Long‐term outcomes of treatment with different stent grafts in acute DeBakey type I aortic dissection

Abstract

Background: We developed an integrated triple-branched stent to treat acute DeBakey type I aortic dissection (AD) and modified it to enhance its adaptability. However, whether the patients treated by the modified stent would achieve better long-term prognosis is unknown. Methods: This study enrolled 147 patients with acute DeBakey type I AD. The original integrated triple-branched stents were used in 57 patients (Group A) between July 2012 and August 2013, and the modified stents in 90 patients (Group B) between September 2013 and March 2015. Clinical characteristics, surgical data, postoperative complications, mortality, and follow-up data of the two groups were analyzed. Results: The two groups presented comparable early death rates (Group A = 7.0%, Group B = 5.9%; p = .719). The incidence of postoperative acute kidney injury (AKI) was lower in Group B (10.0%) versus Group A (24.6%) (p = .018). Compared with the original integrated triple-branched stent graft, the modified stent could reduce the risk of early postoperative AKI (OR [95% CI] = 0.36 [0.14, 0.94]). Early endoleak rates were significantly lower in Group B (1.0%) compared to Group A (9.4%) (p = .004). During follow-up, there were five deaths in Group A (9.4%) and six deaths in Group B (7.2%) (p = .646). Chronic kidney injury (7.5% vs. 3.6%; p = .311), delayed endoleak (11.3% vs. 4.8%; p = .157), and late reinterventions (7.5% vs. 2.4%; p = .155) in the two groups were similar. Conclusions: In patients with acute DeBakey type I AD, the modified stent showed feasible and safe treatment outcomes and reduced early endoleak rates. However, the long-term effects were similar to the original treatment.

Preoperative clinical application of human fibrinogen in patients with acute Stanford type A aortic dissection: A single‐center retrospective study

“…Untreated patients have a mortality rate of 1-2% per hour after symptom onset. Prompt diagnosis and treatment can increase a patient's chances of survival and prevent serious complications (17)(18)(19). The survival rate of patients with acute AD is related to the timing of treatment, presence of end-organ dysperfusion, degree of aortic repair, and development of postoperative complications (20).…”

“…Prompt diagnosis and treatment can increase a patient's chances of survival and prevent serious complications. [17][18][19] The survival rate of patients with acute AD is related to the timing of treatment, presence of end-organ dysperfusion, degree of aortic repair, and development of postoperative complications. 20 ATAAD is a critical condition associated with high early surgical mortality rates, partly owing to bleeding complications.…”

Predicting postoperative hypoxemia risk factors in the patients after triple‐branched stent graft implantation surgery with acute type A aortic dissection: A retrospective study

“…After the air was carefully flushed out, release the block of the left subclavian and innominate artery, restoring the perfusion of the femoral and right axillary artery. CPB was stopped after gradual rewarming and the surgery was completed 7 …”

“…Identification of predictors for postoperative hypoxemia in patients after TBSG implantation allows for early intervention to improve clinical outcomes 6 . Unfortunately, there are no relevant studies on the risk factor assessment of postoperative hypoxemia after TBSG implantation, let alone a predictive model 7 …”

High summation of preoperative and postoperative Interleukin-6 levels predicts prolonged mechanical ventilation in patients with acute DeBakey type I aortic dissection: A single center retrospective study

“…The perioperative management of I-AAD is characterized by its urgent presentation, complexity of surgical management, organ dysfunction, and high in-hospital mortality. Although overall surgical techniques are improving and mortality rates decreasing, postoperative complications remain common [ [3] , [4] , [5] ]. Many considerable efforts to improve postoperative morbidity and mortality for acute type A aortic dissection have been made.…”