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Zheng P, Jiang D, Liu C, Wei X, Li S. Nitric Oxide Inhalation Therapy Attenuates Postoperative Hypoxemia in Obese Patients with Acute Type A Aortic Dissection. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9612548. [PMID: 35360551 PMCID: PMC8964131 DOI: 10.1155/2022/9612548] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 12/21/2022]
Abstract
Objective To investigate the differences between inhaled nitric oxide (iNO) treatment and conventional therapy in the treatment of postoperative hypoxemia in obese patients with acute type A aortic dissection (ATAAD). Methods ATAAD patients diagnosed and treated with emergency surgery in our hospital from June 2017 to December 2019 were retrospectively analyzed. Patients with postoperative hypoxemia were divided into the iNO group and control group. Propensity score matching was used to analyze clinical characteristics and results of the two groups. Results A total of 218 ATAAD patients with BMI ≥ 25 were treated with surgery. Among them, 115 patients developed refractory hypoxemia (64 in the control group and 51 in the iNO group). Patients in the iNO group had significantly shorter invasive mechanical ventilation time, intensive care unit (ICU) stay, and hospital stay. After 6 h of iNO treatment, the PaO2/FiO2 ratio in the iNO group increased significantly, and this ratio was higher than that in the control group at 6, 12, 24, 48, and 72 h after treatment. Conclusion Low-dose iNO could improve oxygenation and shorten mechanical ventilation and ICU stay in patients with hypoxemia after ATAAD surgery, but without significant side effects or increase in postoperative mortality or morbidity. These findings provide a basis for a randomized multicenter controlled trial to assess the efficacy of iNO in the treatment of hypoxemia after ATAAD surgery.
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Affiliation(s)
- Ping Zheng
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Dingsheng Jiang
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Chun Liu
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xiang Wei
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Shiliang Li
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Harky A, Singh VP, Khan D, Sajid MM, Kermali M, Othman A. Factors Affecting Outcomes in Acute Type A Aortic Dissection: A Systematic Review. Heart Lung Circ 2020; 29:1668-1681. [PMID: 32798049 DOI: 10.1016/j.hlc.2020.05.113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/10/2020] [Accepted: 05/18/2020] [Indexed: 11/17/2022]
Abstract
Acute type A aortic dissection is a clinical emergency and is associated with significant morbidity and mortality rates if not managed promptly in specialised and high-volume centres. The mortality rate is increased by 1% for each hour delay in management; however, with advancement in clinical practice, diagnostic imaging and clinician awareness, this has been dramatically reduced to below 30% in most international centres. Not only timing of recognition of the pathology, but also other factors can significantly affect outcomes of such critical pathology. This includes, but is not limited to, age, extent of the pathology, existence of connective tissue disorders, hypertension, diabetes mellitus and surgeon experience. This narrative review will focus on current clinical practice and the evidence behind optimising each factor to minimise adverse outcomes in such high-risk cohort.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK; School of Medicine, University of Liverpool, Liverpool, UK.
| | | | - Darab Khan
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Muhammed Kermali
- Faculty of Medicine, St. George's, University of London, London, UK
| | - Ahmed Othman
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Friedrich C, Salem MA, Puehler T, Hoffmann G, Lutter G, Cremer J, Haneya A. Sex-specific risk factors for early mortality and survival after surgery of acute aortic dissection type a: a retrospective observational study. J Cardiothorac Surg 2020; 15:145. [PMID: 32552706 PMCID: PMC7301454 DOI: 10.1186/s13019-020-01189-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/07/2020] [Indexed: 12/13/2022] Open
Abstract
Background Although gender-related disparities in cardiovascular surgery have been investigated extensively in the past decades, knowledge about the impact of gender on outcomes after surgery for acute aortic dissection type A (AADA) is sparse. This study investigated the impact of gender on early morbidity and mortality and follow-up outcome in patients after surgery for AADA and to analyze gender-related risk factors for 30-day mortality. Methods This retrospective study included 368 consecutive patients (male 65.8% vs. female 34.2%) undergoing surgery for AADA between 2001 and 2016 at our department. Survival was estimated by Kaplan-Meier curves. Risk factors for 30-day mortality were assessed by multivariable logistic regression and interaction analysis. Results Women were older (70.7 years vs. 60.6 years; p < 0.001) and showed a higher logistic EuroSCORE I (31.0% vs. 19.7%, p < 0.001). In the male group, a higher portion of smokers (27.6% vs. 16.0%, p = 0.015) and intraoperatively, more complex procedures and longer cardiopulmonary bypass (CPB) (171 min vs. 149 min, p = 0.001) and cross-clamping times (94 min vs. 85 min, p = 0.018) occurred. 30-day mortality was 19.0% in the female and 16.5% in the male group (p = 0.545). Predictive for 30-day mortality in both genders was intraoperative blood transfusion, while in the female group chronic obstructive pulmonary disease (COPD), peripheral arterial disease and preoperative intubation were predictive. Preoperative cardiopulmonary resuscitation and duration of CPB time were predictors only in males. Averaged follow-up time was 5.2 years and survival did not differ between genders, even if it was stratified by age over 70 years. Conclusions This analysis demonstrated a similar and satisfactory survival in both genders after surgical treatment of AADA. Women and men differed significantly in age, unadjusted and adjusted risk factors and complexity of surgical treatment, but gender itself was no risk factor for mortality. These results suggest that the decision-making for surgical treatment should not depend on gender, but that accounting for sex-specific risk factors rather than common risk factors may help to improve the outcome in both genders.
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Affiliation(s)
- Christine Friedrich
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Hs. C, 24105, Kiel, Germany.
| | - Mohamed Ahmed Salem
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Hs. C, 24105, Kiel, Germany
| | - Thomas Puehler
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Hs. C, 24105, Kiel, Germany
| | - Grischa Hoffmann
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Hs. C, 24105, Kiel, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Hs. C, 24105, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Hs. C, 24105, Kiel, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Hs. C, 24105, Kiel, Germany
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Bojko MM, Suhail M, Bavaria JE, Bueker A, Hu RW, Harmon J, Habertheuer A, Milewski RK, Szeto WY, Vallabhajosyula P. Midterm outcomes of emergency surgery for acute type A aortic dissection in octogenarians. J Thorac Cardiovasc Surg 2020; 163:2-12.e7. [PMID: 32624307 DOI: 10.1016/j.jtcvs.2020.03.157] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The incidence of elderly patients with acute type A aortic dissection is increasing. A recent analysis of the International Registry of Acute Aortic Dissection failed to show a mortality benefit with surgery compared with medical management in octogenarians. Therefore, we compared our institutional outcomes of emergency surgery for acute type A aortic dissection in octogenarians versus septuagenarians to understand the outcomes of surgical intervention in elderly patients. METHODS From 2002 to 2017, 70 octogenarians (aged ≥80 years) and 165 septuagenarians (70-79 years) underwent surgery for acute type A aortic dissection (N = 235, total). Quality of life was assessed by the RAND Short Form-36 quality of life survey. Midterm clinical and functional data were obtained retrospectively. RESULTS At baseline, septuagenarians had a higher prevalence of diabetes (20.6% vs 5.7%, P = .01). The prevalence of cardiopulmonary resuscitation was 4.8% versus 10.0% (P = .24) in septuagenarians and octogenarians. The prevalence of cardiogenic shock was 18.2% versus 27.1% (P = .17). Thirty-day/in-hospital mortality was 21.2% versus 28.6% (P = .29). Multivariable logistic regression identified cardiogenic shock as an independent risk factor for in-hospital mortality (odds ratio, 10.07; 95% confidence interval, 2.30-44.03) in octogenarians. Survival at 5 years was 49.7% (42.1%-58.6%) versus 34.2% (23.9%-48.8%) in septuagenarians and octogenarians, respectively. Responses to the quality of life survey were no different between septuagenarians and octogenarians across all 8 quality of life categories. CONCLUSIONS Clinical outcomes after surgery for acute type A aortic dissection are similar in octogenarians and septuagenarians. For discharged survivors, quality of life remains favorable and does not differ between the 2 groups.
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Affiliation(s)
| | - Maham Suhail
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Alex Bueker
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Robert W Hu
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Joey Harmon
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Andreas Habertheuer
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Rita K Milewski
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
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Borracci RA, Baldi J, Yñon D, Rubio M. Current hospital mortality, neurological deficit, and mid-term survival after surgery for acute type A aortic dissection in Argentina. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:454-459. [PMID: 29857964 DOI: 10.1016/j.acmx.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 04/14/2018] [Accepted: 05/01/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To present the current in-hospital outcomes and mid-term survival of acute type A aortic dissection (AAAD) surgery performed by a group of dedicated high-volume thoracic aortic surgeons in a University Hospital in Argentina. METHODS A retrospective analysis of prospectively collected data over a 6-year period (2011-2016) was performed on a consecutive series of 53 adult patients who underwent emergency cardiac surgery for AAAD in the Buenos Aires University Hospital in Argentina. RESULTS A mean of 8.8 AAAD repairs were performed yearly during the 6-year period. In-hospital mortality was 17%, and was statistically equivalent to the expected operative mortality rate of 21% (EuroSCORE II) (observed-to-expected mortality ratio 0.81; p=0.620). New neurological deficit appeared postoperatively in 6% of cases, and the observed major postoperative morbidity rate was 42%. All-cause death cumulative survival probability was 0.711 (SE 0.074), with a mean follow-up period of 49.2 (SE 5.0) months. Cumulative survival probability for in-hospital survivors was 0.903 (SE 0.053), with a mean follow-up period of 62.5 (SE 3.6) months. CONCLUSION Although the present results do not reach international standards, AAAD surgery in our institution was associated with an acceptable mortality risk and satisfactory mid-term survival compared with previous local studies. In addition to in-hospital mortality, the incidence of new permanent neurological deficit after surgery must be considered the most devastating complication to avoid. Patient-focused care in referral aortic centers with surgery performed by specialized teams should be encouraged in order to improve surgical outcomes in acute aortic dissection surgery in Argentina.
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Affiliation(s)
- Raúl A Borracci
- Department of Cardiac Surgery, Hospital de Clínicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Julio Baldi
- Department of Cardiac Surgery, Hospital de Clínicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Yñon
- Department of Cardiac Surgery, Hospital de Clínicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Miguel Rubio
- Department of Cardiac Surgery, Hospital de Clínicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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Jussli-Melchers J, Panholzer B, Friedrich C, Broch O, Renner J, Schöttler J, Rahimi A, Cremer J, Schoeneich F, Haneya A. Long-term outcome and quality of life following emergency surgery for acute aortic dissection type A: a comparison between young and elderly adults. Eur J Cardiothorac Surg 2017; 51:465-471. [PMID: 28111360 DOI: 10.1093/ejcts/ezw408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/05/2016] [Indexed: 12/28/2022] Open
Abstract
Objectives Innovations in surgical techniques and perioperative management have continuously improved survival rates for acute aortic dissection type A (AADA). The aim of our study was to evaluate long-term outcome and quality of life (QoL) after surgery for AADA in elderly patients compared with younger patients. Methods We retrospectively evaluated 242 consecutive patients, who underwent surgery for AADA between January 2004 and April 2014. Patients were divided into two groups: those aged 70 years and older (elderly group; n = 78, mean age, 76 ± 4 years) and those younger than 70 years (younger group; n = 164, mean age, 56 ± 10 years). QoL was assessed with the Short Form Health Survey Questionnaire (SF-36) 1 year after surgery. Results The questionnaire return rate was 91.0%. There were already significant differences noted between the two groups with regard to preoperative risk factors on admission. The clinical presentation with a cardiac tamponade was higher in the elderly group (62.8% vs 47.6%; P = 0.03). Intraoperatively, complex procedures were more common in the younger group (21.3% vs 5.2%; P = 0.001). Accordingly, cardiopulmonary bypass and cross-clamping times were significantly longer in the younger group. The operative mortality was similar in both groups (3.8% vs 1.2%; P = 0.33). In the elderly population, 30-day mortality was higher (21.8% vs 7.9%; P = 0.003). One-year (72% vs 85%), 3-year (68% vs 84%) and 5-year (63% vs 79%) survival rates were satisfactory for the elderly group, but significantly lower compared with the younger group ( P = 0.008). The physical component summary score also was similar between the groups (39.14 ± 11.12 vs 39.12 ± 12.02; P = 0.99). However, the mental component summary score might be slightly higher in the elderly group but not statistically significant (51.61 ± 10.73 vs 48.63 ± 11.25; P = 0.12). Conclusions Satisfactory long-term outcome and the general perception of well-being encourage surgery in selected elderly patients with AADA.
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Affiliation(s)
- Jill Jussli-Melchers
- Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Bernd Panholzer
- Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christine Friedrich
- Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ole Broch
- Department of Anesthesiology and Intensive Care Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jochen Renner
- Department of Anesthesiology and Intensive Care Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan Schöttler
- Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Aziz Rahimi
- Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Felix Schoeneich
- Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Attributable harm of severe bleeding after cardiac surgery in hemodynamically stable patients. Gen Thorac Cardiovasc Surg 2016; 65:102-109. [DOI: 10.1007/s11748-016-0714-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/09/2016] [Indexed: 10/21/2022]
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Zhang R, Chen S, Zhang H, Wang W, Xing J, Wang Y, Yu B, Hou J. Biomarkers Investigation for In-Hospital Death in Patients With Stanford Type A Acute Aortic Dissection. Int Heart J 2016; 57:622-6. [PMID: 27593537 DOI: 10.1536/ihj.15-484] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This retrospective study aimed to investigate the predictive value of biomarkers for in-hospital mortality of patients with Stanford type A acute aortic dissection (AAD).AAD is a life-threatening disease with an incidence of about 2.6-3.6 cases per 100,000/year.A total of 67 consecutive Stanford type A AAD patients admitted to hospital were divided into a deceased group and survival group. The baseline information of the patients between two groups was systematically compared, followed by examination of the electrocardiograms (ECG). Based on the follow-up during hospitalization, we investigated the simultaneous assessment of indexes like fragmented QRS complex (fQRS), admission systolic blood pressure (SBP), aortic diameter, surgical management, troponin I (TnI), white blood cell (WBC) count, N-terminal pro-brain natriuretic peptide (NT-proBNP), and D-dimer.The levels of TnI and NT-proBNP, WBC counts, and rate of fQRS (+) in patients of the deceased group were significantly higher than those in the survival group. The male sex (hazard ratio, 10.88; P = 0.001), admission SBP (hazard ratio, 0.98; P = 0.012), NT-proBNP (hazard ratio, 1.00; P = 0.001), and WBC count (hazard ratio, 1.10; P = 0.033) were independently related with in-hospital death. As a single marker, WBC count had the highest sensitivity at 84.6% (specificity 65.9%).Admission SBP, NT-proBNP, and WBC count were potential independent risk factors of in-hospital death in Stanford type A AAD patients. WBC count may be a more accurate predictor of type A AAD than either alone.
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Affiliation(s)
- Ruoxi Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
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Bruno VD, Chivasso P, Guida G, Vohra HA. Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis. Ann Cardiothorac Surg 2016; 5:257-64. [PMID: 27563539 DOI: 10.21037/acs.2016.06.03] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The results of surgical treatment of type A aortic dissection (AAD) in the elderly are controversial and aggravated by a higher operative mortality rate. The studies published in this subset of patients are mainly retrospective analyses or small samples from international registries. We sought to investigate this topic by conducting a contemporary meta-analysis of the most recent observational studies. METHODS A systematic literature search was conducted for any study published in the last five years on aortic dissection treated surgically in patients 70 years and older. A pooled risk-ratio meta-analysis has been conducted three main post-operative outcomes: short-term mortality, stroke and acute kidney injury. RESULTS A total of 11 retrospective observational studies have been included in the quantitative meta-analysis. Pooled meta-analysis showed an increased risk of short term mortality for the elderly population [relative risk (RR) =2.25; 95% CI, 1.79-2.83; I (2)=0%; P<0.0001], and this has been confirmed in a sub-analysis of patients 80 years and older. The risk of having stroke (RR =1.15; 95% CI, 0.89-1.5; I (2)=0%; P=0.28) and acute kidney injury (RR =0.79; 95% CI, 0.5-1.25, I (2)=14%, P=0.31) after surgery were comparable to the younger cohort of patients. CONCLUSIONS Although affected by an increased risk of short-term mortality in the elderly, surgical repair remains the treatment of choice for AAD. The main post-operative outcomes are comparable to younger patients and the mid-term survival rates are acceptable.
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Affiliation(s)
- Vito D Bruno
- Cardiac Surgery Department, Bristol Heart Institute, Bristol, UK
| | | | - Gustavo Guida
- Cardiac Surgery Department, Bristol Heart Institute, Bristol, UK
| | - Hunaid A Vohra
- Cardiac Surgery Department, Bristol Heart Institute, Bristol, UK
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