Long-term outcomes of treatment with different stent grafts in acute DeBakey type I aortic dissection

The prognostic value of preoperative systemic inflammatory response index in predicting outcomes of acute type A aortic dissection patients underwent surgical treatment

Background

The systemic inflammatory response index (SIRI) is a novel inflammatory-immune biological marker that has prognostic value in various cardiovascular diseases. This study aims to investigate the relationship between SIRI and short-term and long-term prognosis in patients with acute type A aortic dissection (AAAD) underwent surgical treatment.

Methods

We conducted a retrospective analysis of patients with AAAD who underwent emergency surgical treatment at our center. Through multifactorial logistics regression analysis and cox proportional hazards regression analysis, we identified SIRI as an independent risk factor for major adverse events (MAEs) and long-term aorta-related adverse events (ARAEs) post-surgery. The optimal cutoff value of preoperative SIRI was determined using receiver operating characteristic (ROC) curve analysis, and patients were divided into low SIRI group and high SIRI group. The prognostic outcomes at different time points post-surgery for the two groups of patients were analyzed using Kaplan-Meier survival analysis, and the significance was determined by log-rank test.

Results

A total of 691 AAAD patients were included in this study. Among them, 50 patients (7.2%) died within 30 days post-surgery, and 175 patients (25.3%) experienced MAEs. A total of 641 patients were followed up, with an average follow-up time of 33.5 ± 17.5 months, during which 113 patients (17.6%) experienced ARAEs. The results of multifactorial logistics regression analysis and cox proportional hazards regression analysis showed that SIRI was an independent risk factor for postoperative MAEs (OR=3.148, 95%CI[1.650-6.006], p<0.001) and ARAEs (HR=2.248, 95%CI[1.050-4.809], p<0.037). Kaplan-Meier analysis demonstrated that the MAEs-free survival in the high SIRI group was significantly lower than that in the low SIRI group, and a similar trend was observed in the ARAEs-free survival during follow-up (log-rank test, p<0.001).

Conclusion

Preoperative SIRI is significantly associated with the short-term and long-term prognosis of AAAD patients underwent emergency open surgery, demonstrating its valuable prognostic value. Therefore, preoperative SIRI is a reliable biological marker that can serve as a valuable tool for preoperative risk stratification and decision management.

A predictive model for postoperative adverse outcomes following surgical treatment of acute type A aortic dissection based on machine learning

Acute type A aortic dissection (AAAD) has a high probability of postoperative adverse outcomes (PAO) after emergency surgery, so exploring the risk factors for PAO during hospitalization is key to reducing postoperative mortality and improving prognosis. An artificial intelligence approach was used to build a predictive model of PAO by clinical data-driven machine learning to predict the incidence of PAO after total arch repair for AAAD. This study included 380 patients with AAAD. The clinical features that are associated with PAO were selected using the LASSO regression analysis. Six different machine learning algorithms were tried for modeling, and the performance of each model was analyzed comprehensively using receiver operating characteristic curves, calibration curve, precision recall curve, and decision analysis curves. Explain the optimal model through Shapley Additive Explanation (SHAP) and perform an individualized risk assessment. After comprehensive analysis, the authors believe that the extreme gradient boosting (XGBoost) model is the optimal model, with better performance than other models. The authors successfully built a prediction model for PAO in AAAD patients based on the XGBoost algorithm and interpreted the model with the SHAP method, which helps to identify high-risk AAAD patients at an early stage and to adjust individual patient-related clinical treatment plans in a timely manner.

Risk factors for early death after surgery in patients with acute Stanford type A aortic dissection: A systematic review and meta-analysis

BACKGROUND

There are many risk factors related to early death after surgery among patients with acute Stanford type A aortic dissection (ATAAD) that have been analyzed in previous studies, but no evidence-based study has been conducted to confirm these risk factors.

AIMS

The aims of this study were to investigate risk factors for early death after surgery in patients with ATAAD via systematic review and meta-analysis and assess evidence-based strategies for preventing adverse events.

METHODS

The protocol for this study was prospectively registered with PROSPERO (CRD 42022332772). The authors systematically searched PubMed, Ovid, Scopus, Web of Science and Cochrane Library following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines from database construction to May 2021. Studies that met the selection criteria were determined by two independent researchers, and the odds ratios (ORs) and 95% confidence intervals (95% CIs) were reported for the risk factors and were pooled using Stata 15.0.

RESULTS

A total of 23 studies including 5510 patients met the inclusion criteria, and 10 risk factors were analyzed in this meta-analysis. The preoperative risk factors for early death after surgery in patients with ATAAD were age [(OR: 1.03, 95% CI (1.01, 1.06)], male sex [(OR: 1.43, 95% CI (1.06, 1.92)], shock [(OR: 1.91, 95% CI (1.06, 3.45)], malperfusion [(OR: 3.45, 95% CI (2.24, 5.31)] and cardiac tamponade [(OR: 3.89, 95% CI (1.17, 12.98)].

CONCLUSION

Patients with ATAAD who have an older age, male sex, shock, malperfusion and cardiac tamponade have a higher risk for early death after surgery. However, more highly homogenous studies are needed to demonstrate these results. Clinical staff should pay more attention to these factors and take individual actions to reduce mortality after surgery in patients with ATAAD.

High summation of preoperative and postoperative Interleukin-6 levels predicts prolonged mechanical ventilation in patients with acute DeBakey type I aortic dissection: A single center retrospective study

Objective

This study aimed to investigate the predictive effect of preoperative and postoperative interleukin-6 (IL-6) levels on the duration of mechanical ventilation in patients with acute DeBakey Type I aortic dissection (I-AAD) after emergency surgery.

Methods

We retrospectively enrolled 381 patients with I-AAD who underwent surgery in our hospital, between June 2018 and June 2022. Patients were divided into two groups according to whether prolonged mechanical ventilation (PMV) occurred after surgery. The baseline data, biochemical indicators at admission, surgical data, biochemical indicators at postoperative 6 h, and the postoperative data of the two groups were recorded and analyzed.

Results

The PMV group comprised 199 patients, and the non-PMV group 182. The postoperative in-hospital mortality was different between the two groups (11.1% vs. 3.3%, p = 0.004). The length of intensive care unit and hospitalization time in the PMV group were significantly longer than those in the non-PMV group. Multiple regression analysis showed postoperative IL-6 (post-IL-6) ≥67.1 pg/mL and summation of preoperative and postoperative IL-6 (total IL-6) ≥83.4 pg/mL were associated risk factors for PMV [odds ratio (OR) 3.259, 95% confidence interval (CI) 1.922-5.524, p < 0.001], [(OR) 4.515, 95% CI 2.241-9.098, p < 0.001]. Furthermore, determined by the receiver operating characteristics(ROC) curve, the cut-off point was total IL-6 ≥83.4 pg/mL (area under curve(AUC) = 0.825). The sensitivity and specificity of predicting postoperative PMV of patients with I-AAD were 91.5% and 78.2%, respectively (95% CI 0.782-0.868, p < 0.001).

Conclusion

For predicting postoperative PMV in patients with I-AAD, post IL-6 ≥67.1 pg/mL is potentially valuable and summation of preoperative and postoperative IL-6 (total IL-6) ≥83.4 pg/mL has a more pronounced predictive value.

Preoperative clinical application of human fibrinogen in patients with acute Stanford type A aortic dissection: A single-center retrospective study

OBJECTIVE

To evaluate the perioperative clinical efficacy of preoperative human fibrinogen treatment in patients with acute Stanford type A aortic dissection (ATAAD).

METHODS

Data of 159 patients with ATAAD who underwent emergency surgical treatment in our hospital from January 2019 to December 2020 were retrospectively analyzed. Patients were divided into two groups according to whether human fibrinogen was administered before surgery: patients in group A received fibrinogen before surgery, while those in group B did not. The preoperative clinical data, surgical data, postoperative data, complications related to the coagulation function, and mortality of the two groups were compared and analyzed.

RESULTS

The in-hospital mortality was similar in the two groups (2.9% vs. 9.3%, p = .122). However, group A had a significantly shorter operation time (279.24 ± 39.03 vs. 298.24 ± 45.90, p = .008), lower intraoperative blood loss (240.48 ± 96.75 vs. 353.70 ± 189.80, p < .001), and reduced intraoperative transfusion requirement of red blood cells (2.61 ± 1.18 vs. 6.05 ± 1.86, p < .001). The postoperative suction drainage within 24 h in group A was significantly decreased (243.24 ± 201.52 vs. 504.22 ± 341.08, p = .002). The incidence of postoperative acute kidney injury (AKI) in group A was lower than that in group B (3.8% vs. 14.8%, p = .023). Similarly, the incidence of postoperative hepatic insufficiency in group A was lower than that in group B (1.9% vs. 9.3%, p = .045). In group A, the mechanical ventilation time was shorter (47.68 ± 28.61 vs. 118.21 ± 173.16, p = .004) along with reduced intensive care unit stay time (4.06 ± 1.18 vs. 8.09 ± 9.42, p = .003), and postoperative hospitalization days (19.20 ± 14.60 vs. 23.50 ± 7.56, p = .004).

CONCLUSION

Preoperative administration of human fibrinogen in patients undergoing ATAAD surgery can effectively reduce the intraoperative blood loss, amount of blood transfused, operation time, and postoperative complications, and improve the early prognosis of patients. In addition, this procedure is highly safe.

Predicting postoperative hypoxemia risk factors in the patients after triple-branched stent graft implantation surgery with acute type A aortic dissection: A retrospective study

OBJECTIVE

To evaluate the risk factors of postoperative hypoxemia in patients after triple-branched stent graft implantation surgery with acute type A aortic dissection by conducting a nomogram.

METHODS

We evaluated 97 patients with acute type A aortic dissection (2020-2021), who underwent triple-branched stent graft implantation surgery. The independent risk factors were screened using univariate and multivariate logistic regression. We integrated significant factors as well as potential interference factors to build the nomogram model. The accuracy of the nomogram model was determined by using receiver operating characteristic curves (ROC), decision curve analyses (DCA), and calibration plots. Internal verification was evaluated using bootstrap validation.

RESULTS

Logistic regression analysis illustrated that the postoperative lactic acid, postoperative creatinine, and intraoperative aortic occlusion time were all independent risk factors for hypoxemia. Age, sex, and body mass index (BMI) were clinically relevant for predicting postoperative hypoxemia. We established a nomogram based on these six risk factors. The ROC (area under the curve [AUC] = 0.765), DCA, and calibration confirmed good discriminatory applicability and accuracy of the nomogram. Bootstrap validation (AUC = 0.76) verified the applicability of the nomogram.

CONCLUSIONS

The nomogram model could serve as a tool for the prediction of postoperative hypoxemia in patients after modified triple-branched stent graft implantation surgery with acute type A aortic dissection.