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Background: A patent false lumen (FL) in patients with thoracic endovascular aortic repair (TEVAR)-treated type B aortic dissection (TBAD) can cause a significant risk for late aortic expansion (LAE). We hypothesize that preoperative features can predict the occurrence of LAE. Methods: Sufficient preoperative and postoperative follow-up clinical and imaging feature data for patients treated with TEVAR in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2020 were collected. A univariate analysis and multivariable logistic regression analysis were used to find potential risk factors of LAE. Results: Ninety-six patients were finally included in this study. The mean age was 54.5 ± 11.7 years and 85 (88.5%) were male. LAE occurred in 15 (15.6%) of 96 patients after TEVAR. Two preoperative factors showed strong associations with LAE according to the multivariable logistic regression analysis: preoperative partial thrombosis of the FL (OR = 10.989 [2.295–48.403]; p = 0.002) and the maximum descending aortic diameter (OR = 1.385 [1.100–1.743] per mm increase; p = 0.006). Conclusions: Preoperative partial thrombosis of the FL and an increase in the maximum aortic diameter are strongly associated with late aortic expansion. Additional interventions of the FL may help to improve the prognosis of patients with the high risk of late aortic expansion.

BACKGROUND To investigate whether laboratory signatures on admission could identify risk stratification and district tolerance to hypothermic circulatory arrest in acute type A aortic dissection surgery. METHODS Patients from 10 Chinese hospitals of the Additive Anti-inflammatory Action for Aortopathy & Arteriopathy (5A) study were randomly divided into derivation and validation cohort at a ratio of 7:3 to develop and validate a simple risk score model using preoperative variables associated with in-hospital mortality using multivariable logistic regression. Model performance were assessed using the area under the receiver operating characteristic (AUC) curve. Subgroup analysis were performed to investigate whether the laboratory signature-based risk stratification could differentiate the tolerance to hypothermic circulatory arrest. RESULTS There were 1443 patients and 954 patients in derivation and validation cohort. Multivariable analysis showed the associations of older age, larger body mass index, lower platelet-neutrophile ratio, higher lymphocyte-monocyte ratio, higher D-dimer, lower fibrinogen, and lower estimated glomerular filtration rate with in-hospital mortality, incorporated to develop a simple risk model (5A lab risk score), with an AUC of 0.736 (95% confidence interval 0.700-0.771) and 0.715 (0.681-0.750) in derivation and validation cohort. Patients at low risk were more tolerant to hypothermic circulatory arrest than those at middle-high risk in term of in-hospital mortality (OR 1.814 [0.222-14.846]; OR 1.824 [1.137-2.926]) (Pinteraction=0.996). CONCLUSIONS 5A lab-based risk score model reflecting inflammatory, immune, coagulation, and metabolic pathways provided adequate discrimination performances in in-hospital mortality prediction, which contributed to differentiating the tolerance to hypothermic circulatory arrest in acute type A aortic dissection surgery. Clinical Trials gov number NCT04918108