentioning

confidence: 99%

How Much Malperfusion Is Too Much in Acute Type A Aortic Dissections?

Feier

Cozma

Sintean

et al. 2019

JCM

View full text Add to dashboard Cite

(1) Background: Malperfusion is a central limiting factor in the setting of acute Type A aortic dissections (AAAD). We sought to find preoperative metabolic acidosis thresholds that might influence decision-making in this setting. (2) Methods: We retrospectively reviewed consecutive patients operated on with AAAD between January 2002 and December 2017. We analyzed preoperative variables that might influence early and long-term outcomes, with particular emphasis on malperfusion markers. (3) Results: Our sample consisted of 153 patients, most of them male (69.2%), with a mean age of 55.89 ± 12.8 years. Malperfusion was present in 20.9% of cases: peripheric 25, renal 7, cerebral 4, and mesenteric 3. Cardiogenic shock was present in 18.9% of patients. Logistic regression revealed entry site (odds ratio (OR) = 2.83, p = 0.03), cardiogenic shock (OR = 3.30, p = 0.03), prebypass pH (OR = 0.93, p = 0.02) as independent risk factors for early death (<30 days). Receiver operating characteristic (ROC) analysis identified a prebypass pH of 7.25 as a cutpoint for an unfavourable early outcome. Patients whose prebypass pH was ≤7.25 had a 2.98 higher relative risk (65.7% vs. 22%, p < 0.001). Prebypass pH 7.25 (hazard ratio (HR) = 4.00, p < 0.01) and entry site (HR = 2.10, p = 0.04) were independent predictors of early phase survival (<30 days), while long-term survival (>30 days) was determined by age >65 years (HR = 3.12, p = 0.02). (4) Conclusions: Patients with a prebypass pH ≤ 7.25 have an unacceptably high early mortality after AAAD repair. Those patients might benefit from a two-stage approach.

show abstract

Hyperlactemia Predicts Surgical Mortality in Patients Presenting With Acute Stanford Type-A Aortic Dissection

Cited by 35 publications

References 33 publications

The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

The profound impact of combined severe acidosis and malperfusion on operative mortality in the surgical treatment of type A aortic dissection

How Much Malperfusion Is Too Much in Acute Type A Aortic Dissections?

Contact Info

Product

Resources

About