Surgical Outcomes of Type A Aortic Dissection at a Small- Volume Medical Center: Analysis according to the Extent of Surgery

Lee, Chul Ho; Cho, Jun Woo; Jang, Jae Seok; Yoon, Tae Hong

doi:10.5090/kjtcs.2020.53.2.58

Cited by 3 publications

(1 citation statement)

References 19 publications

(26 reference statements)

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“…A few decades ago, postoperative mortality yielded as high as 60.7% [ 6 ]. An 8% of in-hospital mortality rate in a recent report, although it is a much more improved number, remains high among major surgeries [ 7 ]. Therefore, predictive tools for identifying patients with AAD who are at an increased risk of death after surgery enable physicians to exploit clinical progress and make good decisions.…”

Section: Introductionmentioning

confidence: 99%

Can preoperative neutrophil-to-lymphocyte ratio predict in-hospital mortality in postoperative patients with Stanford type A aortic dissection? Evidence-based appraisal by meta-analysis and GRADE

2021

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Objectives: In-hospital mortality in postoperative patients with type A aortic dissection (AAD) is high. Neutrophil-to-lymphocyte ratio (NLR) is a novel predictor of adverse outcomes in many cardiovascular diseases. We examine NLR as a predictive tool in AAD in this meta-analysis. Materials and Methods: We systematically searched in four databanks. Risk of bias was appraised using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. The midas and metandi commands in Stata 15 were used for the meta-analysis. The certainty of evidence was assessed by the Grading of Recommendations, Assessment, Development, and Evaluation methodology (GRADE). Results: Four studies with 502 cases in total were included. Pooled sensitivity and specificity were 0.71 (95% confidence interval [CI] = 0.52–0.79) and 0.64 (95% CI = 0.55–0.71), respectively. Area under the hierarchical summary receiver operating characteristic curve yielded 0.73 (95% CI = 0.68–0.76). The diagnostic odds ratio was 4.42 (95% CI = 2.56–7.62). Pooled positive and negative likelihood ratios yielded 1.98 (95% CI = 1.53–2.55) and 0.45 (95% CI = 0.32–0.62), respectively. When the pretest probabilities were 25%, 50%, and 75%, the positive posttest probabilities were 40%, 66%, and 86%, and the negative posttest probabilities were 13%, 31%, and 57%, respectively, according to the Fagan's nomogram plot. The overall certainty of evidence in GRADE was low and very low in sensitivity and specificity, respectively. Conclusion: The pooled diagnostic values of preoperative NLR, an inexpensive and routine laboratory examination, provide a practicable help for predicting in-hospital mortality for patients with postoperative AAD in our meta-analysis.

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Section: Introductionmentioning

confidence: 99%

Can preoperative neutrophil-to-lymphocyte ratio predict in-hospital mortality in postoperative patients with Stanford type A aortic dissection? Evidence-based appraisal by meta-analysis and GRADE

2021

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Proximal versus extensive repair in acute type A aortic dissection: an updated systematic review and meta-analysis

Tasoudis

Magouliotis

Varvoglis

et al. 2022

Gen Thorac Cardiovasc Surg

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Outcomes of hemi- vs. total arch replacement in acute type A aortic dissection: A systematic review and meta-analysis

Chai

Yang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAcute type A aortic dissections (ATAAD) pose a challenge to surgeons due to high mortality, and decision making regarding the appropriate procedure is controversial. This study compared the outcomes of hemiarch and total arch replacement for ATAAD.MethodsThe PubMed, Web of Science, Embase and Cochrane databases were searched for comparative studies on hemiarch versus total arch replacement that were published before May 1, 2022.ResultsWe included 23 observational studies with a total of 4,576 patients. Combined data analysis showed that early mortality (RR = 0.82; 95% CI: 0.70–0.97; P = 0.02), incidence of postoperative permanent neurological dysfunction (RR = 0.72; 95%CI:0.54∼0.94; P = 0.02), and incidence of renal failure and dialysis (RR = 0.82; 95%CI:0.71∼0.96; P = 0.01) were all lower for hemiarch than for total arch replacement. However, hemiarch replacement had a higher rate of late mortality (RR = 1.37; 95%CI:1.10∼1.71; P = 0.005). There were no statistically significant differences between the two groups in terms of re-operation for bleeding, aortic re-operation, or postoperative pneumonia.ConclusionIn this study, hemiarch replacement had better early outcomes but a higher late mortality rate than total arch replacement. Decisions regarding the extent of arch repair should be made according to location and extent of ATAAD and the experience of surgeons to ensure the most favorable prognosis.Systematic review registration:[INPLASY.COM], identifier [INPLASY202250088].

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Surgical Outcomes of Type A Aortic Dissection at a Small- Volume Medical Center: Analysis according to the Extent of Surgery

Cited by 3 publications

References 19 publications

Can preoperative neutrophil-to-lymphocyte ratio predict in-hospital mortality in postoperative patients with Stanford type A aortic dissection? Evidence-based appraisal by meta-analysis and GRADE

Can preoperative neutrophil-to-lymphocyte ratio predict in-hospital mortality in postoperative patients with Stanford type A aortic dissection? Evidence-based appraisal by meta-analysis and GRADE

Proximal versus extensive repair in acute type A aortic dissection: an updated systematic review and meta-analysis

Outcomes of hemi- vs. total arch replacement in acute type A aortic dissection: A systematic review and meta-analysis

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