Presenting Systolic Blood Pressure and Outcomes in Patients With Acute Aortic Dissection

Bossone, Eduardo; Gorla, Riccardo; LaBounty, Troy; Suzuki, Toru; Gilon, Dan; Strauss, Craig; Ballotta, Andrea; Patel, Himanshu J.; Evangelista, Arturo; Ehrlich, Marek; Hutchison, Stuart J.; Kline–Rogers, Eva; Montgomery, Daniel; Nienaber, Christoph; Isselbacher, Eric M.; Eagle, Kim A.

doi:10.1016/j.jacc.2018.01.064

Cited by 70 publications

(53 citation statements)

References 23 publications

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“…Previous studies indicated that hypotension and aortic cross-clamp time are predictors for postoperative stroke and neurological dysfunction. [6,20,21] Unexpectedly, aortic cross-clamp time is not an independent risk predictor for postoperative stroke in this study, but it is signi cantly longer in patients with ATAAD with postoperative stroke (113.1 ± 35.3 min) than in subjects without stroke (95.6 ± 19.0 min, P = 0.002 ). Our previous study con rmed that retrograde aAO dissection is an independent predictor of postoperative permanent neurological dysfunction (PND) in patients with ATAAD.…”

Section: Discussioncontrasting

confidence: 53%

Preoperative imaging risk findings for postoperative new stroke in patients with acute type A aortic dissection

Zhao

Guo

et al. 2020

Preprint

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Background Stroke is a common postoperative complication in patients with acute type A aortic dissection (ATAAD). We aimed to explore the preoperative imaging risk findings for postoperative new stroke in patients with ATAAD. Methods From January 2015 to December 2018, 174 patients with ATAAD who underwent preoperative aortic computed tomography angiography (CTA) and cerebral diffusion-weighted imaging (DWI) as well as postoperative brain CT were included, and divided into DWI (+) and DWI (-) groups. Pre- and intraoperative variables were collected, and logistic regression analysis was used to determine the independent risk predictors of postoperative new stroke. Results The incidence of postoperative new stroke was 18.4% (32/174) in patients with ATAAD. Postoperative stroke was detected in 13 (31.0%) patients in the DWI (+) group and in 19 (14.4%) patients in the DWI (-) group with significant difference (P = 0.016). In the DWI (+) group, the lesions of the cerebral infarction located in the unilateral cerebral hemisphere and distributed more than three lobes (P = 0.007) were an independent risk factor for postoperative new stroke. Hypotension (P = 0.002), retrograde ascending aorta dissection with thrombosis of the false lumen (P = 0.010), aortic arch entry (P = 0.035), and coronary artery involvement (P = 0.001) were independent risk factors for postoperative stroke in the DWI (-) cohort. Conclusions Patients with ATAAD with cerebral infarction are more likely to develop postoperative new stroke; thus, a preoperative DWI examination may be necessary. DWI lesions distributed more than 3 lobes in the unilateral hemisphere suggest a high possibility of postoperative stroke. For patients with ATAAD with normal brain, particular attention should be given to the CTA findings of false lumen thrombosis, aortic arch entry, and coronary artery involvement to avoid postoperative stroke. Trial registration: Retrospectively registered.

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Section: Discussioncontrasting

confidence: 53%

Preoperative imaging risk findings for postoperative new stroke in patients with acute type A aortic dissection

Zhao

Guo

et al. 2020

Preprint

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“…[ 8 , 12 , 13 ] Other previous research suggested that higher age, mesenteric ischemia, cardiac tamponade, coma, and kidney failure may be predictors of in-hospital death in this population. [ 14 – 16 ] Of note, the variables predicting death in these prior reports were not associated with long-term mortality in the present study. Possible causes for this discrepancy include variations in the patient population and surgical indications.…”

Section: Discussioncontrasting

confidence: 39%

Long-term prognostic value of the combined assessment of clinical and computed tomography findings in type

et al. 2020

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Type A acute aortic dissection (TAAAD) carries a high mortality rate in the absence of surgical treatment. This study sought to determine whether combining the assessment of clinical and computed tomography (CT) findings can be used to predict the long-term all-cause mortality rate of patients with TAAAD. Eighty-five consecutive patients with TAAAD who had undergone CT imaging and surgery were retrospectively reviewed. For the clinical and CT findings, univariate testing followed by multivariate logistic regression analysis was conducted to identify independent predictors of death. Then, the area under the receiver operating characteristic curve of the combined prediction model was calculated. The long-term mortality rate was 34.1% in our cohort (a median follow-up period of 60 months). Multivariate logistic regression analysis identified the following presenting variables as predictors of death: male sex (odds ratio [OR]: 6.67; 95% confidence interval [CI]: 1.67–25.0; P = .007), kidney malperfusion (OR: 2.18; 95% CI: 1.16–4.1; P = .02), and descending aorta size (OR: 1.12; 95% CI: 1.00–1.25; P = .05). Receiver operating characteristic curve analysis revealed an area under the receiver operating characteristic curve of 0.84 when using the combined model for prediction of long-term all-cause mortality ( P ≤ .01). The combined assessment of clinical and CT findings can reasonably predict the long-term prognosis of TAAAD with surgery.

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“…As reported by Bossone et al, preoperative SBP <80 mmHg was an independent predictor of in-hospital mortality for patients with acute aortic dissection [ 17 ]. In the present study, approximately 80% of patients presented with SBP <60 mmHg; the average SBP was 50 mmHg before undergoing CPR.…”

Section: Discussionmentioning

confidence: 82%

Surgical results in acute type A aortic dissection with preoperative cardiopulmonary resuscitation: Survival and neurological outcome

Lin

Tseng

et al. 2020

PLoS ONE

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Background Acute type A aortic dissection (ATAAD) is a life-threatening disease that requires emergent surgical intervention. This retrospective study aimed to clarify the individual characteristics, short-term and mid-term outcomes, and prognostic factors of patients who underwent surgical repair of ATAAD with preoperative cardiopulmonary resuscitation (CPR). Methods Between January 2007 and January 2020, 656 consecutive patients underwent ATAAD repair at our institution; 22 (3.4%) of these patients underwent CPR prior to surgery. Patients who underwent preoperative CPR were classified as the survivor group (n = 9) and non-survivor group (n = 13), according to whether they survived to hospital discharge. Clinical features, surgical information, and postoperative complications were analyzed and compared. Three-year cumulative survival rates and cerebral performance categories (CPC) scores are presented. Results In patients undergoing CPR prior to ATAAD surgery, the in-hospital mortality rate was 59.1%. A total of 72.7% of patients underwent concomitant surgical resuscitation procedures during CPR such as emergent subxiphoid pericardiotomy and/or emergent cardiopulmonary bypass. The survivor group had a higher rate of return of spontaneous heartbeat (ROSB) compared to the non-survivor group (100% versus 53.8%; P = 0.017). The 3-year cumulative survival rates were 35.1% (95% confidence interval [CI], 27.6%–42.6%) and 85.7% (95% CI, 81.9%–88.8%) for overall patients and for survivors, respectively. As for the neurological outcome, 77.8% (7/9) of patients had full cerebral performance (CPC-1) at the 3-month follow-up examination after discharge. Conclusions Patients with ATAAD undergoing preoperative CPR, especially those without ROSB after CPR, are at high risk for in-hospital mortality. However, the short-term and mid-term outcomes, including the cerebral performance after discharge and 3-year survival rate, are promising for patients who survived to discharge.

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Presenting Systolic Blood Pressure and Outcomes in Patients With Acute Aortic Dissection

Cited by 70 publications

References 23 publications

Preoperative imaging risk findings for postoperative new stroke in patients with acute type A aortic dissection

Preoperative imaging risk findings for postoperative new stroke in patients with acute type A aortic dissection

Long-term prognostic value of the combined assessment of clinical and computed tomography findings in type

Surgical results in acute type A aortic dissection with preoperative cardiopulmonary resuscitation: Survival and neurological outcome

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