Long-term outcome and quality of life following emergency surgery for acute aortic dissection type A: a comparison between young and elderly adults

Jussli-Melchers, Jill; Panholzer, Bernd; Friedrich, Christine; Broch, Ole Jacob; Renner, Jochen; Schöttler, J.; Rahimi, Aziz; Cremer, Jochen; Schoeneich, Felix; Haneya, Assad

doi:10.1093/ejcts/ezw408

Cited by 18 publications

(20 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The 30-day mortality of all enrolled patients was 5.8% (7 out of 121 patients), which was lower than previous studies which enrolled older patients [9,13], indicating age as a significant risk factor affect 30-day mortality [14][15][16]. However, our data suggested a significant difference of 30-day mortality between patients with and without AKI.…”

Section: Discussioncontrasting

confidence: 83%

Risk factors and long-term outcomes of acute kidney injury complication after type A acute aortic dissection surgery in young patients

Zong

Chen

et al. 2020

J Cardiothorac Surg

View full text Add to dashboard Cite

Objective To identify risk factors and long-term outcomes of acute kidney injury (AKI) in young patients who underwent type A acute aortic dissection (TA-AAD) emergency surgeries. Methods This retrospective study enrolled 121 consecutive patients less than 40 years old who received TA-AAD emergency surgeries between January 2014 to December 2018 in Nanjing Drum Tower hospital. The diagnosis of AKI was made based on the KDIGO criteria. Multivariable regression analysis was performed to identify risk factors for postoperative AKI. Kaplan–Meier curves were generated to compare long-term outcomes between patients with and without AKI complication after TA-AAD surgeries. Results Among all enrolled patients, AKI occurred in 51 patients (42.1%) and renal replacement therapy (RRT) was required in 15 patients (12.4%). The development of postoperative AKI was associated with increased 30-day mortality (P = 0.041), longer ICU stay time (P < 0.001) and hospital stay time (P = 0.006). Multivariable analysis indicated that elevated preoperative serum cystatin C (sCyC) (OR = 6.506, 95% CI: 1.852–22.855, P = 0.003) was the only independent risk factor for developing AKI. The areas under the receiver-operating characteristic curve (AUC) of preoperative sCyC was 0.800 (95% CI: 0.719, 0.882). Preoperative sCyC had a sensitivity of 64.7% and a specificity of 83.8% in diagnosing postoperative AKI with a cut-off value of 0.895 mg/L. In addition, our data suggested there was no difference discovered regarding long-term cumulative survival rate between patients with and without AKI during a median 29 months follow-up period. Conclusions Postoperative AKI after TA-AAD surgeries was relatively common in young patients and associated with increased short-term mortality. Elevated preoperative sCyC was identified as an independent risk factor for AKI with potential diagnostic merit.

show abstract

Section: Discussioncontrasting

confidence: 83%

Risk factors and long-term outcomes of acute kidney injury complication after type A acute aortic dissection surgery in young patients

Zong

Chen

et al. 2020

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…Extremely positive outcomes have been reported for elderly patients undergoing hemiarch replacement and a short-time/less-invasive ascending aortic replacement for entry closure [16, 21], and favorable outcomes with a good QOL assessment after AAD surgery have been reported for elderly patients with use of 36-Item Short Form Health Survey (SF36) [23, 24]. Our results also show favorable results with ascending aortic or hemiarch replacement.…”

Section: Discussionsupporting

confidence: 63%

Comparison of surgical and conservative treatment outcomes for type a aortic dissection in elderly patients

Aoyama

Kunisawa

Fushimi

et al. 2018

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundIn recent years, surgical outcomes have improved, and positive reports on surgery for type A aortic dissection (AAD) in the elderly are increasing. However, the difference between surgical and conservative treatments in the elderly remains unclear. Therefore, we conducted this study to determine whether surgery should be performed for Stanford (AAD) in elderly patients.MethodsData of patients aged 80 years or older who were hospitalized for AAD from April 2014 to March 2016 were extracted from the Japanese national inpatient database. Outcome measures were all-cause in-hospital death, stroke, acute kidney injury and tracheotomy, and composite adverse events (consisting of all-cause in-hospital death, stroke, acute kidney injury, and tracheotomy), and we compared them between surgical and conservative treatments using propensity score matching.ResultsThe study cohort included 3258 patients, with 845 matched pairs (1690 patients) in the propensity score matching. All-cause in-hospital death was significantly lower in the surgical treatment group than in the conservative treatment group before and after matching (15.6% vs. 51.1%, p < 0.001; 16.7% vs. 31.6%, p < 0.001, respectively); however, there was no significant difference in composite adverse events after matching (36.0%, conservative vs. 37.2%, surgical; p = 0.65), and adjusted odds ratio was 1.06 and 95% confidence interval was 0.86–1.29 (p = 0.61) with reference to conservative treatment.ConclusionsAll-cause in-hospital death among elderly patients with AAD was significantly lower in patients treated surgically than in those undergoing conservative treatment. However, there was no significant difference between the two groups in the event-free survival, which is important for the elderly. These findings may be used in the consideration of treatment course for elderly patients with AAD.Electronic supplementary materialThe online version of this article (10.1186/s13019-018-0814-6) contains supplementary material, which is available to authorized users.

show abstract

“…[1][2][3] Cardiopulmonary resuscitation (CPR) before surgery has been reported to be a major predictor of in-hospital mortality. [1][2][3][4][5][6][7][8][9] Given recent advances in emergency medical systems, such as transportation systems and critical care inside and outside hospital settings, and the increasing prevalence of knowledge about AAAD and diagnostic equipment, numbers of AAAD repairs after CPR might have increased. However, this might have thwarted decreases in operative mortality after AAAD repair, because patients in a serious condition, including patients undergoing CPR, could be transferred to the operating room.…”

Section: Perspectivementioning

confidence: 99%

Surgical outcomes of acute type A aortic dissection in patients undergoing cardiopulmonary resuscitation

Uehara

Matsuda

Matsuo

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

Objectives: The surgical indications for acute type A aortic dissection (AAAD) in patients in cardiopulmonary arrest remain controversial. Outcomes of AAAD for patients who underwent cardiopulmonary resuscitation (CPR) were evaluated.Methods: Between 2004 and 2018, of the 519 patients who underwent AAAD repair, 34 (6.6%) required CPR before or on starting AAAD repair. The patients were divided into 2 groups, survivors (n ¼ 13) and nonsurvivors (n ¼ 21), to compare the early operative outcomes, including mortality and neurological events.

show abstract

Long-term outcome and quality of life following emergency surgery for acute aortic dissection type A: a comparison between young and elderly adults

Cited by 18 publications

References 28 publications

Risk factors and long-term outcomes of acute kidney injury complication after type A acute aortic dissection surgery in young patients

Risk factors and long-term outcomes of acute kidney injury complication after type A acute aortic dissection surgery in young patients

Comparison of surgical and conservative treatment outcomes for type a aortic dissection in elderly patients

Surgical outcomes of acute type A aortic dissection in patients undergoing cardiopulmonary resuscitation

Contact Info

Product

Resources

About