Outcome After Surgery for Acute Aortic Dissection: Influence of Preoperative Antiplatelet Therapy on Prognosis

Chemtob, Raphaelle A.; Moeller-Soerensen, Hasse; Holmvang, Lene; Olsen, Peter Skov; Ravn, Hanne Berg

doi:10.1053/j.jvca.2016.10.007

Cited by 19 publications

(16 citation statements)

References 26 publications

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“…However, it was not associated with a statistically significant increased mortality. 15 Besides coagulation status, additional CABG showed statistical significance of early mortality of patients with Stanford A AAD in our study. This might depend on the fact that additional surgical work prolongs surgery itself with longer cross clamp and bypass time, but the very initial reason for this will be preoperative cardiac malperfusion of the heart vessels and as also preoperative cerebral and viszeral ischaemia results in an increase in mortality rates.…”

Section: Discussionsupporting

confidence: 56%

Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

et al. 2019

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Objectives: The aim of this study was to evaluate independent risk factors predictive for mortality of patients with Stanford A acute aortic dissection. Methods: From January 2006 to March 2015, a total of 240 consecutive patients diagnosed with acute Stanford A acute aortic dissection underwent surgical aortic repair in our center. After analysis of pre- and perioperative variables, univariate logistic and multivariate logistic regression analyses were performed for mortality of patients. Subsequently, Kaplan–Meier estimation analysis of short- and long-term survival of these variables was carried out. Results: Primary entry tear in descending aorta (odds ratio = 4.71, p = 0.021), preoperative international normalized ratio higher than 1.2 (odds ratio = 7.36, p = 0.001), additional coronary artery bypass grafting (odds ratio = 3.39, p = 0.003), cannulation in ascending aorta (odds ratio = 3.22, p = 0.005), preoperative neurological coma (odds ratio = 3.30, p = 0.003), and reduced perfusion (odds ratio = 2.91, p = 0.006) as well as prolonged reperfusion time (odds ratio = 3.36, p = 0.002) showed to be independent predictors for early mortality as well as for late mortality (hazard ratio of all variables p < 0.05). Kaplan–Meier survival estimation analysis with up to 9-year-follow-up in terms of these risk factors showed significantly poorer short- and long-term survival (log-rank and Breslow test all p < 0.05). Conclusion: Our study revealed that early and late mortality of patients with Stanford A acute aortic dissection surgery was significantly influenced by preoperative and perioperative variables as independent predictors especially of variables displaying coronary, cerebral, and visceral malperfusion. Also, short- and long-term survival of patients was significantly poorer in terms of these risk factors.

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Section: Discussionsupporting

confidence: 56%

Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

et al. 2019

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“…However, as for ischemic heart disease, females often present with more atypical symptoms of ATAAD, resulting in misdiagnosis and treatment for other more common conditions, such as acute coronary syndrome. 13 14 15 It is well defined that the mortality rate increases significantly with time in patients with ATAAD, and a delay in diagnosis can have fatal consequences. 14…”

Section: Discussionmentioning

confidence: 99%

Effects of Sex on Early Outcome following Repair of Acute Type A Aortic Dissection: Results from The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

Chemtob

Hjortdal

Ahlsson

et al. 2019

Aorta

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Background Female sex is known to have increased perioperative mortality in cardiac surgery. Studies reporting effects of sex on outcome following surgical repair for acute Type A aortic dissection (ATAAD) have been limited by small cohorts of heterogeneous patient populations and have shown diverging results. This study aimed to compare perioperative characteristics, operative management, and postoperative outcome between sexes in a large and well-defined cohort of patients operated for ATAAD. Methods The Nordic Consortium for Acute Type A Aortic Dissection study included patients with surgical repair of ATAAD at eight Nordic centers between January 2005 and December 2014. Independent predictors of 30-day mortality were identified using multivariable logistic regression. Results Females represented 373 (32%) out of 1,154 patients and were significantly older (65 ± 11 vs. 60 ± 12 years, p < 0.001), had lower body mass index (25.8 ± 5.4 vs. 27.2 ± 4.3 kg/m2, p < 0.001), and had more often a history of hypertension (59% vs. 48%, p = 0.001) and chronic obstructive pulmonary disease (8% vs. 4%, p = 0.033) compared with males. More females presented with DeBakey class II as compared with males with dissection of the ascending aorta alone (33.4% vs. 23.1%, p = 0.003). Hypothermic cardiac arrest time (28 ± 16 vs. 31 ± 19 minutes, p = 0.026) and operation time (345 ± 133 vs. 374 ± 135 minutes, p < 0.001) were shorter among females. There was no difference between the sexes in unadjusted intraoperative death (9.1% vs. 6.7%, p = 0.17) or 30-day mortality (17.7% vs. 17.4%, p = 0.99). In a multivariable analysis including perioperative factors influencing mortality, no difference was found between females and males in 30-day mortality (odds ratio: 0.92, 95% confidence interval: 0.62–1.38, p = 0.69). Conclusions This study found no association between sex and early mortality following surgery for ATAAD, despite females being older and having more comorbidities, yet also presenting with a less widespread dissection than males.

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“…As demonstrated by published paper, anticoagulation is superior to antiplatelet in patients with embolic stroke caused by atrial fibrillation [13]. According to Chemtob RA, etc., the use of antiplatelet was tied to more incidences of intraoperative bleeding and transfusion requirement in patients with aortic dissection [14]. Thus it is important to identify the subtype of the ischemic stroke for therapeutic strategy on treatment and secondary prevention.…”

Section: Discussionmentioning

confidence: 99%

MicroRNA Expression Profiles Identify Biomarker for Differentiating the Embolic Stroke from Thrombotic Stroke

Chen

Jiang

2018

BioMed Research International

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In order to identify potential biomarkers that distinguish the embolic stroke (ES) from thrombotic stroke (TS), a profile of microRNA expression was analyzed. The GSE60319 expression profile was downloaded from the Gene Expression Omnibus (GEO) database. The GEO2R was applied to screen for differentially expressed microRNAs (DEmiRNAs) between the embolic stroke group and thrombotic stroke group. The miRWalk was utilized to predict the target genes of DEmiRNAs. Genes associated with embolic stroke were downloaded from the Comparative Toxicogenomics Database. Cross reference of target genes to disease related genes was conducted to construct the DEmiRNA-gene network. The protein-protein interaction (PPI) network of overlapping genes was evaluated by STRING, using the MCODE and CytoHubba plugin of Cytoscape to identify the modules and hub genes. The enrichment of Kyoto Encyclopedia of Genes and Genomes (KEGG) in modules was performed. There were 30 microRNAs in total identified as DEmiRNAs between embolic stroke and thrombotic stroke groups, of which 8 were upregulated and 22 were downregulated. Among these differentially expressed miRNAs, miR-15a-5p, miR-17-5p, miR-19b-3p, and miR-20a-5p were significantly associated with an ES to TS. Using the miRWalk 3.0 online tool, target genes regulated by DEmiRNAs were predicted. In addition, disease related genes were predicted and compared with target genes of DEmiRNAs. 166 overlapped genes regulated by miR-15a-5p, miR-17-5p, miR-19b-3p, and miR-20a-5p were identified, suggesting their association with diseases that contributed to ES, mainly including atrial fibrillation, mitral valve stenosis, myocardial infarction, and aortic dissection. Therefore, miR-15a-5p, miR-17-5p, miR-19b-3p, and miR-20a-5p were promising candidate biomarkers for differentiating an ES from TS. The PPI network demonstrated that miR-15a-5p, miR-17-5p, miR-19b-3p, and miR-20a-5p were associated with an ES by mainly regulating “CCND1, E2F2, E2F3, ITCH, UBE4A, UBE3C, RBL2, FBXO31, EIF2C4, and EIF2C1”. Furthermore, miR-15a-5p and miR-17-5p may function through “cell cycle, prostate cancer, and small cell lung cancer” while miR-19b-3p and miR-20a-5p function through “insulin resistance, hepatitis B, and viral carcinogenesis” and “vasopressin-regulated water reabsorption”, respectively. However, these results were approached in the manner of bioinformatics analysis; therefore, further verification is required.

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Outcome After Surgery for Acute Aortic Dissection: Influence of Preoperative Antiplatelet Therapy on Prognosis

Cited by 19 publications

References 26 publications

Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection

Effects of Sex on Early Outcome following Repair of Acute Type A Aortic Dissection: Results from The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

MicroRNA Expression Profiles Identify Biomarker for Differentiating the Embolic Stroke from Thrombotic Stroke

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