Fate of distal aorta after acute type A aortic dissection repair: Change and persistency of postoperative false lumen status

Lin, Fang-Yi; Tseng, Yu Ting; Huang, Jau‐Shyang; Hsieh, Chong‐Chao; Chen, Huai-Min; Chiu, Chaw-Chi; Chen, Ying-Fu

doi:10.1016/j.ijcard.2018.01.010

Cited by 13 publications

(10 citation statements)

References 35 publications

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“…ATAAD is the most lethal cardiovascular disease. Its incidence rate is increasing annually, the natural prognosis is extremely poor, and the rates of surgical complications and mortality are high ( 1 ). The 48-h mortality rate can reach 50% and the 2-week mortality as high as 75% in patients who do not undergo surgery ( 7 , 8 ).…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of sivelestat sodium for the treatment of inflammatory response in acute Stanford type A aortic dissection: a retrospective cohort study

Zhou¹,

Li²,

Chen³

et al. 2022

J Thorac Dis

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Background: Systemic inflammatory response syndrome (SIRS) after surgery for acute Stanford type A aortic dissection (ATAAD) via cardiopulmonary bypass (CPB) are strongly associated with mortality.Although the sivelestat sodium has been approved for the treatment of patients with acute lung injury, there is currently no enough evidence for improving inflammatory response and reducing the associated mortality.Our study aims to investigate the efficacy and safety of sivelestat sodium for the treatment of inflammatory response in acute Stanford type A aortic dissection.Methods: A total of 71 ATAAD patients who received surgical treatment at our center from January 2021 to December 2021 retrospectively reviewed. Patients were divided into the sivelestat sodium group and the control group. Clinical information including the postoperative oxygenation index (PaO 2 /FiO 2 ), white blood cell (WBC) count, procalcitonin (PCT) level, interleukin-6 (IL-6) level, duration of ventilator use (hours), intensive care unit stay (days), and 28-day mortality rate, were collected. The statistical inference differences between the groups were compared using the non-paired Student's t-test, Wilcoxon rank sum test, chi squared test and repeated analysis of variance (ANOVA).Results: There were no significant differences between the sivelestat sodium group and the control group in terms of baseline characteristics (all P>0.05). The mortality rate was decreased in the sivelestat sodium group than the control group (10% vs. 13.73%). The subgroup analysis showed that for patients with a mechanical ventilation duration >96 h, the 48-h oxygenation index (149±53 vs. 260±66, P=0.001), and the 72-h oxygenation index (165±66 vs. 288±95, P=0.002) were significantly lower in the control group than the sivelestat sodium group. And the postoperative WBC count (P=0.015) and PCT level (P=0.033) were significantly lower in the sivelestat group than the sivelestat sodium group in post-operative day 4.Conclusions: Sivelestat sodium can improves the postoperative oxygenation index and inflammatory response for ATAAD patients requiring mechanical ventilation for extended periods.

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Section: Discussionmentioning

confidence: 99%

“…With an in-hospital mortality rate of 5–30% ( 1 ), acute Stanford type A aortic dissection (ATAAD) is one of the most lethal emergency procedures. Surgery remains the mainstay of treatment for ATAAD, during which cardiopulmonary bypass (CPB) is often required.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of sivelestat sodium for the treatment of inflammatory response in acute Stanford type A aortic dissection: a retrospective cohort study

Zhou¹,

Li²,

Chen³

et al. 2022

J Thorac Dis

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“…Larsen et al 12 confirmed this finding in an analysis of the IRAD database in type A aortic dissection. In a recent work, Lin et al 13 showed that the modification of the status of the false lumen after the surgery could influence the aortic growth, but was not associated with the risk of The mechanisms linking sleep apnea and aortic dissection are complex and not well-understood. The prevalence of nondipper patients was high in our cohort: this parameter has been shown to be frequently associated with sleep breathing disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Larsen et al 12 confirmed this finding in an analysis of the IRAD database in type A aortic dissection. In a recent work, Lin et al 13 showed that the modification of the status of the false lumen after the surgery could influence the aortic growth, but was not associated with the risk of T A B L E 3 Age-sex-adjusted correlation between blood pressure-monitoring parameters and aortic diameters mortality. More than the status of the false lumen at admission or at discharge, the modification of the status during follow-up needs to be explored.…”

Section: Bp Parameters Aortic Diameters and Incidence Of An Aortic Event After Dischargementioning

confidence: 99%

Aortic morphology post type A acute aortic syndrome: Prognosis significance and association with 24‐hour blood pressure‐monitoring parameters

Delsart¹,

Soquet

Ramdane

et al. 2020

J Card Surg

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Background: After an emergent surgery for type A acute aortic syndrome, medical management is based on optimal blood pressure (BP) control. We assessed the prognostic significance of BP monitoring and its relationship with aortic morphology following type A acute aortic syndrome.Methods: The data of 120 patients who underwent BP monitoring after a type A acute aortic syndrome from January 2005 to June 2016 were retrospectively collected. The first CT angiogram performed after surgery was used for the morphological analysis.Results: The population included 79 males, with an overall mean age of 60 ± 12 years.Seven patients (5.8%) died during a median follow-up of 5.5 years. The median delay between BP monitoring and discharge was 3 (1-5) months. The mean 24-hour BP of the cohort was 127/73 mm Hg ± 10/17. During follow-up, different parameters of BP monitoring were not associated with the risk of aortic events. However, the diameter of the false lumen of the descending thoracic aorta was the best predictor associated with the risk of new aortic events during follow-up, particularly for the threshold of 28 mm or more (P < .001; Hazard ratio 4.7[2.7-8.2]). The diameter of the false lumen was associated with night-time systolic BP (P = .025; r = .2), 24-hour pulse pressure (P = .002; r = .28), and night-time pulse pressure (P = .008; r = .24). Conclusion:The risk of new aortic events following type A acute aortic syndrome is associated with the size of the residual false lumen, but not directly with BP parameters. Night-time BP parameters are associated with the size of the residual false lumen.

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“…Such persistent growth is associated with an increased mortality rate due to the increased risk of rupture. Even in Type A dissections, persistent FL patency results in increased aortic root growth, which correlates with an increased rupture rate . Chou et al studied patients with chronic or acute complicated Type B aortic dissection that required TEVAR and showed that FL thrombosis occurred in only 24.5% of patients, with no evidence of favorable remodeling.…”

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confidence: 99%

Aortic dissection: Is the false lumen really important?

Shatila

Krajcer

2018

Cathet Cardio Intervent

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Key Points Aortic dissection is associated with a high mortality rate and has been increasingly treated with endovascular therapy. False lumen (FL) patency has been shown to be associated with worse outcomes. FL interventions that incorporate the FLIRT (FL intervention to promote remodeling and thrombosis) concept have been associated with improved aortic remodeling that may confer favorable long‐term outcomes.

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Fate of distal aorta after acute type A aortic dissection repair: Change and persistency of postoperative false lumen status

Cited by 13 publications

References 35 publications

Efficacy and safety of sivelestat sodium for the treatment of inflammatory response in acute Stanford type A aortic dissection: a retrospective cohort study

Efficacy and safety of sivelestat sodium for the treatment of inflammatory response in acute Stanford type A aortic dissection: a retrospective cohort study

Aortic morphology post type A acute aortic syndrome: Prognosis significance and association with 24‐hour blood pressure‐monitoring parameters

Aortic dissection: Is the false lumen really important?

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