Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis

Bruno, Vito Domenico; Chivasso, Pierpaolo; Guida, Gustavo; Vohra, Hunaid A.

doi:10.21037/acs.2016.06.03

Cited by 24 publications

(17 citation statements)

References 20 publications

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“…Among a set of 16 variables WATAS identified increased age as an independent predictor of late mortality, which was a well-documented independent predictor of late death (29,30). In addition, WATAS found that extensive distal aortic operations including conventional or frozen elephant trunk operations related to longterm mortality.…”

Section: Other Clinical Predictors Of Late Outcomementioning

confidence: 98%

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Kodolitsch¹,

Wilson²,

Schuler³

et al. 2017

Cardiovasc. Diagn. Ther.

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Background: Early survivors of acute type A aortic dissection (AAAD) remain at risk for late death and late aortic events. However, the frequency and long-term effects of warfarin anticoagulation on long-term outcome in post-surgical AAAD survivors have not been elucidated. Methods:Two tertiary care centers performed a retrospective observational cohort study of warfarin anticoagulation in AAAD in 243 persons with early survival of surgical repair (WATAS). Serial postoperative tomographic imaging was available in 106 persons.Results: A total of 88 postoperative AAAD survivors (36%) were on long-term warfarin anticoagulation.The indication for anticoagulation was a mechanical aortic prosthesis in 46 (52%), atrial fibrillation in 33 (38%), stroke in 7 (8%), and pulmonary embolism in 1 (1%). The indication for anticoagulation remained unclear in 1 person (1%). Survival and aortic event free survival were 98.3±0.01 and 98.7±0.01 at 1 year, and 76.4±0.03 and 91.8±0.02 at 5 years, respectively, with no differences irrespective of warfarin anticoagulation. Multivariate Cox regression analysis established higher age (P<0.001), and operation extending into the descending aorta (P=0.030) as independent predictors of late death. Follow-up without tomographic imaging independently predicted increased long-term mortality (P<0.001) and lower rates of documented aortic events (P=0.003). Kaplan-Meyer analysis showed a relationship of aortic diameter growth ≥0.5 cm per year with late death (P=0.041) and with late aortic events (P<0.001). However, rapid aortic growth did not relate to warfarin anticoagulation.Conclusions: Warfarin anticoagulation is frequent in postsurgical AAAD and it is administered for vital indications. Warfarin anticoagulation does not relate to late mortality or to late aortic events. Rapid aortic growth predicts late mortality and late aortic events, but warfarin anticoagulation is not associated with aortic growth. Follow-up tomographic imaging is mandatory for long-term survival after surgical repair of AAAD. von Kodolitsch et al. Warfarin in aortic dissection

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Section: Other Clinical Predictors Of Late Outcomementioning

confidence: 98%

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Kodolitsch¹,

Wilson²,

Schuler³

et al. 2017

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

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“…The in-hospital mortality rate was 26%, with an estimated 5-year survival rate of 46%±16% (10 finding also being confirmed for octogenarians. However, the incidence of neurological complications and renal failure was similar in both groups (11). In any case, other studies report a high incidence of postoperative neurological complications (12), with a surgical mortality rate up to 83% (13,14).…”

mentioning

confidence: 51%

Emergent aortic surgery in octogenarians: is the advanced age a contraindication?

Castaño¹,

Gualis²,

Martínez‐Comendador³

et al. 2017

J. Thorac. Dis.

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“…For type B AD, Mussa et al reported a 30-day mortality rate of 0-27% for medical treatment, 13-17% for open surgical procedures, and 0-18% for TEVAR. Moreover, they reviewed two important RCTs comparing medical therapy with TEVAR in patients with uncomplicated type B AD (2,3). The ADSORB trial compared medical therapy with TEVAR in an RCT of 61 patients with uncomplicated acute type B AD (5).…”

Section: Tomoaki Ishigamimentioning

confidence: 99%

The current evidence on diagnosis and treatment of acute aortic syndrome

et al. 2016

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In their article titled "Acute Aortic Dissection and Intramural Hematoma: A Systematic Review" Mussa et al. highlight the important evidence on diagnosis and treatment of acute aortic syndrome (AAS) (1). AAS describes the presentation of patients with one of a number of life threatening aortic pathologies, including aortic dissection (AD), intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU). Several studies and meta-analyses have discussed the management of AAS (2-4). Mussa et al. analyzed many studies involving large numbers of patient, and provided new insights; 82 studies with a total of 57,311 patients were included. The information is of great use in the management of AAS. However, the optimal treatment of patients with AAS is still unclear, due to selection bias and the paucity of randomized trials. Only two randomized clinical trials (RCTs) (5,6) were identified, and the remaining 80 were observational cohort studies.T h e a c u t e o n s e t o f t h o r a c i c p a i n w i t h s e v e r e hypertension should raise suspicion for AAS. In the review, 50-81% of patients were males, with ages ranging from 60 to 70 years. The most common risk factor for AD is hypertension, which was observed in 45-100% of patients. Other risk factors include a smoking history, chronic renal insufficiency, chronic obstructive pulmonary disease, and stroke or transient ischemic attack. Although few studies have accurately determined the incidence of AAS, AD is the most common form of AAS, followed by IMH and PAU. A recent analysis of AD reported an incidence of 15 per 100,000 patient-years (7).The diagnosis of AAS can be made using imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and transesophageal echocardiography (TEE). The ideal diagnostic tool in AAS should have high sensitivity and specificity, and should provide assessment of anatomical aspects for use in management. Early diagnosis and accurate radiological classification is associated with improvement of clinical outcomes in AAS. In the analysis of eligible articles, the sensitivities of CT and MRI for diagnosis of AAS were 100% and 95-100%, respectively. Although MRI provides detailed anatomic information comparable to that of CT, it is limited by availability and long scan times. The authors also reviewed the diagnostic value of TEE. TEE has considerable potential for the diagnosis of AAS. However, TEE does not visualize the aortic arch or abdominal aorta well. These imaging modalities have their advantages and limitations. This important aspect has been reviewed by Macura et al. in detail (8).Mussa et al. came to the conclusion that the lack of studies prevents any suggestions regarding the diagnostic use of serologic biomarkers to improve outcomes. To the best of our knowledge, their review included only limited Editorial

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Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis

Cited by 24 publications

References 20 publications

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Emergent aortic surgery in octogenarians: is the advanced age a contraindication?

The current evidence on diagnosis and treatment of acute aortic syndrome

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