Predicting long-term outcomes of acute aortic dissection: a focus on gender

Divchev, Dimitar; Najjar, Tarek; Tillwich, Falko; Rehders, Tim C.; Palisch, Holger; Nienaber, Christoph

doi:10.1586/14779072.2015.1004313

Cited by 10 publications

(4 citation statements)

References 35 publications

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“…Stanford A AAD is a complex life-threatening disease with steadily increasing incidence and high mortality. 10 In order to improve outcomes after surgical repair for Stanford A AAD, various intraoperative techniques have been developed and successfully implemented in last decades, such as switch from isolated hypothermia to bilateral selective brain perfusion, advantages in cannulation techniques and use of newer prostheses. 4,11 One of the independent predictors for early and late mortality was location of the primary entry tear in descending aorta.…”

Section: Discussionmentioning

confidence: 99%

Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

et al. 2019

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Objectives: The aim of this study was to evaluate independent risk factors predictive for mortality of patients with Stanford A acute aortic dissection. Methods: From January 2006 to March 2015, a total of 240 consecutive patients diagnosed with acute Stanford A acute aortic dissection underwent surgical aortic repair in our center. After analysis of pre- and perioperative variables, univariate logistic and multivariate logistic regression analyses were performed for mortality of patients. Subsequently, Kaplan–Meier estimation analysis of short- and long-term survival of these variables was carried out. Results: Primary entry tear in descending aorta (odds ratio = 4.71, p = 0.021), preoperative international normalized ratio higher than 1.2 (odds ratio = 7.36, p = 0.001), additional coronary artery bypass grafting (odds ratio = 3.39, p = 0.003), cannulation in ascending aorta (odds ratio = 3.22, p = 0.005), preoperative neurological coma (odds ratio = 3.30, p = 0.003), and reduced perfusion (odds ratio = 2.91, p = 0.006) as well as prolonged reperfusion time (odds ratio = 3.36, p = 0.002) showed to be independent predictors for early mortality as well as for late mortality (hazard ratio of all variables p < 0.05). Kaplan–Meier survival estimation analysis with up to 9-year-follow-up in terms of these risk factors showed significantly poorer short- and long-term survival (log-rank and Breslow test all p < 0.05). Conclusion: Our study revealed that early and late mortality of patients with Stanford A acute aortic dissection surgery was significantly influenced by preoperative and perioperative variables as independent predictors especially of variables displaying coronary, cerebral, and visceral malperfusion. Also, short- and long-term survival of patients was significantly poorer in terms of these risk factors.

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Section: Discussionmentioning

confidence: 99%

Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

et al. 2019

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“…Thoracic endovascular aortic repair (TEVAR) has evolved as the treatment modality of choice for various pathologies of the thoracic aorta, including Stanford type B aortic dissections (TBAD) [ 1 ]. Increasing evidence, including studies like ADSORB and INSTEAD XL, of TEVAR in acute and chronic TBAD (aTBAD)/cTBAD) patients defines more and more subgroups of patients benefiting from TEVAR [ 2 – 5 ]. Nevertheless, TEVAR for TBAD remains a technically demanding endeavor.…”

Section: Introductionmentioning

confidence: 99%

Device Conformability and Morphological Assessment After TEVAR for Aortic Type B Dissection: A Single-Centre Experience with a Conformable Thoracic Stent-Graft Design

Bischoff

Müller–Eschner

Meisenbacher

et al. 2015

Med Sci Monit Basic Res

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BackgroundThe aim of this study was to analyze device conformability in TEVAR of acute and chronic (a/c) type B aortic dissections (TBAD) using the Gore Conformable Thoracic Aortic Stent-graft (CTAG).Material/MethodsFrom January 1997 to February 2014, a total of 90 out of 405 patients in our center received TEVAR for TBAD. Since November 2009, 23 patients (16 men; median age: 62 years) were treated with the CTAG. Indications were complicated aTBAD in 15 (65%) and expanding cTBAD in 8 (35%) patients. Primary endpoints were the assessment of device conformability by measuring the distance (D) from the radiopaque gold band marker (GM) at the proximal CTAG end to the inner curvature (IC) of the arch on parasagittal multiplanar reformations of CT angiography, as well as the evaluation of aortic diameter changes following TEVAR. Median follow-up was 13.3 months (range: 2 days to 35 months).ResultsPrimary and secondary success rates were 91.3% (21/23) and 95.6% (22/23), respectively. There was 1 type Ia endoleak, retrograde dissection or primary conversion was not observed. Median GM-IC-D was 0 mm (range: 0 mm to 10 mm). GM-IC-D was associated with zone 2 placement compared to zone 3 (P=0.036). There was no association between GM-IC-D formation and arch type. In aTBAD cases the true lumen significantly increased after TEVAR (P=0.017) and the false lumen underwent shrinkage (P=0.025). In cTBAD patients the false lumen decreased after TEVAR (P=0.036).ConclusionsThe CTAG shows favorable conformability and wall apposition in challenging arch pathologies such as TBAD.

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“…Sun's procedure can simplify operative method and decrease operative time and postoperative complications. At present, nearly 8000 patients with AAAD in China have received TAR using Sun's procedure and produced satisfactory outcomes [Divchev 2015].…”

Section: Discussionmentioning

confidence: 99%

Sex Differences of Clinical Presentation and Outcomes in Propensity-Matched Patients with Acute Type A Aortic Dissection

Yang

Liu

et al. 2021

HSF

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Objectives: To assess sex differences of clinical presentation and outcomes in propensity-matched patients with acute type A aortic dissection (AAAD). Methods: We collected the clinical data of patients with AAAD from a single heart center between January 2009 and July 2014. After propensity score matching, we compared differences in clinical presentation and outcomes of patients with AAAD between men and women. Results: There were 590 patients (295 men and 295 women) with AAAD through propensity matching on demographics and patients’ history. We found that the presentation and diagnosis of AAAD often were more delayed in women. Severe signs of congestive heart failure (9.8% vs. 5.1%, P = 0.017), cardiac tamponade/shock (9.1% vs. 4.1%, P < 0.001), and periaortic hematoma (26.4% vs. 21.7%, P < 0.001) were more commonly presented in women. Surgery was more commonly performed in men than in women (95.4% (281/295) vs. 91.5% (270/295), P = 0.045), indicating the association of sex with surgical decision. To investigate the association of sex with outcomes after surgery, patients who underwent surgical treatment were re-matched (262 men and 262 women) by propensity score. Women suffered from greater in-hospital mortality than men (8.4% vs. 3.4%, P < 0.001). Postoperative complications of congestive heart failure (9.1% vs. 3.8%, P < 0.001), visceral ischemia (6.8% vs. 1.1%, P < 0.001), and limb ischemia (7.6% vs. 1.5%, P < 0.001) were more frequent in women. For women, prolonged operative time may increase in-hospital mortality, especially after 12 hours from the start of surgery (30.0% vs. 14.3%, P < 0.001). Kaplan-Meier survival analysis indicated worse late outcomes in women in the matched surgery group (log-rank P = 0.012). Conclusions: Our analysis provides new insights into sex differences in clinical presentation and outcomes of AAAD.

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Predicting long-term outcomes of acute aortic dissection: a focus on gender

Cited by 10 publications

References 35 publications

Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

Device Conformability and Morphological Assessment After TEVAR for Aortic Type B Dissection: A Single-Centre Experience with a Conformable Thoracic Stent-Graft Design

Sex Differences of Clinical Presentation and Outcomes in Propensity-Matched Patients with Acute Type A Aortic Dissection

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