Proximal vs Extensive Repair in Acute Type A Aortic Dissection Surgery

Liu, Hong; Zhang, Yingyuan; Ding, Xiao-hang; Qian, Sichong; Sun, Mingyu; Hamzah, Al-Wajih; Gao, Yanan; Shao, Yongfeng; Li, Haiyang; Wang, Kai; Ni, Bu-qing; Zhang, Hongjia

doi:10.1016/j.athoracsur.2023.04.019

Cited by 7 publications

(10 citation statements)

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“…This study confirmed that current rates of early mortality, major adverse complications, and 10-year mortality after surgery for TAAD are still high. The identification of determinants of poor outcome in these patients is of utmost importance to stratify their operative risk, because it may guide clinicians in the decision-making process by avoiding extensive surgery or even planning endovascular/hybrid procedures in TAAD patients at highest operative risk ( 6 ). Therefore, the development of risk scoring methods is not a mere mathematical exercise, but an important means for a more in-depth grading of the severity of clinical conditions of TAAD patients.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, after excluding these risk factors from the regression model of the derivation dataset, the AUC of the probabilities of in-hospital mortality was 0.708 (95% CI, 0.680–0.736) with a Brier score of 0.135. Recent studies showed that biomarkers may be helpful in stratifying the operative risk of TAAD patients ( 6 , 18 , 19 ). In particular, preoperative levels of creatinine and arterial lactate have been shown to be significant predictors of early postoperative mortality ( 6 , 18 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies showed that biomarkers may be helpful in stratifying the operative risk of TAAD patients ( 6 , 18 , 19 ). In particular, preoperative levels of creatinine and arterial lactate have been shown to be significant predictors of early postoperative mortality ( 6 , 18 , 19 ). The prognostic impact of eGFR on adverse events after cardiac surgery has been largely demonstrated ( 20 ), while the value of arterial lactate in predicting the outcome of critically ill cardiac surgery patients is rather novel ( 6 , 18 , 19 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

“…In particular, preoperative levels of creatinine and arterial lactate have been shown to be significant predictors of early postoperative mortality ( 6 , 18 , 19 ). The prognostic impact of eGFR on adverse events after cardiac surgery has been largely demonstrated ( 20 ), while the value of arterial lactate in predicting the outcome of critically ill cardiac surgery patients is rather novel ( 6 , 18 , 19 , 21 ). A recent study by Nappi et al ( 19 ) showed that preoperative arterial lactate was an independent risk factor for early postoperative mortality (OR, 1.378, 95% CI, 1.176–1.616) along with eGFR (OR, 0.978, 95% CI, 0.991–0.997) after surgery for TAAD.…”

Section: Discussionmentioning

confidence: 99%

“…In Western countries, large series demonstrated that early postoperative mortality in these patients is about 17% (2,3). Early mortality rates lower than 15% have been reported in Asian centers (4)(5)(6). Furthermore, surgery for TAAD is often complicated by end-organ injury, which may impact patient recovery.…”

Section: Introductionmentioning

confidence: 99%

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Baseline risk factors of in-hospital mortality after surgery for acute type A aortic dissection: an ERTAAD study

Biancari,

Demal,

Nappi

et al. 2024

Front. Cardiovasc. Med.

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BackgroundSurgery for type A aortic dissection (TAAD) is associated with high risk of mortality. Current risk scoring methods have a limited predictive accuracy.MethodsSubjects were patients who underwent surgery for acute TAAD at 18 European centers of cardiac surgery from the European Registry of Type A Aortic Dissection (ERTAAD).ResultsOut of 3,902 patients included in the ERTAAD, 2,477 fulfilled the inclusion criteria. In the validation dataset (2,229 patients), the rate of in-hospital mortality was 18.4%. The rate of composite outcome (in-hospital death, stroke/global ischemia, dialysis, and/or acute heart failure) was 41.2%, and 10-year mortality rate was 47.0%. Logistic regression identified the following patient-related variables associated with an increased risk of in-hospital mortality [area under the curve (AUC), 0.755, 95% confidence interval (CI), 0.729–0.780; Brier score 0.128]: age; estimated glomerular filtration rate; arterial lactate; iatrogenic dissection; left ventricular ejection fraction ≤50%; invasive mechanical ventilation; cardiopulmonary resuscitation immediately before surgery; and cerebral, mesenteric, and peripheral malperfusion. The estimated risk score was associated with an increased risk of composite outcome (AUC, 0.689, 95% CI, 0.667–0.711) and of late mortality [hazard ratio (HR), 1.035, 95% CI, 1.031–1.038; Harrell's C 0.702; Somer's D 0.403]. In the validation dataset (248 patients), the in-hospital mortality rate was 16.1%, the composite outcome rate was 41.5%, and the 10-year mortality rate was 49.1%. The estimated risk score was predictive of in-hospital mortality (AUC, 0.703, 95% CI, 0.613–0.793; Brier score 0.121; slope 0.905) and of composite outcome (AUC, 0.682, 95% CI, 0.614–0.749). The estimated risk score was predictive of late mortality (HR, 1.035, 95% CI, 1.031–1.038; Harrell's C 0.702; Somer's D 0.403), also when hospital deaths were excluded from the analysis (HR, 1.024, 95% CI, 1.018–1.031; Harrell's C 0.630; Somer's D 0.261).ConclusionsThe present analysis identified several baseline clinical risk factors, along with preoperative estimated glomerular filtration rate and arterial lactate, which are predictive of in-hospital mortality and major postoperative adverse events after surgical repair of acute TAAD. These risk factors may be valuable components for risk adjustment in the evaluation of surgical and anesthesiological strategies aiming to improve the results of surgery for TAAD.Clinical Trial Registrationhttps://clinicaltrials.gov, identifier NCT04831073.

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Section: Discussionmentioning

confidence: 99%