Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up

Freundt, Miriam; Kolat, Philipp; Friedrich, Christine; Salem, Mohamed A.; Gruenewald, Matthias; Elke, Gunnar; Pühler, Thomas; Cremer, Jochen; Haneya, Assad

doi:10.3390/jcm10225370

Cited by 6 publications

(3 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To guide efforts to improve patient outcomes and decrease mortality rates, future research should be focused on these potential factors and detecting the fundamental mechanisms of their relationships with overall mortality [30].…”

Section: Discussionmentioning

confidence: 99%

Histopathological Gap in Aortic Diseases: A Prospective Analysis

Banceu,

Gurzu,

Satala

et al. 2023

IJMS

View full text Add to dashboard Cite

Aortic dissection (AD) is a critical cardiovascular condition with the potential for devastating consequences. This study evaluated the histological changes in the aorta wall in patients with AD and aortic aneurysm (AA) who received surgical aortic replacement. Histopathological data showed that modifications of the media layer (p = 0.0197), myxomatous aspect (p = 0.0001), and subendothelial layer degeneration (p = 0.0107) were more frequently seen in AA versus AD samples. Patients with AA were approximately twice as likely to develop histological changes than those with AD (p = 0.0037). Patients with moderate or severe medial degeneration had a higher chance of developing AD (p = 0.0001). Because the histopathological score proved to be a predictor of both in-hospital and overall mortality, its evaluation should become the standard of care in any patients who undergo aortic replacement. Individualized postoperative management might be influenced by the histopathological aspect of the aortic layer.

show abstract

Section: Discussionmentioning

confidence: 99%

Histopathological Gap in Aortic Diseases: A Prospective Analysis

Banceu,

Gurzu,

Satala

et al. 2023

IJMS

View full text Add to dashboard Cite

show abstract

“…Nevertheless, an analysis from the International Registry of Acute Aortic Dissection (IRAD) indicates that the median time from emergency department presentation to a definitive diagnosis of acute aortic dissection is 4.3 h, with an additional 4 h between diagnosis and surgical intervention ( 22 , 23 ). In comparison to IRAD data, in our department, patients with AADA received surgical treatment 6.0 h (median) following the initial painful event.…”

Section: Discussionmentioning

confidence: 99%

Onset of pain to surgery time in acute aortic dissections type A: a mandatory factor for evaluating surgical results?

Kaufeld

Martens

Beckmann

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

ObjectiveAn acute aortic dissection type A (AADA) is a rare but life-threatening event. The mortality rate ranges between 18% to 28% and mortality is often within the first 24 h and up to 1%–2% per hour. Although the onset of pain to surgery time has not been a relevant factor in terms of research in the field of AADA, we hypothesize that a patient's preoperative conditions depend on the length of this time.MethodsBetween January 2000 and January 2018, 430 patients received surgical treatment for acute aortic dissection DeBakey type I at our tertiary referral hospital. In 11 patients, the exact time point of initial onset of pain was retrospectively not detectable. Accordingly, a total of 419 patients were included in the study. The cohort was categorized into two groups: Group A with an onset of pain to surgery time < 6 h (n = 211) and Group B > 6 h (n = 208), respectively.ResultsMedian age was 63.5 years (y) ((IQR: 53.3–71.4 y); (67.5% male)). Preoperative conditions differed significantly between the cohorts. Differences were detected in terms of malperfusion (A: 39.3%; B: 23.6%; P: 0.001), neurological symptoms (A: 24.2%; B: 15.4%; P: 0.024), and the dissection of supra-aortic arteries (A: 25.1%; B: 16.8%; P: 0.037). In particular, cerebral malperfusion (A 15.2%: B: 8.2%; P: 0.026) and limb malperfusion (A: 18%, B: 10.1%; P: 0.020) were significantly increased in Group A. Furthermore, Group A showed a decreased median survival time (A: 1,359.0 d; B: 2,247.5 d; P: 0.001), extended ventilation time (A: 53.0 h; B: 44.0 h; P: 0.249) and higher 30-day mortality rate (A: 25.1%; B: 17.3%; P: 0.051).ConclusionsPatients with a short onset of pain to surgery time in cases of AADA present themselves not only with more severe preoperative symptoms but are also the more compromised cohort. Despite early presentation and emergency aortic repair, these patients show increased chances of early mortality. The “onset of pain to surgery time” should become a mandatory factor when making comparable surgical evaluations in the field of AADA.

show abstract

“…Acute type A aortic dissection (ATAAD) remains a challenge and it is accompanied by high morbidity and mortality 1–4 . Nowadays, emergency cardiac surgery is recommended as the treatment of choice for ATAAD corrections 1–15 . Many patients with ATAAD present with malperfusion syndrome due to inadequate blood supply to target organs.…”

mentioning

confidence: 99%

Acute renal failure after acute type A aortic dissection repair. Insidious postoperative complication with poor short‐ and long‐term prognosis

Samanidis

Kanakis

Kourelis

et al. 2022

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Acute type A aortic dissection (ATAAD) is a life-threatening aortic disease. Many systems and organs are affected by malperfusion which presents preoperatively and postoperatively. Postoperative acute renal failure after ATAAD constitutes a severe and insidious complication. Acute renal damage is observed in many patients with ATAAD preoperatively and it burdens the renal function postoperatively. Renal replacement therapy represents an additional risk factor for short-, mid-, and longterm outcomes after ATAAD repair. Brown et al.'s present study highlight the clinical significance of this complication. Also, they remind us of the importance of optimizing perioperative renal protective strategies in patients undergoing ATAAD repair.

show abstract

Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up

Cited by 6 publications

References 24 publications

Histopathological Gap in Aortic Diseases: A Prospective Analysis

Histopathological Gap in Aortic Diseases: A Prospective Analysis

Onset of pain to surgery time in acute aortic dissections type A: a mandatory factor for evaluating surgical results?

Acute renal failure after acute type A aortic dissection repair. Insidious postoperative complication with poor short‐ and long‐term prognosis

Contact Info

Product

Resources

About