Management strategy of Type A Aortic Dissection in a developing center from China: 16 years experiences

Abstract

Background: Type A Aortic Dissection (TAAD) remains a lethal disease of increasing incidence. However the incidence, standardized treatment and survival rates of TAAD is still a lack in China. This study aims to share the management strategy of TAAD from a developing center of this country. Methods: All subjects identified with TAAD in Nanjing Drum Tower Hospital, China, from Jan. 2002 to Dec. 2018 were included in this study. Of 1,037 individuals, 932 (89.9%) were underwent surgery. Based on annual case volume patients underwent surgery were stratified into three operative stages : Early, Middle and Current stage, and patient characteristics, operative trends and outcomes across the operative stages were assessed. Results: The annual admissions of patients increased from approximately 20 during 2002-2013 (early era), 100 during 2014-2016 (middle era) to 200 during 2017-2018 (current era). The median age of patients increased from 49.0 to 53.0 among different eras (P<0.001). The overall in-hospital mortality was 16.5%, which significantly decreased from 21.3% to 13.1% with eras (P=0.023). The median time from admission to surgery was remarkedly shorted from 30.4 h during the early era to 14.0 h during the current era. Compared with in the early era, the percentages of aortic arch repair were increased in middle or current eras, while total arch replacement decreased. Conclusions: During the last 16 years, the prevalence of TAAD was increasing, and the annual number of operations increased substantially in China. Hospital survival improved over time was challenging prompt management and suitable operations.

The prognosis and risk factors for acute kidney injury in high-risk patients after surgery for type A aortic dissection in the ICU

“…Acute kidney injury (AKI) is a major complication and an independent risk factor for high morbidity and mortality in critically ill patients (1,2). According to previous studies, the prevalence of AKI after cardiac surgery ranges from 19.3% to 54% (3)(4)(5), which was higher than that reported for type A aortic dissection (TAAD) patients (6). Insufficient tissue perfusion, cellular oxygenation, and heart dysfunction may be the leading causes of this kind of kidney injury (7).…”

“…J Thorac Dis 2021;13 (7):4427-4437 | https://dx.doi.org/10.21037/jtd-21-823 advanced age, perioperative peak serum C-reactive protein (CRP) concentration, perioperative sepsis, preexisting renal impairment, and cardiopulmonary bypass time were independent risk factors for postoperative AKI (6,(8)(9)(10).…”

“…However, the survival of patients with AKI remains low (15)(16)(17), with mortality rates of 12.2% for none renal replacement therapy (non-RRT) AKI and 46.9% for RRT-AKI patients (18). Previous studies have documented that approximately 2-9% of TAAD patients require CRRT after surgery, and the mortality of this cohort is up to 64% (6,9,19).…”

“…The independent risk factors for postoperative AKI were preoperative lactic acid level and CPB duration, and the independent risk factors for 28-day mortality in those who developed AKI and required CRRT were norepinephrine dose upon diagnosis of AKI and CPB duration.Previous studies have reported the incidence and risk factors for postoperative AKI in cardiovascular surgery departments(6,23,24). Ko et al(6) reported that the incidence of AKI in TAAD patients was 44%, and only 9% patients required CRRT. In that study, CPB, high BMI, perioperative peak serum CRP concentration, renal malperfusion, and perioperative sepsis were identified as independent risk factors for postoperative AKI.…”

Treatment and referral experiences of patients with type A aortic dissection and their families: a qualitative study

“…The anatomical classification of AD determines clinical treatment methods, including medical management, open surgical repair or endovascular interventions. 12 Therefore, emergency surgery is recommended for TAAD patients, and 90% of them have undergone surgery, 13 which is a routine treatment. In addition, patients with AD require urgent treatment and referral to minimise tear progression by controlling blood pressure and lowering blood pressure changes.…”