Impact of renal dysfunction on surgical outcomes in patients with aortic dissection

Fan, Pei-Yi; Chen, Chao‐Yu; Lee, Cheng‐Chia; Liu, Kuo‐Sheng; Wu, Victor Chien‐Chia; Fan, Pei‐Chun; Chang, Ming‐Yang; Chang, Jason C.; Tian, Ya‐Chung; Chen, Shaowei

doi:10.1097/md.0000000000015453

Cited by 8 publications

(8 citation statements)

References 21 publications

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“…These results show that an increase of Cr before the operation can increase the mortality after operation. The results of this study also confirmed that preoperative Cr increase is an independent risk factor for postoperative death (17). Wang et al's research shows that preoperative renal insufficiency is closely related to the increase of postoperative complications.…”

Section: Discussionsupporting

confidence: 81%

Development and evaluation of an early death risk prediction model after acute type A aortic dissection

Zhang¹,

Chen²,

Chen³

et al. 2021

Ann Transl Med

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Background: The purpose of the study was to assess the relationship between preoperative laboratory examination, clinical imaging data, and postoperative death of patients with acute type A aortic dissection (ATAAD) and to establish a prediction model of hospital death risk after the operation.Methods: A total of 224 cases of acute Standford A aortic dissection were treated by total arch replacement using a tetrafurcate graft with stented elephant trunk implantation in Tianjin Chest Hospital. Based on preoperative laboratory examination and clinical imaging data of patients with ATAAD, the independent risk factors of postoperative hospital death were obtained using logistic analysis, and a risk prediction model of postoperative hospital death was developed. Results: Independent risk factors of postoperative death in patients with ATAAD were: body mass index (BMI), preoperative neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), creatinine (Cr), D-dimer, high-sensitive cardiac troponin T (hs-CTnT), apolipoprotein A1, left subclavian artery involvement, and iliac artery involvement. The regression equation of postoperative death risk was: logitP1 = −9.584 + 1.060 × NLR + 1.586 × MPV + 1.009 × Cr + 1.067 × D-dimer + 2.023 × hs-CTnT; the regression equation of postoperative death risk was: logitP2 = −3.296 + 3.242 × left subclavian artery involved + 4.564 × iliac artery involved; the regression equation of postoperative death risk was: logitP3 = −12.864 + 1.149 × BMI + 4.731 × left subclavian artery involved + 4.150 × iliac artery involved + 1.064 × NLR + 1.011 × Cr + 1.084 × D-dimer + 2.242 × hs-CTnT + 3.233 × apolipoprotein A1.Conclusions: BMI, NLR, MPV, Cr, D-dimer, hs-CTnT, apolipoprotein A1, left subclavian artery involvement and iliac artery involvement can affect the hospital mortality rate of aortic dissection undergoing Sun's operation to varying degrees, which may be helpful to guide the design of the perioperative treatment strategy.

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Section: Discussionsupporting

confidence: 81%

Development and evaluation of an early death risk prediction model after acute type A aortic dissection

Zhang¹,

Chen²,

Chen³

et al. 2021

Ann Transl Med

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“…Mortality of acute AD type A patients with neurological complications reaches 50% in case of further intra-and postoperative complications. Still, patients with neurological deficits, with a favorable early postoperative course, usually recover fully [15]. In our study, preoperative neurological complications were not very frequent (around 7%), but having CVI on admission was associated with more postoperative complications.…”

Section: Discussionmentioning

confidence: 43%

Factors influencing early surgical outcomes of patients with acute aortic dissection type A

et al. 2021

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Introduction/Objective. Even with the current treatment mortality from aortic dissection remains high. The study aimed to evaluate the early postoperative outcome of patients with aortic dissection and identify which factors could have influence on it. Methods. The study included all consecutive patients who underwent surgery for acute aortic dissection type A from 2012 to 2017. We registered all parameters that could potentially impact the outcome (general data, medical history, clinical and cardiological diagnostic test findings, preoperative complications, type of cannulation and the operation performed, additional surgical procedures, operation duration, etc.). Patients were surgically treated according to the current protocols. The main outcome measures were complications and mortality during a one-month postoperative period. All data collected pre-, intra-, and postoperatively were compared and statistically analyzed. Results. The study included 246 patients, of an average 57.54+/-12.88 years of age and mostly male sex (74%). Early postoperative mortality occurred in 17% of patients. Preoperative chronic kidney insufficiency (p = 0.005) and cerebrovascular insult (p = 0.047) and tamponade (p = 0.036) were the major risk factors for postoperative complications and mortality. Long hypothermic cardiac arrest (p = 0.001), cross clamp (p = 0.017) and cardiopulmonary bypass time (p = 0.036) increased postoperative complications. Postoperative complications started occurring after ?33.5 minutes hypothermic cardiac arrest and ?67.5 minutes cross clamp time. Having more postoperative complications (p = 0.034) increased, while performing anterograde cerebral perfusion decreased the frequency of lethal outcome (p = 0.001). Conclusion. The majority of patients surgically treated for acute aortic dissection had good postoperative outcome. However, numerous pre-, intra- and postoperative factors can impact patient survival.

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“…Our 30-day and overall mortality rates are similar to these. Two of the most commonly cited preoperative factors that portend worse prognosis are the presence of MPS and renal dysfunction 7,9,11,18 . Berretta et al examined IRAD data and showed that while all forms of MPS were associated with increased mortality, mesenteric ischemia was particularly devastating and carried a 2.5-fold increase in mortality (63% vs. 24%) 19 .…”

Section: Discussionmentioning

confidence: 99%

“…Our 30-day and overall mortality rates are similar to these. Two of the most commonly cited pre-operative factors that portend worse prognosis are the presence of MPS and renal dysfunction 7 , 9 , 11 , 18 . Berretta et al .…”

Section: Discussionmentioning

confidence: 99%

“…Our data show equally distressing outcomes with 83% of cases presenting with mesenteric ischemia resulting in death. Fan and colleagues reported that patients with preoperative renal dysfunction had higher postoperative mortality, while IRAD registry analysis by Mehta and associates showed preoperative renal dysfunction having an odds ratio of 4.77 for mortality 11 , 18 . Although preoperative CKD class was not associated with mortality in our cohort, we did find that an elevated preoperative creatinine level was associated with increased mortality.…”

Section: Discussionmentioning

confidence: 99%

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Impact of time between diagnosis to treatment in Acute Type A Aortic Dissection

Matthews

Madison

Timsina

et al. 2021

Sci Rep

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There is a paucity of data describing the effect of time interval between diagnosis and surgery for Acute Type A Aortic Dissection. We describe our 8-year experience and investigate the impact of time interval between symptom onset, diagnosis and surgery on outcomes. Retrospective single-center study utilizing our Society of Thoracic Surgeons registry and patient records. Subjects were grouped by time interval between radiographic diagnosis and surgical treatment: Group A (0–4 h), Group B (4.1–8 h), Group C (8.1–12 h), and Group D (12.1 + h). Data were analyzed to identify factors associated with mortality and outcomes. 164 patients were included. Overall mortality was 21.3%. Group C had the greatest intervals between symptom onset to diagnosis to surgery, and also the highest mortality (66.7%). Preoperative tamponade, cardiac arrest, malperfusion, elevated creatinine, cardiopulmonary bypass time, and blood transfusions were associated with increased mortality, while distance of referring hospital was not. Time intervals between symptom onset, diagnosis and surgery have a significant effect on mortality. Surgery performed 8–12 h after diagnosis carries the highest mortality, which may be exacerbated by longer interval since symptom onset. Time-dependent effects should be considered when determining optimal strategy especially if inter-facility transfer is necessary.

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Impact of renal dysfunction on surgical outcomes in patients with aortic dissection

Cited by 8 publications

References 21 publications

Development and evaluation of an early death risk prediction model after acute type A aortic dissection

Development and evaluation of an early death risk prediction model after acute type A aortic dissection

Factors influencing early surgical outcomes of patients with acute aortic dissection type A

Impact of time between diagnosis to treatment in Acute Type A Aortic Dissection

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