Single Stage Hybrid Repair for DeBakey Type I Aortic Dissection in High Risk Patients

Lin, Hao; Du, Yuxuan; Yu, Cuntao; Qian, Xiangyang; Sun, Xiaogang; Tian, Chuan; Meng, Yanhai; Pei, Hanjun; Wang, Chunmao; Liu, Penghong; Guo, Xinfeng; Ma, Mingxing; Chang, Qian

doi:10.1016/j.ejvs.2018.05.023

Cited by 20 publications

(6 citation statements)

References 20 publications

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“…In our study, it was found that the short-term 30-day mortality rate and the long-term 1- and 3-year mortality rates of the two surgical methods were similar. In the recent studies of hybrid surgery, it was found that the in-hospital mortality rate of hybrid surgery for type A aortic dissection is about 6.0–9.2% ( 23 , 24 ), which is similar to the mortality rate of FET surgery. In addition, in the multivariate regression analysis of this study, the surgical method is not an independent predictor of short-term and long-term post-operative mortality.…”

Section: Discussionmentioning

confidence: 70%

Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients

Wang

et al. 2021

Front. Cardiovasc. Med.

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Background: It is unclear whether the total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and hybrid debranching surgery have a difference in the prognosis of patients with type A acute aortic syndrome (AAS). We attempted to compare the short-term and long-term prognosis of total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and hybrid debranching surgery in patients with type A acute aortic syndrome (AAS).Methods: From January 2014 to September 2020, a total of 518 patients who underwent TAR with FET surgery and 31 patients who underwent hybrid surgery were included. We analyzed the post-operative mortality and morbidity of complications of the two surgical methods, and we determined 67 patients for subgroup analysis through a 1:2 propensity score match (PSM). We identified risk factors for patient mortality and post-operative neurological complications through multivariate regression analysis.Results: Compared with the TAR with FET group, hybrid surgery could reduce aortic cross-clamp time, reduce intraoperative blood loss and prevent some patients from cardiopulmonary bypass. There was no significant difference in 30-day mortality between the TAR with FET group and the hybrid surgery group (10.6 vs. 9.7%). However, hybrid surgery had increased the incidence of permanent neurological complications in patients (95%CI: 4.7–35.7%, P = 0.001), especially post-operative cerebral infarction (P < 0.001). During the average follow-up period of 31.6 months, there was no significant difference in the 1-year survival rate and 3-year survival rate between the TAR with FET group and the hybrid surgery group (P = 0.811), but hybrid surgery increased the incidence of long-term neurological complications (P < 0.001). In multivariate regression analysis, surgical methods were not a risk factor for post-operative deaths, but hybrid surgery was a risk factor for post-operative neurological complications (P < 0.001).Conclusions: Hybrid surgery is an acceptable treatment for AAS, and its post-operative mortality is similar to FET. But hybrid surgery may increase the risk of permanent neurological complications after surgery, and this risk must be carefully considered when choosing hybrid surgery.

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Section: Discussionmentioning

confidence: 70%

Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients

Wang

et al. 2021

Front. Cardiovasc. Med.

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“…Composite primary endpoints for this analysis included peri-operative mortality, permanent neurological damage (paraplegia or stroke), and renal disorder necessitating hemodialysis upon release from hospitalization [ 17 ]. Secondary mid-term outcome endpoints included delayed death and a lack of need for delayed aortic reinterventions.…”

Section: Methodsmentioning

confidence: 99%

Age-dependent differences in the prognostic relevance of body composition-related variables in type A aortic dissection patients

Luo

Chen

2021

J Cardiothorac Surg

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Background The current research is allocated to appraise the association between the parameters of body composition and findings in type A aortic dissection (TAAD) cases in diverse age groups. Methods Data from consecutive TAAD patients undergoing implantation of modified triple-branched stent-graft from January 2017 and December 2019 were prospectively collected and analyzed. A regression model of Cox proportional hazard was employed to assess correlations among body composition-related variables (body mass index [BMI], lean body mass [LBM], body surface area [BSA], and LBM index) as well as cumulative mortality. Results Overall, 258 patients (53.9 ± 11.1 years old; 72.9% male) were separated into young (n = 110) and elderly (n = 148) age groups based upon whether they were younger or older than 50 years of age. Of these patients, 247 survivors were included in subsequent analyses over an average 26.8 ± 11.6 month follow-up duration. Multivariate analyses in the elderly group instead of young group indicated that increased BMI (p = 0.042), BMI ≤ 18.5 kg/m2 (p = 0.025), and lower LBM index values (p = 0.019) were significant predictors of increased total all-cause cumulative mortality. BMI was considerably positively correlated with estimated all-cause cumulative mortality in elderly but not young TAAD cases. Conclusion Briefly, these results suggest that BMI and LBM indices are only significant predictors of TAAD patient all-cause mortality in elderly patient cohorts, whereas they do not offer significant prognostic value for younger patients. As such, these age differences must be taken into consideration when conducting stratified risk assessments based upon TAAD patient body composition characteristics.

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“…1 5 . LBM was determined with the James Composite primary endpoints for this analysis included peri-operative mortality, permanent neurological damage (paraplegia or stroke), and renal disorder necessitating hemodialysis upon release from hospitalization 17 . Secondary mid-term outcome endpoints included delayed death and a lack of need for delayed aortic reinterventions.…”

Section: Outcome Measuresmentioning

confidence: 99%

Age-Dependent Differences in the Prognostic Relevance of Body Composition-Related Variables in Type a Aortic Dissection Patients

Luo

Chen

2021

Preprint

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Background: The current research is allocated to appraise the association between the parameters of body composition and findings in type A aortic dissection (TAAD) cases in diverse age groups. Methods: Data from consecutive TAAD patients undergoing implantation of modified triple-branched stent-graft from January 2017 and December 2019 were prospectively collected and analyzed. A regression model of Cox proportional hazard was employed to assess correlations among body composition-related variables (body mass index [BMI], lean body mass [LBM], body surface area [BSA], and LBM index) as well as cumulative mortality. Results: Overall, 258 patients (53.9±11.1 years old; 72.9% male) were separated into young (n=110) and elderly (n=148) age groups based upon whether they were younger or older than 50 years of age. Of these patients, 247 survivors were included in subsequent analyses over an average 26.8 ± 11.6 month follow-up duration. Multivariate analyses in the elderly group instead of young group indicated that increased BMI (p=0.042), BMI ≤ 18.5 kg/m2 (p=0.025), and lower LBM index values (p=0.019) were significant predictors of increased total all-cause cumulative mortality. BMI was considerably positively correlated with estimated all-cause cumulative mortality in elderly but not young TAAD cases. Conclusion: Briefly, these results suggest that BMI and LBM indices are only significant predictors of TAAD patient all-cause mortality in elderly patient cohorts, whereas they do not offer significant prognostic value for younger patients. As such, these age differences must be taken into consideration when conducting stratified risk assessments based upon TAAD patient body composition characteristics.

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Single Stage Hybrid Repair for DeBakey Type I Aortic Dissection in High Risk Patients

Abstract: IAD was treated safely and durably by Z0 HAR, and peri-operative mortality and morbidity were not substantially higher despite the older age and high risk of patients.

Cited by 20 publications

References 20 publications

Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients

Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients

Age-dependent differences in the prognostic relevance of body composition-related variables in type A aortic dissection patients

Age-Dependent Differences in the Prognostic Relevance of Body Composition-Related Variables in Type a Aortic Dissection Patients

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