Risk factors of cerebral complications after Stanford type A aortic dissection undergoing arch surgery

Song, Yan-Yan; Liu, Li; Jiang, Bo; Wang, Yun

doi:10.1016/j.asjsur.2021.07.071

Cited by 8 publications

(7 citation statements)

References 8 publications

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“…It is generally considered that PND and TND are caused by different mechanisms, PND always occurs as a result of cerebral hemorrhage or infarction caused by cerebrovascular disease. 16 Previous studies have found that risk factors for postoperative PND included cerebral malperfusion, preoperative cardiopulmonary resuscitation, higher EuroSCORE, complete thrombosis of the dissected supra‐aortic branch vessels. 17 , 18 , 19 , 20 These indicate a critical preoperative status, which is likely reflective of worse clinical outcome.…”

Section: Discussionmentioning

confidence: 98%

“…Currently, on account of the severe and acute nature of PND and the greater impact on the quality of life of patients after surgery, reports have been relatively comprehensive. It is generally considered that PND and TND are caused by different mechanisms, PND always occurs as a result of cerebral hemorrhage or infarction caused by cerebrovascular disease 16 . Previous studies have found that risk factors for postoperative PND included cerebral malperfusion, preoperative cardiopulmonary resuscitation, higher EuroSCORE, complete thrombosis of the dissected supra‐aortic branch vessels 17–20 .…”

Section: Discussionmentioning

confidence: 99%

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A nomogram‐based model to predict postoperative transient neurological dysfunctions in patients receiving acute type A aortic dissection surgery

Lin,

Xie,

et al. 2023

J of Clinical Hypertension

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The purposes of this study were to develop and validate a nomogram for predicting postoperative transient neurological dysfunctions (TND) in patients with acute type A aortic dissection (AAAD) who underwent modified triple‐branched stent graft implantation. This retrospective study developed a nomogram‐based model in a consecutive cohort of 146 patients. Patient characteristics, preoperative clinical indices, and operative data were analyzed. Univariate and multivariable analyses were applied to identify the most useful predictive variables for constructing the nomogram. Discrimination and the calibration of the model was evaluated through the receiver operating characteristic curve (ROC), the Hosmer–Lemeshow goodness‐of‐fit test and the decision curve analysis (DCA). At the same time, to identify and compare long‐term cumulative survival rate, Kaplan‐Meier survival curve was plotted. The incidence rate of postoperative TND observed in our cohort were 40.9%. Supra‐aortic dissection with or without thrombosis, creatinine >115 μmol and albumin <39.7 g/L, selective antegrade cerebral perfusion (SACP) time >7 min and total operation time >303 min, were confirmed as independent predictors that enhanced the likelihood of TND. Internal validation showed good discrimination of the model with under the ROC curve (AUC) of 0.818 and good calibration (Hosmer–Lemeshow test, p > .05). DCA revealed that the nomogram was clinically useful. In the long‐term survival there was no significant difference between patients with or without TND history. The results showed the predict model based on readily available predictors has sufficient validity to identify TND risk in this population, that maybe useful for clinical decision‐making.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

A nomogram‐based model to predict postoperative transient neurological dysfunctions in patients receiving acute type A aortic dissection surgery

Lin,

Xie,

et al. 2023

J of Clinical Hypertension

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“…However, this surgical procedure is particularly complicated, needs to be completed under HCA and prolonged CPB and ACC times are inevitable, leading to increased risk of postoperative complications and mortality, especially in elderly patients or patients with malperfusion syndrome 6 , 16 . Prolonged CPB and ACC times are independent risk factors of adverse outcomes and mortality following cardiac surgery 17 , 18 , and HCA time is an independent risk factor of mortality in a-TAAD patients 19 . With the rapid development of interventional techniques in recent years, new concepts in the surgical treatment of a-TAAD have been proposed.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of two-stage type II hybrid aortic arch repair in elderly patients with acute type A aortic dissection

Xiang,

He,

Pen

et al. 2024

Sci Rep

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Acute type A aortic dissection (a-TAAD) is a severe disease characterized by high mortality, which can be fatal in elderly patients. The objective of this study was to investigate the safety and efficacy of two-stage type II hybrid aortic arch repair (HAR) in elderly patients with acute type A aortic dissection (a-TAAD). This was a single-center, retrospective study involving 119 patients with a-TAAD, including 82 males and 37 females, aged 22–81 years old. Eighty-eight patients underwent total aortic arch replacement (TAR) with frozen elephant trunk (FET) implantation (TAR with FET group) and 31 patients underwent two-stage type II HAR (HAR group). Propensity score matching was applied to adjust for preoperative data, and match 25 pairs. The preoperative, perioperative, postoperative and follow-up data were recorded. Fifteen patients died during the perioperative period; 13 cases were in the TAR with FET group and 2 cases were in the HAR group. The age, body mass index, cerebral infarction, renal insufficiency were significantly higher, and the 24-h fluid drainage, the incidence of acute liver injury, acute kidney injury and pulmonary infection were lower in the HAR group (all P < 0.05). Moreover, the mechanical ventilation time, intensive care unit time, hospital stay time were shorter in the HAR group (all P < 0.05). The follow-up period ranged from 12 to 54 months, with 7 deaths (9.3%) in the TAR with FET group and 2 deaths (6.9%) in the HAR group. The true lumen of the aortic arch and the middle descending thoracic aorta were larger and the false lumen thrombosis rates of the middle descending thoracic aorta and renal artery level were higher in the HAR group (all P < 0.05). Two-stage type II HAR is a safe and effective method for the treatment of elderly patients with a-TAAD. It may be a good choice for elderly patients with a-TAAD and comorbidities.

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“…However, this surgical procedure is particularly complicated, needs to be completed under HCA and prolonged CPB and ACC times are inevitable, leading to increased risk of postoperative complications and mortality, especially in elderly patients or patients with malperfusion syndrome (6,16). Several studies have shown that prolonged CPB and ACC times are independent risk factors for adverse outcomes and mortality after cardiac surgery (17)(18), and HCA time is an independent risk factor for mortality in a-TAAD patients (19). With the rapid development of interventional techniques in recent years, new concepts in the surgical treatment of a-TAAD have been proposed.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of two-stage type II hybrid aortic arch repair in elderly patients with acute type A aortic dissection: a propensity score-matched analysis

Xiang

Pen

et al. 2023

Preprint

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Objective: To investigate the safety and efficacy of two-stage type II hybrid aortic arch repair (HAR) in elderly patients with acute type A aortic dissection (a-TAAD). Methods: This was a single-center, prospective study involved 119 patients with a-TAAD, included 82 males and 37 females, aged 22 ~81 years old. Eighty-eight patients underwent total aortic arch replacement (TAR) with stented frozen elephant trunk (FET) implantation (TAR with FET group) and 31 patients underwent two-stage type II HAR (HAR group). Propensity score matching (PSM) was applied to adjust for preoperative data, and 25 pairs were matched successfully. The preoperative, perioperative, postoperative and follow-up data in the HAR group and TAR with FET group were compared. Results: Fifteen patients died during the perioperative period; 13 cases were in the TAR with FET group and 2 cases were in the TAR group. The age, body mass index, cerebral infarction, renal insufficiency were significantly higher, and the 24-h fluid drainage, the incidence of acute liver injury, acute kidney injury and pulmonary infectionwere were lower in the HAR group. Moreover, the mechanical ventilation time, intensive care unit time, hospital stay timewere shorter in the HAR group.The follow-up period ranged from 12 to 54 months, with 7 deaths (9.3%) in the TAR with FET group and 2 deaths (6.9%) in the HAR group. The true lumen of the aortic arch (P<0.001) and the middle descending thoracic aorta were larger and the false lumen thrombosis rates of the middle descending thoracic aorta and renal artery level were higher in the HAR group. Conclusion: Two-stage type II HAR is a safe and effective method for elderly patients with a-TAAD. It may be a good choice for elderly patients with a-TAAD and comorbidities.

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Risk factors of cerebral complications after Stanford type A aortic dissection undergoing arch surgery

Cited by 8 publications

References 8 publications

A nomogram‐based model to predict postoperative transient neurological dysfunctions in patients receiving acute type A aortic dissection surgery

A nomogram‐based model to predict postoperative transient neurological dysfunctions in patients receiving acute type A aortic dissection surgery

Outcomes of two-stage type II hybrid aortic arch repair in elderly patients with acute type A aortic dissection

Safety and efficacy of two-stage type II hybrid aortic arch repair in elderly patients with acute type A aortic dissection: a propensity score-matched analysis

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