Long-term mortality prediction after operations for type A ascending aortic dissection

Macrina, Francesco; Puddu, Paolo Emilio; Sciangula, Alfonso; Totaro, Marco; Trigilia, Fausto; Cassese, Mauro; Toscano, Michele

doi:10.1186/1749-8090-5-42

Cited by 17 publications

(12 citation statements)

References 25 publications

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“…Meanwhile, there was controversy of these predictors for type B AD. Some studies focused on the new models to predict the mortality of aortic dissection [18] . Techniques in molecular and genetic biology and the other definite indictors await further study [19,20] .…”

Section: Predictors Of Follow-up Mortalitymentioning

confidence: 99%

Analysis of 287 patients with aortic dissection: General characteristics, outcomes and risk factors in a single center

Jin

Zheng

Lai

et al. 2011

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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The general characteristics, outcomes and risk factors of the patients with aortic dissection (AD) were evaluated in a single medical center. From January 2002 to December 2008, 284 patients with AD were treated and followed-up at our institution, including 105 cases of type A AD and 179 cases of type B AD. The patients in each type were divided into three groups according to management: medical treatment group (A or B), open surgery group (A or B), and stent-graft group (A or B). The characteristics and follow-up outcomes were compared between the groups or subgroups. The results showed that there was significant difference in the prognosis for type A AD between medical treatment group and open surgery group, but there was no significant difference in the prognosis for type B AD between medical treatment group and stent-graft group. Independent risk factors of follow-up mortality for patients with type A AD included a history of atherosclerosis (HR, 3.807; 95% confidence interval [CI], 1.489 to 7.611; P=0.003), in-hospital hypotension/shock (HR, 4.687; 95% CI, 1.846 to 11.900; P=0.001), in-hospital myocardial ischemia or infarction (HR, 3.734; 95% CI, 1.613 to 8.643; P=0.002), pleural effusion (HR, 2.210; 95% CI, 1.080 to 4.521; P=0.030), branch vessel involvement (HR, 2.747; 95% CI, 1.202 to 6.278; P=0.016) and surgical treatment (HR, 0.177; 95% CI, 0.063 to 0.502; P=0.001). And there were insignificant independent predictors for mortality of the patients with type B AD. It was concluded that there were significant differences in characteristics and one year mortality between type A AD and type B AD, but after one year, there was no significant difference in the mortality and complications of them. There were several discordant risk factors of AD, such as female gender, age, thrombus, abrupt onset of pain that were considered as the risk factors in some papers. And there was no definite risk factor of mortality in this study in the patients with type B AD.

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Section: Predictors Of Follow-up Mortalitymentioning

confidence: 99%

Analysis of 287 patients with aortic dissection: General characteristics, outcomes and risk factors in a single center

Jin

Zheng

Lai

et al. 2011

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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“…The incidence of AD ranges between 5 to 30 cases per million people per year, depending on the study population (1,2). Although AD is uncommon, it frequently has fatal outcome, with an overall hospital mortality rate of 27.4 %, and as high as 58 % in patients with Debakey type I AD patients who didn't receive surgical treatment (1,3). Therefore rapid diagnosis and treatment of AD is very important and can't be overemphasized.…”

Section: Case Discussionmentioning

confidence: 99%

A case of ascending aortic dissection mimicking acute myocardial infarction and complicated with pericardial tamponade

Hawatmeh

Arqoub

Isbitan

et al. 2016

Cardiovasc. Diagn. Ther.

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A 60-year-old male with past medical history of hypertension, presented to emergency department complaining of chest pain for 2 hours, the pain was described as tearing, substernal pain and was radiating to the neck and shoulders and associated with nausea and sweating. Initial vital signs showed Blood pressure of 120/90 mmHg in right arm, and 110/70 mmHg in left arm, Heart rate of 90 beat per minute, Respiratory rate was 18 breath per minute, temperature of 37.6 ℃ and Oxygen saturation of 95% breathing ambient air. Physical exam was significant for jugular venous distension and cardiac exam showed normal heart sounds, an early diastolic murmur, 3/6 in intensity, best heard on left 3 rd intercostal space without radiation, and no S3 or S4 gallop. Initial lab results showed a white blood cell count of 8.1 k/μL, hemoglobin of 12.2 g/dL, platelets of 177 k/μL, creatinine of 1.19 mg/dL, AST of 30 IU/L, ALT of 29 IU/L, initial set of troponin I was 0.02 ng/mL. Twelve lead electrocardiogram (EKG) showed ST segment elevations in inferior leads ( Figure 1). Emergent coronary angiography was done and revealed normal coronary arteries without evidence of dissection ( Figure 2). After the catheter was pulled back across the aortic valve, an aortic root angiogram was performed and showed aortic insufficiency (grade 3), and an aortic dissection flap that started in the ascending aorta and progressed through to the descending aorta ( Figure 3); this was classified as a Stanford type A (DeBakey type I). A bedside transthoracic echocardiogram was also performed after cardiac catheterization, and showed an EF of 40 % with inferior wall hypokinesia, a dilated aortic root with an evidence of intimal tear in the ascending aorta and moderate aortic regurgitation. In addition, mild pericardial effusion was also noted.Vascular surgery team was immediately consulted, and an aortic computed tomography (CT) scan was done and revealed a Stanford type A (DeBakey type I) aortic Abstract: Acute aortic dissection (AD) is the most common life-threatening disorder affecting the aorta with an incidence that ranges between 5 to 30 cases per million people per year. The symptoms of aortic dissection may be variable and can mimic other more common conditions such as myocardial ischemia. We report a case of a 60-year-old male who presented with inferior wall ST-elevation myocardial infarction (MI).Emergent coronary angiography revealed an ascending aortic dissection with normal coronary arteries. In addition, his aortic dissection was complicated with pericardial tamponade. The patient was managed with an immediate surgical repair, after that he had an uncomplicated postoperative course and was discharged in a stable condition. This case report illustrates the importance of having a high index of suspicion for AD in cases of chest pain. If AD is suspected in a patient with acute coronary syndrome (ACS), confirming the diagnosis with the appropriate imaging studies should be done as quickly as possible, as misdiagnosis with ACS may lead to the inappr...

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“…Many Citation: Khan MF, Fa X, Yu HB (2016) Factors of Prolonged Intensive Care Unit Stay After Surgery in Patients with Type A Acute Aortic studies have pointed out that the elderly, renal failure, preoperative hemodynamic instability, cardiopulmonary resuscitation, cardiac tamponade, prolonged deep hypothermic cardio-circulatory arrest (DHCA), damaged nervous system(CVA), respiratory insufficiency are important factors of postoperative death [16][17][18][19]. Postoperative ICU stay time affects on recovery of Stanford acute type A aortic dissection.…”

Section: Discussionmentioning

confidence: 99%

Factors of Prolonged Intensive Care Unit Stay After Surgery in Patients with Type A Acute Aortic Dissection

Khan¹,

Fa²,

Yu³

2017

Biol Med (Aligarh)

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Objective: To identify the risk factors of prolonged Intensive Care Unit stay after surgery in patients with the type A acute aortic dissection. Methods:Retrospective analysis of 80 patients, 54 males (67.5%) and 26 females (32.5%) who underwent surgery for the treatment of Stanford type A acute aortic dissection in the cardiovascular department of 2nd affiliated hospital of Zhengzhou university through December 2014 to July 2016 were done. The mean age of the patients was 48.9 ± 12.5 years. The patients were divided into two groups, group A, prolonged (n=13) and group B, nonprolonged (n=67) based on the duration of ICU stay time either above or below 5 days. Univariate and multivariate analysis were done to find out the predictive risk factors. Results:The mean length of ICU stay time was 206.9 ± 25.4 hours in group A and 63.2 ± 17.4 hours in group B respectively. Mortality rate was 15.4% in group A and 3.0% in group B while overall mortality was 5%. ICU stay time was significantly influenced by the following factors; age (P=0.

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Long-term mortality prediction after operations for type A ascending aortic dissection

Cited by 17 publications

References 25 publications

Analysis of 287 patients with aortic dissection: General characteristics, outcomes and risk factors in a single center

Analysis of 287 patients with aortic dissection: General characteristics, outcomes and risk factors in a single center

A case of ascending aortic dissection mimicking acute myocardial infarction and complicated with pericardial tamponade

Factors of Prolonged Intensive Care Unit Stay After Surgery in Patients with Type A Acute Aortic Dissection

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