Initial clinical evaluation of preoperative frailty in surgical patients with Stanford type A acute aortic dissection

Furukawa, Hiroshi; Yamane, Naoki; Honda, Takeshi; Yamasawa, Takahiko; Kanaoka, Yuji; Tanemoto, Kazuo

doi:10.1007/s11748-018-0994-y

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…We attempted to match the groups using inverse probability treatment weighting by propensity score; however, this may not completely nullify the differences between the groups. The later age of presentation of women does not take into account their socioeconomic background and frailty which may explain the conservatism among operating surgeons given that previous studies have shown poorer outcomes in this cohort of patients [40][41][42]. Matching may negate some of the differences, especially in the absence of randomization in studies such as this one.…”

Section: Discussionmentioning

confidence: 94%

Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study

Nappi

Petiot

Salsano

et al. 2023

JCDD

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Background: Type A Acute Aortic Dissection (TAAAD) repair is a surgical emergency associated with high morbidity and mortality. Registry data have noted several sex-specific differences in presentation with TAAAD which may account for the differences in men and women undergoing surgery for this condition. Methods: A retrospective review of data from three departments of cardiac surgery (Centre Cardiologique du Nord, Henri-Mondor University Hospital, San Martino University Hospital, Genoa) between January 2005 and 31 December 2021 was conducted. Confounders were adjusted using doubly robust regression models, a combination of regression models with inverse probability treatment weighting by propensity score. Results: 633 patients were included in the study, of which 192 (30.3%) were women. Women were significantly older with reduced haemoglobin levels and pre-operative estimated glomerular filtration rate compared to men. Male patients were more likely to undergo aortic root replacement and partial or total arch repair. Operative mortality (OR 0.745, 95% CI: 0.491–1.130) and early postoperative neurological complication results were comparable between the groups. The adjusted survival curves using IPTW by propensity score confirmed the absence of a significant impact of gender on long-term survival (HR 0.883, 95% CI 0.561–1.198). In a subgroup analysis of women, preoperative levels of arterial lactate (OR 1.468, 95% CI: 1.133–1.901) and mesenteric ischemia after surgery (OR 32.742, 95% CI: 3.361–319.017) were significantly associated with increased operative mortality. Conclusions: The advancing age of female patients alongside raised preoperative level of arterial lactate may account for the increasing preponderance among surgeons to perform more conservative surgery compared to their younger male counterparts although postoperative survival was similar between the groups.

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Section: Discussionmentioning

confidence: 94%

Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study

Nappi

Petiot

Salsano

et al. 2023

JCDD

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“…Previous studies evaluated clinical risk factors [11], annual growth rates of aortic aneurysm [12], or the role of routine biomarkers (e.g., D-dimer) [13] to elucidate the complex pathophysiology of the aortopathy progression. Given the limitations of such conventional tools, circulating microRNAs have been increasingly reported in the association with distinct aortopathies [14].…”

Section: Discussionmentioning

confidence: 99%

Expression Patterns of Circulating MicroRNAs in the Risk Stratification of Bicuspid Aortopathy

Girdauskas

Neumann²,

Petersen

et al. 2020

JCM

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Objective: Aortic size-based criteria are of limited value in the prediction of aortic events, while most aortic events occur in patients with proximal aortic diameters < 50 mm. Serological biomarkers and especially circulating microRNAs (miRNAs) have been proposed as an elegant tool to improve risk stratification in patients with different aortopathies. Therefore, we aimed to evaluate the levels of circulating miRNAs in a surgical cohort of patients presenting with bicuspid aortic valve disease and distinct valvulo-aortic phenotypes. Methods: We prospectively examined a consecutive cohort of 145 patients referred for aortic valve surgery: (1) Sixty three patients (mean age 47 ± 11 years, 92% male) with bicuspid aortic valve regurgitation and root dilatation (BAV-AR), (2) thirty two patients (mean age 59 ± 11 years, 73% male) with bicuspid aortic valve stenosis (BAV-AS), and (3) fifty patients (mean age 56 ± 14 years, 55% male) with tricuspid aortic valve stenosis and normal aortic root diameters (TAV-AS) who underwent aortic valve+/-proximal aortic surgery at a single institution. MicroRNAs analysis included 11 miRNAs, all published previously in association with aortopathies. Endpoints of our study were (1) correlation between circulating miRNAs and aortic diameter and (2) comparison of circulating miRNAs in distinct valvulo-aortic phenotypes. Results: We found a significant inverse linear correlation between circulating miRNAs levels and proximal aortic diameter in the whole study cohort. The strongest correlation was found for miR-17 (r = −0.42, p < 0.001), miR-20a (r = −0.37, p < 0.001), and miR-106a (r = −0.32, p < 0.001). All miRNAs were significantly downregulated in BAV vs. TAV with normal aortic root dimensions Conclusions: Our data demonstrate a significant inverse correlation between circulating miRNAs levels and the maximal aortic diameter in BAV aortopathy. When comparing miRNAs expression patterns in BAV vs. TAV patients with normal aortic root dimensions, BAV patients showed significant downregulation of analyzed miRNAs as compared to their TAV counterparts. Further multicenter studies in larger cohorts are needed to further validate these results.

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“…The use of outcome measures such as the clinical frailty scores aids identification of patients at higher risk of reduced functional ability post-operatively. 37 For non-elective cases this is often not possible and communication with the patients next of kin and family are vital to establish functional baseline. Family and friends play an important role in the rehabilitation process and should be provided with regular updates and involved in rehabilitation as much as possible with consideration of the patients' wishes.…”

Section: Therapist Inputmentioning

confidence: 99%

Management of acute aortic dissection in critical care

Flower

Arrowsmith

Bewley

et al. 2023

Journal of the Intensive Care Society

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Aortic dissections are associated with significant mortality and morbidity, with rapid treatment paramount. They are caused by a tear in the intimal lining of the aorta that extends into the media of the wall. Blood flow through this tear leads to the formation of a false passage bordered by the inner and outer layers of the media. Their diagnosis is challenging, with most deaths caused by aortic dissection diagnosed at post-mortem. Aortic dissections are classified by location and chronicity, with management strategies depending on the nature of the dissection. The Stanford method splits aortic dissections into type A and B, with type A dissections involving the ascending aorta. De Bakey classifies dissections into I, II or III depending on their origin and involvement and degree of extension. The key to diagnosis is early suspicion, appropriate imaging and rapid initiation of treatment. Treatment focuses on initial resuscitation, transfer (if possible and required) to a suitable specialist centre, strict blood pressure and heart rate control and potentially surgical intervention depending on the type and complexity of the dissection. Effective post-operative care is extremely important, with awareness of potential post-operative complications and a multi-disciplinary rehabilitation approach required. In this review article we will discuss the aetiology and classifications of aortic dissection, their diagnosis and treatment principles relevant to critical care. Critical care clinicians play a key part in all these steps, from diagnosis through to post-operative care, and thus a thorough understanding is vital.

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Initial clinical evaluation of preoperative frailty in surgical patients with Stanford type A acute aortic dissection

Abstract: Preoperative frailty in AAAD surgical patients has potential as a prognostic factor that affects delays in ADL recovery, but does not influence the early or mid-term clinical outcomes of prompt surgical strategies for life rescue in AAAD patients with frailty.

Cited by 5 publications

References 23 publications

Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study

Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study

Expression Patterns of Circulating MicroRNAs in the Risk Stratification of Bicuspid Aortopathy

Management of acute aortic dissection in critical care

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