Objective To assess the independent risk factors of in-hospital mortality and morbidity after surgical procedure for Stanford type A aortic dissection (TAAD). Methods Between May 2013 and May 2015, 341 TAAD patients were treated with surgical procedure in Fu Wai Hospital. There were 246 males and 95 females with a mean age of 47.42±11.54 years (range 29-73 years). Among them, 87 patients suffered severe complications or death after the procedure (complication group) and the other 254 patients recovered well without any severe complications (no complication group). Perioperative clinical data were compared between the two groups. Results Mean age of patients in the complication group was significantly higher than that of the no complication group (49.91±11.22 yearsvs. 46.57±11.54 years,P=0.019). The incidence of preoperative ischemic organ injury in the complication group was significantly higher than that in the no complication group: cerebral ischemia (18.4%vs. 5.9%,P=0.001), spinal cord injury (16.1%vs. 4.7%,P=0.001), acute kidney injury (31.0%vs. 10.6%,P=0.000). The incidence of branch vessels involvement in the complication group was significantly higher than that in the no complication group: coronary artery involvement (52.9%vs. 17.1%,P=0.000), supra-aortic vessels involvement (73.6%vs. 53.9%,P=0.001), celiac artery involvement (37.9%vs. 22.0%,P=0.003), mesenteric artery involvement (18.4%vs. 9.8%,P=0.030), and unilateral or bilateral renal artery involvement (27.6%vs. 9.8%,P=0.000). Surgical time of patients in the complication group was significantly longer than that of the no complication group, including cardiopulmonary bypass time (205.05±63.65 minvs. 167.67±50.24 min,P<0.05) and cross-clamp time (108.11±34.79 minvs. 90.75±27.33 min,P<0.05). Multiple regression analysis found that age, preoperative concomitant cerebral ischemic injury, preoperative concomitant acute renal injury, preoperative limb sensory and/or motor dysfunction, coronary artery involvement, cardiopulmonary bypass time were independent risk factors of postoperative death and severe complications in TAAD patients. However, risk of postoperative mortality and morbidity significantly decreased after the concomitant coronary artery bypass graft [OR=0.167 (0.060, 0.467),P=0.001]. Conclusion The high risk factors of postoperative complication in TAAD patients are explored to provide an important clinical basis for preoperative identification of patients at high risk and we need pay more attention to the prevention of these postoperative complications.
ObjectiveTo investigate the independent risk factors associated with postoperative acute respiratory distress syndrome in patients undergoing type A aortic dissection surgery.MethodsThe clinical data of 147 patients who underwent acute type A aortic dissection surgery in the First Affiliated Hospital of Anhui Medical University from 2015 to 2019 were retrospectively analyzed. There were 110 males at age of 51.9±10.1 years and 37 females at age of 54.3±11.1 years. According to whether the patients developed ARDS after surgery, all of the patients were divided into a ARDS group or a non-ARDS group. Logistic regress analysis was utilized to establish the predictive mode to identify the independent risk factors related to ARDS.ResultsOf the patients, 25 developed postoperative ARDS. Among them, 5 patients were mild ARDS, 13 patients were moderate, and 7 patients were severe ARDS. Multivariate logistic regression analysis showed that deep hypothermic circulatory arrest time [odds ratio (OR)=1.067, 95% confidence interval (CI) 1.014-1.124, P=0.013], cardiopulmonary bypass time (OR=1.012, 95%CI 1.001-1.022, P=0.027) and perioperative plasma input (OR=1.001, 95%CI 1.000-1.002, P=0.011) were independently associated with ARDS in patients undergoing acute A aortic dissection surgery. Receiver operating characteristic (ROC) curve analysis demonstrated a good discrimination ability of the logistic regression model, with an area under the curve of 0.835 (95%CI 0.740-0.929, P=0.000).ConclusionDuration of deep hypothermic circulatory arrest, cardiopulmonary bypass time and perioperative plasma are independent risk factors for postoperative ARDS in patients undergoing type A aortic dissection surgery.
ObjectiveTo analyze the risk factors for neurological complications after emergency surgery of acute type A aortic dissection.MethodsThe clinical data of 51 patients with acute Stanford type A aortic dissection who were admitted to Shanghai Delta Hospital from October 2018 to May 2019 were retrospectively analyzed. There were 37 males (72.5%) and 14 females (27.5%), aged 29-85 (55.1±12.3) years. The patients were divided into two groups, including a N1 group (n=12, patients with postoperative neurological insufficiency) and a N0 group (n=39, patients without postoperative neurological insufficiency). The clinical data of the two groups were compared and analyzed.ResultsThere were statistical differences in age (62.6±11.2 years vs. 51.7±11.4 years, P=0.003), preoperative D-dimer (21.7±9.2 μg/L vs.10.8±10.7 μg/L, P=0.001), tracheal intubation time (78.7±104.0 min vs. 19.6±31.8 min, P=0.003), ICU stay time (204.1±154.8 min vs. 110.8±139.9 min, P=0.037) and preoperative coagulation factor activity R (4.0±1.5 vs. 5.1±1.6, P=0.022). Preoperative coagulation factor activity R was the independent risk factor for neurological insufficiency after emergency (OR=2.013, 95%CI 1.008-4.021, P=0.047).ConclusionFor patients with pre-emergent acute aortic dissection who are older (over 62.6-64.5 years), with reduced coagulation factor R (less than 4.0), it is recommended to take more active brain protection measures to reduce the occurrence of postoperative neurological complications in patients with acute aortic dissection, and further improve the quality of life.
Objective To investigate the early diagnostic value of urinary neutrophil gelatinase-associated lipocalin (NGAL) for acute kidney injury (AKI) after acute Stanford type A aortic dissection. Methods From January 2018 to December 2018, the clinical data of 50 patients who underwent open surgery for acute Stanford type A aortic dissection were analyzed in Nanjing First Hospital. Urine specimens were collected before and 2 hours after the aortic dissection surgery. Patients were divided into an AKI group (n=27) and a non-AKI group (n=23) according to the Kidney Disease Improving Global Outcomes criteria. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of urine NGAL. ResultsThe incidence of postoperative AKI was 54.00% (27/50). There was a statistically significant difference between the two groups in serum creatinine concentration at 2 hours after surgery and urinary NGAL concentration before the surgery (P<0.05). The area under ROC curve of preoperative urinary NGAL concentration was 0.626. When cut-off value was 43 ng/mL, the sensitivity was 40.7%, specificity was 95.7%. The area under ROC curve of urinary NGAL concentration at 2 hours after surgery was 0.655, and when the cut-off value was 46.95 ng/mL, the sensitivity was 63.0%, specificity was 78.3%. Conclusion Urine NGAL can predict postoperative AKI in patients with acute Stanford type A aortic dissection, but its value is limited.
Objective To explore the therapeutic effect of mild hypothermia on the inflammatory response, organ function and outcome in perioperative patients with acute Stanford type A aortic dissection (AAAD). Methods From February 2017 to February 2018, 56 patients with AAAD admitted in our department were enrolled and randomly allocated into two groups including a control group and an experimental group. After deep hypothermia circulatory arrest during operation, in the control group (n=28), the patients were rewarmed to normal body temperatures (36 to 37 centigrade degree), and which would be maintained for 24 hours after operation. While in the experimental group (n=28), the patients were rewarmed to mild hypothermia (34 to 35 centigrade degree), and the rest steps were the same to the control group. The thoracic drainage volume and the incidence of shivering at the first 24 hours after operation, inflammatory indicators and organ function during perioperation, and outcomes were compared between the two groups. There were 20 males and 8 females at age of 51.5±8.7 years in the control group, 24 males and 4 females at age of 53.3±11.2 years in the experimental group.Results There was no obvious difference in the basic information and operation information in patients between the two groups. Compared to the control group, at the 24th hour after operation, the level of peripheral blood matrix metalloproteinases (MMPs) was lower than that in the experimental group (P=0.008). In the experimental group, after operation, the awakening time was much shorter (P=0.008), the incidence of bloodstream infection was much lower (P=0.019). While the incidence of delirium, acute kidney injury (AKI), hepatic insufficiency, mechanical ventilation duration, intensive care unit (ICU) stays, or hospital mortality rate showed no statistical difference. And at the first 24 hours after operation, there was no difference in the thoracic drainage volume between the two groups, and no patient suffered from shivering. Conclusion The mild hypothermia therapy is able to shorten the awakening time and reduce the incidence of bloodstream infection after operation in the patients with AAAD, and does not cause the increase of thoracic drainage volume or shivering.
ObjectiveTo discuss the effect of Cabrol in treatment of Stanford type A aortic dissection.MethodsThe clinical data of patients whom were diagnosed with type A aortic dissection of Stanford in our hospital from January 2013 to January 2018 were retrospectively analyzed. All of 40 patients underwent Cabrol surgical procedure. There were 31 males and 9 females aged 26–75 (48.8±3.3) years. The surgical treatment effect of the patients was evaluated, mainly including the aortic index, the changes in cardiac function before and after operation, and the postoperative follow-up.ResultsAll the 40 patients completed the operation successfully. The diameter of ascending aorta and aortic sinus in postoperative patients were smaller than those before operation (P<0.05). Postoperative left ventricular ejection fraction and cardiac output increased, central venous pressure and left ventricular end-diastolic dimension decreased, and cardiac function indexes were significantly different from those before the operation (P<0.05). Seven patients suffered complications in postoperative follow-up including one stenting leakage, three neurological diseases and three acute renal failure. Two patients died postoperatively.ConclusionCabrol’s operation is effective in the treatment of Stanford type A aortic dissection, which can significantly improve the cardiac function of patients, simplify the anastomosis of coronary artery ostia and decrease amount of bleeding.
ObjectiveTo explore the risk factors for 24-hour death in acute type A aortic dissection (ATAAD) patients with conservative treatment.MethodsFrom January 2009 to January 2018, 243 ATAAD patients who received non-surgical intervention were admitted in Beijing Anzhen Hospital, including 167 males and 76 females with an average age of 53.0±12.0 years. The risk factors for 24-hour mortality were analyzed.ResultsThe total in-hospital mortality rate was 37.9% (93/243), and 13.6% (33/243) patients died within 24 hours of onset. We found that left ventricular end diastolic diameter [LVEDD, OR=0.45, 95%CI (0.25, 0.83), P<0.01] and aortic regurgitation [OR=7.26, 95%CI (1.67, 31.53), P<0.01] were independent risk factors for 24-hour death in patients with ATAAD.ConclusionIn this study, LVEDD and aortic regurgitation are identified as independent risk factors for 24-hour mortality in ATAAD patients. Therefore, patients with aortic regurgitation and small LVEDD should be treated with sugery as soon as possible.
ObjectiveTo investigate the effect of early postoperative systemic inflammatory response syndrome (SIRS) on the short-term outcome of patients with acute Stanford type A aortic dissection (ATAAD).MethodsThe clinical data of 88 patients with ATAAD who were treated in our hospital from January 2018 to January 2020 were retrospectively analyzed. Patients were divided into a SIRS group (n=37) and a non-SIRS group (n=51) according to whether SIRS occurred within 24 hours after surgery. The perioperative data of the two groups were compared.ResultsThere was no significant difference between the two groups in general clinical data, preoperative left ventricular ejection fraction, white blood cell (WBC) and body temperature (P>0.05). Compared with the non-SIRS group, the cardiopulmonary bypass time in the SIRS group was significantly longer (P<0.05), and the WBC and body temperature within 1 day after surgery in the SIRS group were higher (P<0.01). A significant difference was revealed in the mechanical ventilation time, ICU stay, total hospitalization time and hospitalization costs between two groups (P<0.01). Patients in the SIRS group had higher postoperative acute physiology and chronic health evaluationⅡscores, sequential organ failure assessment score as well as a greater risk of developing postoperative acute lung injury, acute kidney injury, continuous renal replacement therapy, delirium, liver dysfunction and morbidity (P<0.05).ConclusionEarly postoperative SIRS significantly increases the incidence of major adverse complications and the mortality rate of patients with ATAAD.