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Teurneau-Hermansson K, Ede J, Larsson M, Linton G, von Rosen D, Sjögren J, Wierup P, Nozohoor S, Zindovic I. Mortality after non-surgically treated acute type A aortic dissection is higher than previously reported. Eur J Cardiothorac Surg 2024; 65:ezae039. [PMID: 38310329 PMCID: PMC10871943 DOI: 10.1093/ejcts/ezae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/10/2024] [Accepted: 01/31/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES It has been commonly accepted that untreated acute type A aortic dissection (ATAAD) results in an hourly mortality rate of 1-2% during the 1st 24 h after symptom onset. The data to support this statement rely solely on patients who have been denied surgical treatment after reaching surgical centres. The objective was to perform a total review of non-surgically treated (NST) ATAAD and provide contemporary mortality data. METHODS This was a regional, retrospective, observational study. All patients receiving one of the following diagnoses: International Classification of Diseases (ICD)-9 4410, 4411, 4415, 4416 or ICD-10 I710, I711, I715, I718 in an area of 1.9 million inhabitants in Southern Sweden during a period of 23 years (January 1998 to November 2021) were retrospectively screened. The search was conducted using all available medical registries so that every patient diagnosed with ATAAD in our region was identified. The charts and imaging of each screened patient were subsequently reviewed to confirm or discard the diagnosis of ATAAD. RESULTS Screening identified 2325 patients, of whom 184 NST ATAAD patients were included. The mortality of NST ATAAD was 47.3 ± 4.4%, 55.0 ± 4.4%, 76.7 ± 3.7% and 83.9 ± 4.3% at 24 h, 48 h, 14 days and 1 year, respectively. The hourly mortality rate during the 1st 24 h after symptom onset was 2.6%. CONCLUSIONS This study observed higher mortality than has previously been reported. It emphasizes the need for timely diagnosis, swift management and emergent surgical treatment for patients suffering an acute type A aortic dissection.
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Affiliation(s)
- Karl Teurneau-Hermansson
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jacob Ede
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mårten Larsson
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Gustaf Linton
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - David von Rosen
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Johan Sjögren
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Per Wierup
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Shahab Nozohoor
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Igor Zindovic
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
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Kurz SD, Mahlke H, Graw K, Prasse P, Falk V, Knosalla C, Matzarakis A. Patterns in acute aortic dissection and a connection to meteorological conditions in Germany. PLoS One 2024; 19:e0296794. [PMID: 38265976 PMCID: PMC10807778 DOI: 10.1371/journal.pone.0296794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Acute type A aortic dissection (ATAAD) is a dramatic emergency exhibiting a mortality of 50% within the first 48 hours if not operated. This study found an absolute value of cosine-like seasonal variation pattern for Germany with significantly fewer ATAAD events (Wilcoxon test) for the warm months of June, July, and August from 2005 to 2015. Many studies suspect a connection between ATAAD events and weather conditions. Using ERA5 reanalysis data and an objective weather type classification in a contingency table approach showed that for Germany, significantly more ATAAD events occurred during lower temperatures (by about 4.8 K), lower water vapor pressure (by about 2.6 hPa), and prevailing wind patterns from the northeast. In addition, we used data from a classification scheme for human-biometeorological weather conditions which was not used before in ATAAD studies. For the German region of Berlin and Brandenburg, for 2006 to 2019, the proportion of days with ATAAD events during weather conditions favoring hypertension (cold air advection, in the center of a cyclone, conditions with cold stress or thermal comfort) was significantly increased by 13% (Chi-squared test for difference of proportions). In contrast, the proportion was decreased by 19% for conditions associated with a higher risk for patients with hypotension and therefore a lower risk for patients with hypertension (warm air advection ahead of warm fronts, conditions with no thermal stress or heat stress, in the center of a cyclone with thermal stress). As many studies have shown that hypertension is a risk factor for ATAAD, our findings support the hypothesized relation between ATAAD and hypertension-favoring weather conditions.
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Affiliation(s)
- Stephan Dominik Kurz
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Holger Mahlke
- Wetter3.de - R. Behrendt und H. Mahlke GbR, Wehrheim im Taunus, Germany
- Institute of Meteorology and Climate Research, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Kathrin Graw
- Research Centre Human Biometeorology, German Meteorological Service, Freiburg, Germany
- Chair of Environmental Meteorology, Faculty of Environment and Natural Resources, Albert-Ludwigs-University, Freiburg, Germany
| | - Paul Prasse
- Department of Computer Science, University of Potsdam, Potsdam, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Health Sciences and Technology, Translational Cardiovascular Technologies, Institute of Translational Medicine, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Andreas Matzarakis
- Research Centre Human Biometeorology, German Meteorological Service, Freiburg, Germany
- Chair of Environmental Meteorology, Faculty of Environment and Natural Resources, Albert-Ludwigs-University, Freiburg, Germany
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Toimela JM, Sedha J, Hedman M, Valtola A, Selander T, Husso A. Twenty years' experience of type B aortic dissections: a population-based national registry study from Finland. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad184. [PMID: 37947327 PMCID: PMC10651432 DOI: 10.1093/icvts/ivad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/13/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The objective of this study was to investigate the incidence, treatment and survival of Stanford type B aortic dissection (BTAD) during 20 years in the Finnish population. METHODS Data collection was made from the Nationwide Care Register for Health Care, Finnish National Institute for Health and Welfare. All patients over 15 years of age with BTAD from 2000 to 2019 were included in the study. A data search of the Registry of Death Cause (Statistic Finland) was carried out to identify the date and cause of death. RESULTS There were 1742 cases of BTAD during the study period. BTAD represented 45.6% of all aortic dissections leading to hospital admission. Incidence for BTAD was 1.62 per 100 000 inhabitants per year. The median survival was 12.7 years [95% confidence interval (CI) 9.63-14.7], 12.4 years (95% CI 10.5-14.4) and 8.6 years (95% CI 7.5-9.7) for patients treated with thoracic endovascular aortic repair (TEVAR), surgery and medical treatment (MT), respectively. Survival was significantly better after TEVAR and surgery, compared to MT only (P < 0.001). Age-adjusted survival was significantly better after TEVAR compared to patients treated with MT or surgery (hazard ratio 0.578, 95% CI 0.420-0.794, P < 0.001). Aortic-related death was the most common cause of death in all groups (41%). CONCLUSIONS The incidence of BTAD seems to be similar in the Finnish population compared to other populational studies. Patients treated with TEVAR had significantly better survival compared to other patients. A high risk for late aortic-related death should be recognized in patients with BTAD.
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Affiliation(s)
| | - Jagdeep Sedha
- Department of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti Valtola
- Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Annastiina Husso
- Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland
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Berger T, Kreibich M, Czerny M. Acute type A aortic dissection: stay and play or load and run? Eur Heart J 2023; 44:4373-4375. [PMID: 37638778 DOI: 10.1093/eurheartj/ehad517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Tim Berger
- Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre, Südring 15, D-79189 Bad Krozingen, Freiburg Germany
- University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre, Südring 15, D-79189 Bad Krozingen, Freiburg Germany
- University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre, Südring 15, D-79189 Bad Krozingen, Freiburg Germany
- University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Kuzniar M, Wanhainen A, Tegler G, Hansen T, Mani K. Longitudinal Assessment of Inflammatory Activity in Acute Type B Aortic Dissection with Integrated Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Imaging. Eur J Vasc Endovasc Surg 2023; 66:323-331. [PMID: 37247689 DOI: 10.1016/j.ejvs.2023.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/14/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The significance of the inflammatory response in the natural course of acute type B aortic dissection (ATBAD) is unknown. The aim was to characterise inflammation and its transformation over time in ATBAD using 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) with contrast enhanced magnetic resonance imaging (MRI). METHODS Ten patients underwent FDG-PET/MRI within two weeks of ATBAD (acute phase), three to four months (subacute phase), nine to 12 months (early chronic phase), and 21 to 24 months (late chronic phase) after ATBAD. Target background ratios (TBRs) were measured in the ascending aorta, aortic arch, and descending aorta. MRI inflammatory markers were assessed in the descending aorta. RESULTS Ten patients were included: median age 69 years, median clinical follow up 32 months. In the acute phase there was increased FDG uptake in the descending aorta (maximum TBR 5.8, SD [standard deviation] 1.3) compared with the ascending aorta (TBR 3.3, SD 0.8, p < .010) and arch (TBR 4.2, SD 0.6, p = .010). The maximum TBR of the descending aorta decreased from the acute to subacute phase (TBR 3.5, SD 0.6, p = .010) and further to the early chronic phase (TBR 2.9, SD 0.4, p = .030) but was stable thereafter. The acute phase maximum TBR in the ascending aorta (TBR 3.3) and arch (TBR 4.2) decreased to the subacute phase (ascending: TBR 2.8, SD 0.6, p = .020; arch: TBR 2.7, SD 0.4, p = .010) and was stable thereafter. Four patients underwent surgical aortic repair (three for aortic dilatation at one, five, and 28 months and one for visceral ischaemia at three weeks). MRI signs of inflammation were present in all surgically treated patients vs. two of six of medically treated patients (p= .048). CONCLUSION ATBAD is associated with increased FDG uptake in the acute phase primarily in the descending aorta, but also involving the aortic arch and ascending aorta, indicating an inflammatory response in the whole aorta. Inflammation subsides early in the ascending aorta and arch (three months), whereas it stabilised later in the descending aorta (nine to 12 months). MRI signs of inflammation were more frequent in patients who later needed surgical treatment and merit further investigation.
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Affiliation(s)
- Marek Kuzniar
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences and Peri-operative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Gustaf Tegler
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Tomas Hansen
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
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Dohle DS, Pfeiffer P, Probst C, Treede H. Andexanet alfa and heparin resistance in cardiac surgery: Experiences and risks associated with the reversal of direct oral anticoagulants. Eur J Cardiothorac Surg 2023; 63:ezad189. [PMID: 37144957 DOI: 10.1093/ejcts/ezad189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 05/06/2023] Open
Affiliation(s)
| | - Philipp Pfeiffer
- Department of Cardiovascular Surgery, Johannes-Gutenberg University, Mainz, Germany
| | - Chris Probst
- Department of Cardiovascular Surgery, Johannes-Gutenberg University, Mainz, Germany
| | - Hendrik Treede
- Department of Cardiovascular Surgery, Johannes-Gutenberg University, Mainz, Germany
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Yang M. Acute Lung Injury in aortic dissection : new insights in anesthetic management strategies. J Cardiothorac Surg 2023; 18:147. [PMID: 37069575 PMCID: PMC10109228 DOI: 10.1186/s13019-023-02223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/02/2023] [Indexed: 04/19/2023] Open
Abstract
Acute aortic dissection (AAD) is a severe cardiovascular disease characterized by rapid progress and a high mortality rate. The incidence of acute aortic dissection is approximately 5 to 30 per 1 million people worldwide. In clinical practice, about 35% of AAD patients are complicated with acute lung injury (ALI). AAD complicated with ALI can seriously affect patients' prognosis and even increase mortality. However, the pathogenesis of AAD combined with ALI remains largely unknown. Given the public health burden of AAD combined with ALI, we reviewed the anesthetic management advances and highlighted potential areas for clinical practice.
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Affiliation(s)
- Ming Yang
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China.
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Pitts L, Kofler M, Montagner M, Heck R, Iske J, Buz S, Kurz SD, Starck C, Falk V, Kempfert J. Cerebral Protection Strategies and Stroke in Surgery for Acute Type A Aortic Dissection. J Clin Med 2023; 12:2271. [PMID: 36983272 PMCID: PMC10056182 DOI: 10.3390/jcm12062271] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Perioperative stroke remains a devastating complication in the operative treatment of acute type A aortic dissection. To reduce the risk of perioperative stroke, different perfusion techniques can be applied. A consensus on the preferred cerebral protection strategy does not exist. Methods: To provide an overview about the different cerebral protection strategies, literature research on Medline/PubMed was performed. All available original articles reporting on cerebral protection in surgery for acute type A aortic dissection and neurologic outcomes since 2010 were included. Results: Antegrade and retrograde cerebral perfusion may provide similar neurological outcomes while outperforming deep hypothermic circulatory arrest. The choice of arterial cannulation site and chosen level of hypothermia are influencing factors for perioperative stroke. Conclusions: Deep hypothermic circulatory arrest is not recommended as the sole cerebral protection technique. Antegrade and retrograde cerebral perfusion are today’s standard to provide cerebral protection during aortic surgery. Bilateral antegrade cerebral perfusion potentially leads to superior outcomes during prolonged circulatory arrest times between 30 and 50 min. Arterial cannulation sites with antegrade perfusion (axillary, central or carotid artery) in combination with moderate hypothermia seem to be advantageous. Every concept should be complemented by adequate intraoperative neuromonitoring.
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Teurneau-Hermansson K, Ede J, Larsson M, Moseby-Knappe M, Bjursten H, Nozohoor S, Sjögren J, Zindovic I. S100B predicts neurological injury and 30-day mortality following surgery for acute type A aortic dissection: an observational cohort study. J Cardiothorac Surg 2023; 18:62. [PMID: 36747206 PMCID: PMC9900954 DOI: 10.1186/s13019-023-02151-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/22/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Neurological injuries are frequent following Acute Type A Aortic Dissection (ATAAD) repair occurring in 4-30% of all patients. Our objective was to study whether S100B can predict neurological injury following ATAAD repair. METHODS This was a single-center, retrospective, observational study. The study included all patients that underwent ATAAD repair at our institution between Jan 1998 and Dec 2021 and had recorded S100B-values. The primary outcome measure was neurological injury, defined as focal neurological deficit or coma diagnosed by clinical assessment with or without radiological confirmation and with a symptom duration of more than 24 h. Secondary outcome measure was 30-day mortality. RESULTS 538 patients underwent surgery during the study period and 393 patients, had recorded S100B-values. The patients had a mean age of 64.4 ± 11.1 years and 34% were female. Receiver operating characteristic curve for S100B 24 h postoperatively yielded area under the curve 0.687 (95% CI 0.615-0.759) and best Youden's index corresponded to S100B 0.225 which gave a sensitivity of 60% and specificity of 75%. Multivariable logistic regression identified S100B ≥ 0.23 μg/l at 24 h as an independent predictor for neurological injury (OR 4.71, 95% CI 2.59-8.57; p < 0.01) along with preoperative cerebral malperfusion (OR 4.23, 95% CI 2.03-8.84; p < 0.01) as well as an independent predictor for 30-day mortality (OR 4.57, 95% CI 1.18-11.70; p < 0.01). CONCLUSIONS We demonstrated that S100B, 24 h after surgery is a strong independent predictor for neurological injury and 30-day mortality after ATAAD repair. TRIAL REGISTRATION As this was a retrospective observational study it was not registered.
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Affiliation(s)
- Karl Teurneau-Hermansson
- Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, 221 85, Lund, Sweden.
| | - Jacob Ede
- grid.411843.b0000 0004 0623 9987Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, 221 85 Lund, Sweden
| | - Mårten Larsson
- grid.411843.b0000 0004 0623 9987Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, 221 85 Lund, Sweden
| | - Marion Moseby-Knappe
- grid.411843.b0000 0004 0623 9987Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Henrik Bjursten
- grid.411843.b0000 0004 0623 9987Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, 221 85 Lund, Sweden
| | - Shahab Nozohoor
- grid.411843.b0000 0004 0623 9987Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, 221 85 Lund, Sweden
| | - Johan Sjögren
- grid.411843.b0000 0004 0623 9987Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, 221 85 Lund, Sweden
| | - Igor Zindovic
- grid.411843.b0000 0004 0623 9987Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, 221 85 Lund, Sweden
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Huang PF, Zhang YJ, Lou XZ, Ma D, Wu YY, Zhao YB. Predictive value of admission CO 2 combining power combined with serum sodium for the prognosis in acute Stanford type A aortic dissection patients. Sci Rep 2023; 13:1048. [PMID: 36658204 PMCID: PMC9852255 DOI: 10.1038/s41598-022-27099-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/26/2022] [Indexed: 01/20/2023] Open
Abstract
Acute Stanford type A aortic dissection (ATAAD) with sudden onset and high mortality requiries a standard Bentall operation and a accurate prognosis in common, together with alteration of CO2 combining power (CO2CP) and serum sodium rase concern, hence, we evaluated the prognostic value of CO2CP combined with serum sodium in ATAAD patients. This retrospective study included 183 patients who underwent Bentall operation for ATAAD from 2015 to 2021 in the Fourth Hospital of Hebei Medical University, subsequently followed grouping by the levels of CO2CP and serum sodium. The study endpoint was 30-day all-cause mortality, and the prognostic value of CO2CP combined with serum sodium levels in ATAAD patients were evaluated with multivariate logistic regression method. The postoperative incidence of in-hospital death and adverse events in patients with ATAAD were 18% and 25.7%, respectively. Combination of CO2CP and serum sodium for predicting ATAAD death and adverse events presented a higher predictive value than each single indicator with ROC curve analysis (the AUC of CO2CP combined with serum sodium was 0.786, 95% CI 0.706-0.869, P < 0.001), along with CO2CP < 22.5 mmol/L + serum sodium > 138.5 mmol/L group had the worst prognostic. Multivariate regression analyse showed that CO2CP < 22.5 mmol/L combined with serum sodium > 138.5 mmol/L preferably predicted the prognosis of ATAAD (OR =6.073, 95% CI 2.557-14.425, P < 0.001). Consistently, the cumulative 30-day survival after surgery in ATAAD patients with the low CO2CP and high serum sodium simultaneously was the worst (log-rank P < 0.05). The combination of CO2CP and serum sodium increases the predictive value of prognosis, which is conducive to risk stratification of patients with ATAAD.
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Affiliation(s)
- Peng-Fei Huang
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China
| | - Yun-Jing Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China
| | - Xian-Zhe Lou
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China
| | - Dong Ma
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China. .,Department of Biochemistry and Molecular Biology, Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China.
| | - Yun-Yan Wu
- Cardiac Surgery Department, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Yong-Bo Zhao
- Cardiac Surgery Department, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China.
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Yin J, Liu F, Wang J, Yuan P, Wang S, Guo W. Aortic dissection: global epidemiology. Cardiology Plus 2022; Publish Ahead of Print. [DOI: 10.1097/cp9.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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12
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Oudin A, Bjursten H, Oudin Åström D, Nozohoor S, Ahmad K, Tang M, Bjurbom M, Hansson EC, Jeppsson A, Moeller CH, Jormalainen M, Juvonen T, Mennander A, Olsen PS, Olsson C, Ahlsson A, Pan E, Raivio P, Wickbom A, Sjögren J, Geirsson A, Gudbjartsson T, Zindovic I. Impact of national holidays and weekends on incidence of acute type A aortic dissection repair. Sci Rep 2022; 12:20552. [PMID: 36446905 PMCID: PMC9708832 DOI: 10.1038/s41598-022-25076-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Previous studies have demonstrated that environmental and temporal factors may affect the incidence of acute type A aortic dissection (ATAAD). Here, we aimed to investigate the hypothesis that national holidays and weekends influence the incidence of surgery for ATAAD. For the period 1st of January 2005 until 31st of December 2019, we investigated a hypothesised effect of (country-specific) national holidays and weekends on the frequency of 2995 surgical repairs for ATAAD at 10 Nordic cities included in the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) collaboration. Compared to other days, the number of ATAAD repairs were 29% (RR 0.71; 95% CI 0.54-0.94) lower on national holidays and 26% (RR 0.74; 95% CI 0.68-0.82) lower on weekends. As day of week patterns of symptom duration were assessed and the primary analyses were adjusted for period of year, our findings suggest that the reduced surgical incidence on national holidays and weekends does not seem to correspond to seasonal effects or surgery being delayed and performed on regular working days.
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Affiliation(s)
- Anna Oudin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Daniel Oudin Åström
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Khalil Ahmad
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark
| | - Mariann Tang
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark
| | - Markus Bjurbom
- Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Emma C Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian H Moeller
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikko Jormalainen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Ari Mennander
- Heart Centre, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Peter S Olsen
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Olsson
- Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ahlsson
- Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Emily Pan
- Heart Center, Turku University Hospital, Turku, Finland
- Brigham and Women's Hopistal and Harvard Medical School, Boston, MA, USA
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Anders Wickbom
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Igor Zindovic
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
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Evangelista Masip A, López-Sainz Á, Barros Membrilla AJ, Calvo Iglesias F, López Ayerbe J, Azqueta Molluna M, Mosquera Rodríguez VX, Arregui Montoya F, Tarrío Fernández R, Revilla Orodea A, Sánchez Sánchez V, Cantero Pérez EM, Ferrera C, Toral Sepúlveda D, Nistal F, Fernández Golfín C, Sao A, Rodríguez-Palomares J. Spanish Registry of Acute Aortic Syndrome (RESA). Changes in therapeutic management and lower mortality in acute aortic syndrome. Rev Esp Cardiol (Engl Ed) 2022; 75:816-824. [PMID: 35527170 DOI: 10.1016/j.rec.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Spanish Registry of Acute Aortic Syndrome (RESA) was launched in 2005 to identify the characteristics of acute aortic syndrome (AAS) in Spain. The aim of this study was to analyze the differences in management and mortality in the 3 RESA iterations. METHODS We analyzed data from patients with AAS prospectively included by 24 to 30 tertiary centers during the 3 iterations of the registry: RESA I (2005-2006), RESA-II (2012-2013), and RESA III (2018-2019). RESULTS AAS was diagnosed in 1902 patients (74% men; age, 60.7±12.5 years): 1329 (69.9%) type A and 573 (30.1%) type B. Comparison of the 3 periods revealed that the use of computed tomography increased as the first diagnostic technique (77.1%, 77.9%, and 84.2%, respectively; P=.001). In type A, surgical management increased (79.6%, 78.7%, and 84.5%; P=.045) and overall mortality decreased (41.2%, 34.5%, and 31.2%; P=.002), due to a reduction in surgical mortality (33.4%, 25.1%, and 23.9%; P=.003). In type B, endovascular treatment increased (22.8%, 32.8%, and 38.7%; P=.006), while medical and surgical treatment decreased. Overall type B mortality also decreased (21.6%, 16.1%, and 12.0%; P=.005) in line with a reduction in mortality with medical (16.8%, 13.8%, and 8.8%, P=.030) and endovascular (27.0%, 18.0%, and 9.2%; P=.009) treatments. CONCLUSIONS The iterations of RESA show a decrease in mortality from type A AAS, coinciding with an increase in surgical treatment and a reduction in surgical mortality. In type B, the use of endovascular treatment was associated with improved survival, allowing better management in patients with complications.
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Affiliation(s)
| | - Ángela López-Sainz
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Jordi López Ayerbe
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | - Francisco Arregui Montoya
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Ana Revilla Orodea
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Carlos Ferrera
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - David Toral Sepúlveda
- Servei de Cirurgia Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Nistal
- Servicio de Cirugía Cardiaca, Hospital Universitario Valdecilla, Santander, Spain
| | | | - Augusto Sao
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Cote CL, De Waard D, Kivell M, Fagan A, Horne G, Hassan A, Hajizadeh M, Herman CR. Sex Differences in Trends in Incidence of Thoracic Aortic Aneurysm Repair and Aortic Dissection: 2005-2015. CJC Open 2022; 4:1081-1089. [PMID: 36562011 PMCID: PMC9764113 DOI: 10.1016/j.cjco.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/26/2022] [Indexed: 12/25/2022] Open
Abstract
Background The purpose of this study was to examine trends in the incidence of thoracic aortic aneurysm (TAA) repair and aortic dissection. Methods A retrospective study was conducted of patients from the period 2005-2015 with thoracic aortic disease. Unadjusted mortality was compared in women vs men. Rates of scheduled TAA repair, dissection events, acute type A aortic dissection (TAAD) repair, and aorta-related mortality were obtained from our institution's clinical registry and administrative data sources and used to calculate the age-adjusted incidence for each sex, adjusted to the Canadian standard population. Weighted linear regression was performed to analyze trends over time. Results A total of 382 scheduled TAA repair operations, 345 dissection events, 85 TAAD repairs, and 182 aorta-related mortalities were identified. Women accounted for 23% of TAA repairs, 39% of dissection events, 22% of TAAD repairs, and 45% of aorta-related mortalities. The incidence of TAA repair was 3.5 per 100,000 person-years (95% confidence interval [CI]: 3.2-3.9), and increased in men (P = 0.02) but not women (P = 0.10) over time. The incidence of aortic dissection was 3.4 per 100,000 (95% CI: 3.1-3.8) and was stable over time (P = 0.43). The average annual age-adjusted incidence of TAAD repair was 0.8 per 100,000 (95% CI: 0.6-1.0) and increased over time (P = 0.001). The overall incidence of aorta-related mortality was 1.8 per 100,000 (95% CI: 1.5-2.0) and decreased over time (P = 0.02). Conclusion The incidence of TAA repair is increasing in men but not women. Although aorta-related mortality is decreasing overall, disparities exist between the male and female population.
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Affiliation(s)
- Claudia L. Cote
- Division of Cardiac Surgery, Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada,School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada,Corresponding author: Claudia Cote, Nova Scotia Health, Division of Cardiac Surgery, 2269-1796 Summer St., Halifax, Nova Scotia B3H 3A7, Canada. Tel.: +1-902-473-5590; fax: +1-902-473-4448
| | - Dominique De Waard
- Division of Cardiac Surgery, Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew Kivell
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Fagan
- Division of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gabrielle Horne
- Division of Cardiology, Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ansar Hassan
- Department of Cardiovascular Surgery, Maine Medical Centre, Portland, Maine, USA
| | - Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine R. Herman
- Division of Cardiac Surgery, Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada,Division of Vascular Surgery, Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada
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15
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Yang G, Chai X, Ding N, Yang D, Ding Q. A retrospective observational study of serum uric acid and in-hospital mortality in acute type A aortic dissection. Sci Rep 2022; 12:12289. [PMID: 35853989 PMCID: PMC9296441 DOI: 10.1038/s41598-022-16704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
There is currently insufficient evidence of correlation between on-admission serum uric acid and in-hospital mortality of patients with acute type A aortic dissection. Thus, this study analysed the relation between serum uric acid and in-hospital deaths in patients with acute type A aortic dissection. A total of 1048 patients with acute type A aortic dissection participated in this study between January 2010 and December 2018. The independent variable was on-admission serum uric acid, whilst the dependent variable was in-hospital deaths. The covariates of the study included patient age, gender, body mass index, smoking status, hypertension, diabetes, Marfan syndrome, bicuspid aortic valve, chronic renal insufficiency, stroke, atherosclerosis, time to presentation, systolic blood pressure, diastolic blood pressure, aortic diameter, aortic regurgitation, abdominal vessel involvement, arch vessel involvement, ejection fraction value, laboratory parameters, symptom, coronary malperfusion, mesenteric malperfusion, cerebral malperfusion, hypotension/shock, cardiac tamponade and operation status. The mean age of the sample was 50.17 ± 11.47 years, with approximately 24.24% of the participants being female. After analysis, it was found that the admission serum uric acid of patients with acute type A aortic dissection was positively correlated with in-hospital death (OR = 1.04, 95% CI 1.02–1.06). Subsequently, a non-linear relationship was determined between admission serum uric acid (point 260 µmol/L) and in-hospital mortality for patients with acute type A aortic dissection. The effect sizes and confidence intervals of the right (serum uric acid > 260 µmol/L) and left (serum uric acid ≤ 260 µmol/L) aspects of the inflection point were 1.04 (1.02–1.05) and 1.00 (0.99–1.02), respectively. Furthermore, subgroup analysis indicated a stable relationship between serum uric acid and in-hospital mortality, whilst an insignificant difference was found for the interactions between different subgroups. Overall, a non-linear correlation was determined between admission serum uric acid and in-hospital mortality of patients with acute type A aortic dissection. When serum uric acid > 260 µmol/L, it showed a positive correlation with in-hospital mortality.
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Affiliation(s)
- Guifang Yang
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.,Trauma Center of Hunan Province, Changsha, China
| | - Xiangping Chai
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.,Trauma Center of Hunan Province, Changsha, China
| | - Ning Ding
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.,Trauma Center of Hunan Province, Changsha, China
| | - Donghua Yang
- Department of Nursing, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, 410004, Hunan, China
| | - Qiong Ding
- Department of Nursing, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, 410004, Hunan, China.
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16
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Montagner M, Kofler M, Seeber F, Pitts L, Starck C, Sündermann SH, Kurz S, Grubitzsch H, Falk V, Kempfert J. The Arch Remodeling Stent for DeBakey I Acute Aortic Dissection: Experience with 100 Implantations. Eur J Cardiothorac Surg 2022; 62:6637516. [PMID: 35809065 DOI: 10.1093/ejcts/ezac384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES A novel hybrid non-covered stent was developed to treat malperfusion and prevent aneurysm formation following hemiarch procedure for DeBakey I acute aortic dissection (AAD). The present analysis investigates the performance of the device in 100 consecutive implantations. METHODS Between 2018 and 2021, 100 patients underwent surgical repair of DeBakey I AAD with implantation of a non-covered stent in the arch and descending aorta. The primary entry tear was located in the root or in the ascending aorta. Clinical and imaging data were collected and analyzed retrospectively. Endpoints of the study were 30-day mortality, neurologic outcome and need of additional procedures due to postoperative malperfusion. Technical success was assessed in the first post-operative computed tomography in regard to the induction of false lumen thrombosis in the descending aorta. RESULTS Median age was 61 [54-73] years. Preoperative malperfusion was present in 46 (46%) patients. Primary arterial cannulation strategy was the right axillary artery and an open distal anastomosis was performed in a median caudal circulatory arrest of 40 [34-52] minutes. In 48% of cases, a 55-40 tapered stent was implanted. The 30-day mortality was 18%, an operation-related new postoperative neurologic deficit was present in 8%. Technical success was achieved in 76% of patients. CONCLUSIONS The novel non-covered stent can be safely applied to complement aortic repair with the hemiarch procedure for DeBakey I AAD. The expansion of the true lumen through the device may prevent postoperative malperfusion and induces positive vascular remodeling with thrombosis of false lumen.
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Affiliation(s)
- Matteo Montagner
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany
| | - Fabian Seeber
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany
| | - Leonard Pitts
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany.,Charité - Universitaetsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
| | - Stephan Kurz
- Charité - Universitaetsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
| | - Herko Grubitzsch
- Charité - Universitaetsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany.,Charité - Universitaetsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany.,Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
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Gao Y, Wang M, Zhang G, Zhou L, Luo J, Liu L. Cluster-Based Ensemble Learning Model for Aortic Dissection Screening. Int J Environ Res Public Health 2022; 19:5657. [PMID: 35565052 DOI: 10.3390/ijerph19095657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022]
Abstract
Aortic dissection (AD) is a rare and high-risk cardiovascular disease with high mortality. Due to its complex and changeable clinical manifestations, it is easily missed or misdiagnosed. In this paper, we proposed an ensemble learning model based on clustering: Cluster Random under-sampling Smote–Tomek Bagging (CRST-Bagging) to help clinicians screen for AD patients in the early phase to save their lives. In this model, we propose the CRST method, which combines the advantages of Kmeans++ and the Smote–Tomek sampling method, to overcome an extremely imbalanced AD dataset. Then we used the Bagging algorithm to predict the AD patients. We collected AD patients’ and other cardiovascular patients’ routine examination data from Xiangya Hospital to build the AD dataset. The effectiveness of the CRST method in resampling was verified by experiments on the original AD dataset. Our model was compared with RUSBoost and SMOTEBagging on the original dataset and a test dataset. The results show that our model performed better. On the test dataset, our model’s precision and recall rates were 83.6% and 80.7%, respectively. Our model’s F1-score was 82.1%, which is 4.8% and 1.6% higher than that of RUSBoost and SMOTEBagging, which demonstrates our model’s effectiveness in AD screening.
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Evangelista Masip A, López-sainz Á, Barros Membrilla AJ, Calvo Iglesias F, López Ayerbe J, Azqueta Molluna M, Mosquera Rodríguez VX, Arregui Montoya F, Tarrío Fernández R, Revilla Orodea A, Sánchez Sánchez V, Cantero Pérez EM, Ferrera C, Toral Sepúlveda D, Nistal F, Fernández Golfín C, Sao A, Rodríguez-palomares J. Cambios en el tratamiento y disminución de la mortalidad del síndrome aórtico agudo. Lecciones del Registro Español del Síndrome Aórtico Agudo (RESA). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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19
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Leonova MV. Collagen-associated side effects of fluoroquinolones: aneurysm and aortic dissection (systematic review). Consilium Medicum 2022. [DOI: 10.26442/20751753.2022.1.201380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Well known for fluoroquinolones cause the development of collagen-associated side effects tendopathies with the risk of tendon rupture and retinal detachment, which is associated with the damaging effect and degradation of type I and type III collagen. The aorta is also rich in collagen type I and type III up to 8090%, which has the potential to play a role in the development of aortopathies in cases of fluoroquinolone use. Since 2015, the first publications of research results on the collagen-associated effect of fluoroquinolones on the development of aneurysm and aortic dissection, often called aortopathy, began to appear. A systematic review of observational studies and 5 meta-analyzes of the development of a novel side effect of fluoroquinolones is presented. An absolute incidence of this side effect of 1.1% and a twofold increased relative risk of developing aneurysm/aortic dissection (RR 2.042.23), aortic aneurysm (RR 1.742.83), and aortic dissection (RR 1.882.79). When analyzing age subgroups, an increase in the risk of aneurysm/aortic dissection was noted already from the age of 35 years and was more significant in elderly patients (over 65 years). Analisys of the course duration of fluoroquinolone use (314 days or 14 days) was carried out in two studies and showed an increase in the risk of aneurysm/aortic dissection with increasing duration of fluoroquinolone therapy (RR 1.72 versus RR 1.92). The risk of developing a fluoroquinolone-associated aortopathy was highest during the first 30 days after the course use of fluoroquinolones, with a slight decrease within 6090 days after the course. The signal was confirmed by the FDA pharmacovigilance system (USA) during the analysis of cases of aneurysm/aortic dissection against the background of fluoroquinolones use. International regulatory authorities (FDA and EMA) have announced official documents warning of an increased incidence of rare but serious cases of aortic dissection or ruptured aortic aneurysm with oral fluoroquinolones. Fluoroquinolones should not be given to patients at increased risk unless other treatment options are available. The increased risk category includes patients with a history of aortic or other blood vessel aneurysm, high blood pressure, and the elderly.
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Li L, Zhou J, Luo L, Chen X, Li Y. Application of the Care Bundle in Perioperative Nursing Care of the Type A Aortic Dissection. Int J Gen Med 2021; 14:5949-5958. [PMID: 34584447 PMCID: PMC8464374 DOI: 10.2147/ijgm.s322755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background To investigate the effect of the care bundle in the nursing care of the type A aortic dissection (TAAD). Methods A total of 161 patients with TAAD were included in the study. They were divided into control group (n=79) and care bundle group (n=82). The patients in the control group received routine nursing, while the patients in the care bundle group received routine nursing and care bundle. IL-2, IL-6 and IL-10 levels in the three periods of T0 (before anesthesia), T1 (before anesthesia to 6 h after surgery) and T2 (6–24 h after surgery), intraoperative blood loss, postoperative recovery, ICU stay time, intraoperative pressure ulcer rate, postoperative delirium rate, bloodstream infection rate and doctor satisfaction. Results The postoperative T and pH levels in two groups were all in the normal range. The levels of IL-2, IL-6 and IL-10 in the care bundle group at different periods were also significantly different. The levels of IL-2 and IL-10 showed an increased trend, while that of IL-6 showed a downward trend. The intraoperative blood loss, postoperative recovery and ICU stay time, intraoperative pressure sore rate, postoperative delirium rate, and bloodstream infection rate were lower, whereas doctor satisfaction was all significantly higher in care bundle group. Conclusion Care bundle increased the safety of the operation, and it was beneficial to the postoperative rehabilitation for TAAD patients. Relevance to Clinical Practice Patients with TAAD who underwent operation need higher quality care during the entire operation. Cluster nursing is the kind of the nursing model that can better meet the requirements of the intraoperative nursing quality. The intervention methods in this study include 5 core nursing measures. These measures are implemented together in a synergistic manner to effectively improve the quality of nursing care in operating room and the health outcomes of patients with TAAD. Care bundle is worthy of clinical application.
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Affiliation(s)
- Li Li
- Xinjiang Medical University,Urumqi, 830000,Xinjiang, People's Republic of China.,Nursing School, Xinjiang Medical University,Urumqi, 830000, Xinjiang, People's Republic of China.,Operating Room,The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, People's Republic of China
| | - Jiangqi Zhou
- Operating Room,The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, People's Republic of China
| | - Likun Luo
- Operating Room,The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, People's Republic of China
| | - Xiaoqing Chen
- Operating Room,The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, People's Republic of China
| | - Yinglan Li
- Nursing School, Xinjiang Medical University,Urumqi, 830000, Xinjiang, People's Republic of China.,Xiangya Nursing School, Central South University, Changsha, 410000, Hunan Province, People's Republic of China
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21
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Kurz SD, Sido V, Herbst H, Ulm B, Salkic E, Ruschinski TM, Buschmann CT, Tsokos M. Discrepancies between clinical diagnosis and hospital autopsy: A comparative retrospective analysis of 1,112 cases. PLoS One 2021; 16:e0255490. [PMID: 34388154 PMCID: PMC8362952 DOI: 10.1371/journal.pone.0255490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/17/2021] [Indexed: 11/21/2022] Open
Abstract
Aims The aim of this study was to compare discrepancies between diagnosed and autopsied causes of death in 1,112 hospital autopsies and to determine the factors causing this discrepancies. Methods 1,112 hospital autopsies between 2010 and 2013 were retrospectively studied. Ante-mortem diagnoses were compared to causes of death as determined by autopsy. Clinical diagnoses were extracted from the autopsy request form, and post-mortem diagnoses were assessed from respective autopsy reports. Variables, such as sex, age, Body Mass Index, category of disease, duration of hospital stay and new-borns were studied in comparison to discrepancy. P-values were derived from the Mann-Whitney U test for the constant features and chi-2 test, p-values < 0,05 were considered significant. Results 73.9% (n = 822) patients showed no discrepancy between autopsy and clinical diagnosis. The duration of hospitalisation (6 vs. 9 days) and diseases of the cardiovascular system (61.7%) had a significant impact on discrepancies. Conclusion Age, cardiovascular diseases and duration of hospital stay significantly affect discrepancies in ante- and post-mortem diagnoses.
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Affiliation(s)
- Stephan D. Kurz
- German Heart Institute Berlin, Institute for Anaesthesiology, Berlin, Germany
- Institute of Physiology, Berlin Institute of Health, Charite–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Berlin Institute of Health, Charite–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- * E-mail: (SDK); (VS)
| | - Viyan Sido
- Department of Cardiovascular Surgery, Berlin Institute of Health, Charite–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- * E-mail: (SDK); (VS)
| | - Hermann Herbst
- Department of Pathology, Vivantes Klinikum Neukölln, Berlin, Germany
| | | | - Erma Salkic
- German Heart Institute Berlin, Institute for Anaesthesiology, Berlin, Germany
- Department of Cardiology, Berlin Institute of Health, Charite–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Claas T. Buschmann
- Institute of Legal Medicine, University Hospital Schleswig-Holstein Kiel/Lübeck, Lubeck, Germany
| | - Michael Tsokos
- Institute of Legal Medicine and Forensic Sciences, Berlin Institute of Health, Charite–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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22
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Wee I, Chin B, Syn N, Lee KS, Ng JJ, Choong AMTL. The association between fluoroquinolones and aortic dissection and aortic aneurysms: a systematic review and meta-analysis. Sci Rep 2021; 11:11073. [PMID: 34040146 DOI: 10.1038/s41598-021-90692-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/17/2021] [Indexed: 01/05/2023] Open
Abstract
Previous studies have drawn causal associations between fluoroquinolone use and collagen pathologies including tendon rupture and retinopathy. This meta-analysisattempted to assess the association between fluoroquinolone use and the risk of aortic dissection or aortic aneurysm. A systematic search was performed on Medline, EMBASE, and the Cochrane library. 9 studies were included in final analysis. Primary random-effects meta-analysis of 7 studies, excluding 2 pharmacovigilance studies demonstrated statistically increased odds of aortic dissection (OR, 2.38; 95% CI, 1.71-3.32) aortic aneurysm (OR, 1.98; 95% CI, 1.59-2.48), and aortic aneurysm or dissection (OR, 1.47; 95% CI, 1.13-1.89; I2 = 72%) with current use of fluoroquinolones compared to their nonuser counterparts. Based on the "number needed-to-harm" analysis, 7246 (95% CI: 4329 to 14,085) patients would need to be treated with fluoroquinolones for a duration of at least three days in order for one additional patient to be harmed, assuming a population baseline incidence of aortic dissection and aneurysm rupture to be 10 per 100,000 patient-years. With strong statistical association, these findings suggest a causal relationship, warranting future research to elucidate the pathophysiological and mechanistic plausibility of this association. These findings however, should not cease prescription of fluoroquinolones, especially when clinically indicated.
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23
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Pitts L, Montagner M, Kofler M, Van Praet KM, Heck R, Buz S, Kurz SD, Sündermann S, Hommel M, Falk V, Kempfert J. State of the Art Review: Surgical Treatment of Acute Type A Aortic Dissection. Surg Technol Int 2021; 38:279-288. [PMID: 33823055 DOI: 10.52198/21.sti.38.cv1413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Acute type A aortic dissection (ATAAD) is a life-threatening event that requires immediate surgical treatment. Improvements in surgical treatment, graft technology, organ protection and imaging techniques have led to improved clinical outcomes. Individualized treatment concepts have emerged based on more advanced planning tools that allow for a tailored approach even in complex situations such as multi-level malperfusion. This review provides an overview of the current surgical treatment of ATAAD, focusing on new disease classifications, preoperative computed tomography angiography (CTA) assessment, new prosthesis and stent technologies, and organ-protection strategies.
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Affiliation(s)
- Leonard Pitts
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
| | - Matteo Montagner
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
| | - Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
| | - Roland Heck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
| | - Semih Buz
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
| | - Stephan D Kurz
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
- Charité - Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
| | - Simon Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
- Charité - Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
| | - Matthias Hommel
- Department of Anesthesiology, German Heart Center Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
- Charité - Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
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24
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Smedberg C, Steuer J, Leander K, Hultgren R. Sex differences and temporal trends in aortic dissection: a population-based study of incidence, treatment strategies, and outcome in Swedish patients during 15 years. Eur Heart J 2021; 41:2430-2438. [PMID: 32558879 PMCID: PMC7340356 DOI: 10.1093/eurheartj/ehaa446] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/26/2020] [Accepted: 05/11/2020] [Indexed: 01/01/2023] Open
Abstract
Aims As large population-based studies of aortic dissection are lacking, the incidence numbers and knowledge about time-trends and sex differences are uncertain. The objective was to describe incidence, temporal trends and outcome of aortic dissection with particular emphasis on sex differences. Methods and results During the study period 2002–2016, 8057 patients in Sweden were diagnosed with aortic dissection, identified from the National Patient Register and the Cause of Death Register. A total of 5757 (71%) patients were hospitalized, whereas 2300 (29%) patients were deceased without concurrent hospital stay. The annual incidence was 7.2 per 100 000 (9.1 in men and 5.4 in women), decreasing over time in men (P = 0.005). Mean age in the hospitalized patients was 68 years (SD 13), 2080 (36%) were women. Within the first 14 days after onset, 1807 patients (32%) underwent surgical repair. The proportion of surgically treated increased from the 5-year period 2002–2006 to 2012–2016 [27% vs. 35%, odds ratio (OR) 1.61, 95% confidence interval (CI) 1.39–1.86; P < 0.001]. In hospitalized patients, 30-day mortality decreased between the same periods (26% vs. 21%, OR 0.68, 95% CI 0.59–0.80; P < 0.001). Long-term mortality decreased as well (hazard ratio 0.74, 95% CI 0.67–0.82; P < 0.001). Women had higher 30-day mortality than men after acute repair, a sex difference that remained after age adjustment (17% vs. 12%, OR 1.38, 95% CI 1.04–1.82; P = 0.006). Conclusion This population-based study detected a higher incidence of aortic dissection than prior reports, but a decreasing incidence in men. Surgical therapy was increasingly used and with more favourable outcome but was less frequently offered to elderly patients. The sustained sex differences regarding both incidence and outcome require further attention. ![]()
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Affiliation(s)
- Christian Smedberg
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, SE-11883 Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Sjukhusbacken 10, SE-11883 Stockholm, Sweden
| | - Johnny Steuer
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, SE-11883 Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Sjukhusbacken 10, SE-11883 Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177 Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm S301 SE-17176, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm S301 SE-17176, Sweden
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25
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Möller CM, Ellmauer PP, Zeman F, Bitzinger D, Flörchinger B, Graf BM, Zausig YA. Postoperative acute respiratory dysfunction and the influence of antibiotics after acute type A aortic dissection surgery: A retrospective analysis. PLoS One 2021; 16:e0246724. [PMID: 33571258 PMCID: PMC7877985 DOI: 10.1371/journal.pone.0246724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/25/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Surgery for acute type A aortic dissection is associated with several perioperative complications, such as acute respiratory dysfunction (ARD). The aim of this study was to investigate perioperative risk factors involved in the development of ARD and whether antibiotic treatment has an impact. METHODS 243 patients underwent surgery for acute type A aortic dissection between 2008 and 2017. The patients were retrospectively divided into the ARD and NON-ARD group. ARD was defined as PaO2/FiO2 ≤ 200 mmHg (PF ratio) within 48 hours after surgery. All patients received either narrow- or broad-spectrum antibiotics. RESULTS After the exclusion of 42 patients, 201 patients were analyzed. The PF ratio of the ARD group was significantly lower than of the NON-ARD group within the first 7 days. ARD patients (n = 111) were significantly older (p = .031) and had a higher body mass index (BMI) (p = .017). ARD patients required longer postoperative ventilation (2493 vs. 4695 [min], p = .006) and spent more days in the intensive care unit (7.0 vs. 8.9 [days], p = .043) compared to NON-ARD. The mortality was significantly lower for ARD than for NON-ARD patients (p = .030). The incidence of pneumonia was independent of the antibiotic treatment regime (p = .391). Renal and neurological complication rate was higher in patients treated with broad-spectrum antibiotic. CONCLUSION ARD is the main complication (55%) that occurs approximately 24 hours after surgery for acute type A aortic dissection. The preoperative risk factors for ARD were higher age and increased BMI. Patients on broad-spectrum antibiotics did not show an improved postoperative outcome compared to patients with narrow-spectrum antibiotics.
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Affiliation(s)
- Christina M. Möller
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Peter-Paul Ellmauer
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Florian Zeman
- Center of Clinical Studies, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Diane Bitzinger
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Bernhard Flörchinger
- Department of Cardiac Surgery, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Bernhard M. Graf
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - York A. Zausig
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Bavaria, Germany
- Department of Anesthesiology and Operative Intensive Care Medicine, Aschaffenburg-Alzenau Hospital, Aschaffenburg, Bavaria, Germany
- * E-mail: ,
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26
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Matthews CR, Madison M, Timsina LR, Namburi N, Faiza Z, Lee LS. Impact of time between diagnosis to treatment in Acute Type A Aortic Dissection. Sci Rep 2021; 11:3519. [PMID: 33568755 DOI: 10.1038/s41598-021-83180-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/27/2021] [Indexed: 01/03/2023] Open
Abstract
There is a paucity of data describing the effect of time interval between diagnosis and surgery for Acute Type A Aortic Dissection. We describe our 8-year experience and investigate the impact of time interval between symptom onset, diagnosis and surgery on outcomes. Retrospective single-center study utilizing our Society of Thoracic Surgeons registry and patient records. Subjects were grouped by time interval between radiographic diagnosis and surgical treatment: Group A (0-4 h), Group B (4.1-8 h), Group C (8.1-12 h), and Group D (12.1 + h). Data were analyzed to identify factors associated with mortality and outcomes. 164 patients were included. Overall mortality was 21.3%. Group C had the greatest intervals between symptom onset to diagnosis to surgery, and also the highest mortality (66.7%). Preoperative tamponade, cardiac arrest, malperfusion, elevated creatinine, cardiopulmonary bypass time, and blood transfusions were associated with increased mortality, while distance of referring hospital was not. Time intervals between symptom onset, diagnosis and surgery have a significant effect on mortality. Surgery performed 8-12 h after diagnosis carries the highest mortality, which may be exacerbated by longer interval since symptom onset. Time-dependent effects should be considered when determining optimal strategy especially if inter-facility transfer is necessary.
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27
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Abstract
Background As a particularly dangerous and rare cardiovascular disease, aortic dissection (AD) is characterized by complex and diverse symptoms and signs. In the early stage, the rate of misdiagnosis and missed diagnosis is relatively high. This study aimed to use machine learning technology to establish a fast and accurate screening model that requires only patients' routine examination data as input to obtain predictive results. Methods A retrospective analysis of the examination data and diagnosis results of 53,213 patients with cardiovascular disease was conducted. Among these samples, 802 samples had AD. Forty-two features were extracted from the patients' routine examination data to establish a prediction model. There were five ensemble learning models applied to explore the possibility of using machine learning methods to build screening models for AD, including AdaBoost, XGBoost, SmoteBagging, EasyEnsemble and XGBF. Among these, XGBF is an ensemble learning model that we propose to deal with the imbalance of the positive and negative samples. The seven-fold cross validation method was used to analyze and verify the performance of each model. Due to the imbalance of the samples, the evaluation indicators were sensitivity and specificity. Results Comparative experiments showed that the sensitivity of XGBF was 80.5%, which was better than the 16.1% of AdaBoost, 15.7% of XGBoost, 78.0% of SmoteBagging and 77.8% of EasyEnsemble. Additionally, XGBF had relatively high specificity, and the training time consumption was short. Based on these three indicators, XGBF performed best, and met the application requirements, which means through careful design, we can use machine learning technology to achieve early AD screening. Conclusions Through reasonable design, the ensemble learning method can be used to build an effective screening model. The XGBF has high practical application value for screening for AD.
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Affiliation(s)
- Lijue Liu
- School Of Information Science And Engineering, Central South University, Changsha, China.,Hunan ZIXING Artificial Intelligence Research Institute, Changsha, China
| | - Shiyang Tan
- School Of Information Science And Engineering, Central South University, Changsha, China
| | - Yi Li
- School Of Information Science And Engineering, Central South University, Changsha, China.,Hunan ZIXING Artificial Intelligence Research Institute, Changsha, China
| | - Jingmin Luo
- Xiangya Hospital, Central South University, Changsha, China
| | - Wei Zhang
- Xiangya Hospital, Central South University, Changsha, China
| | - Shihao Li
- School Of Information Science And Engineering, Central South University, Changsha, China
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28
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Zaschke L, Habazettl H, Thurau J, Matschilles C, Göhlich A, Montagner M, Falk V, Kurz SD. Acute type A aortic dissection: Aortic Dissection Detection Risk Score in emergency care – surgical delay because of initial misdiagnosis. European Heart Journal. Acute Cardiovascular Care 2020; 9:S40-S47. [DOI: 10.1177/2048872620914931] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background:
Acute type A aortic dissection requires immediate surgical treatment, but the correct diagnosis is often delayed. This study aimed to analyse how initial misdiagnosis affected the time intervals before surgical treatment, symptoms associated with correct or incorrect initial diagnosis and the potential of the Aortic Dissection Detection Risk Score to improve the sensitivity of initial diagnosis.
Methods:
We conducted a retrospective analysis of 350 patients with acute type A aortic dissection. Patients were divided into two groups: initial misdiagnosis (group 0) and correct initial diagnosis of acute type A aortic dissection (group 1). Symptoms were analysed as predictors for the correct or incorrect initial diagnosis by multivariate analysis. Based on these findings, the Aortic Dissection Detection Risk Score was calculated retrospectively; a result ⩾2 was defined as a positive score.
Results:
The early suspicion of aortic dissection significantly shortened the median time from pain to surgical correction from 8.6 h in patients with an initial misdiagnosis to 5.5 h in patients with the correct initial diagnosis (p<0.001). Of all acute type A aortic dissection patients, 49% had a positive Aortic Dissection Detection Risk Score. Of all initial misdiagnosed patients, 41% had a positive score (⩾2). The presence of lumbar pain (p<0.001), any paresis (p=0.037) and sweating (p=0.042) was more likely to lead to the correct initial diagnosis.
Conclusion:
An early consideration of acute aortic dissection may reduce the delay of surgical care. The suggested Aortic Dissection Detection Risk Score may be a useful tool to improve the preclinical assessment.
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Affiliation(s)
- Lisa Zaschke
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany
- Institute for Anaesthesiology, German Heart Center Berlin, Germany
| | - Helmut Habazettl
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany
| | - Jana Thurau
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany
- Institute for Anaesthesiology, German Heart Center Berlin, Germany
| | - Christian Matschilles
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany
- Institute for Anaesthesiology, German Heart Center Berlin, Germany
| | - Amélie Göhlich
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany
- Institute for Anaesthesiology, German Heart Center Berlin, Germany
| | - Matteo Montagner
- Department of Cardiothoracic Surgery, German Heart Center Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic Surgery, German Heart Center Berlin, Germany
- Department of Health Science and Technology, Swiss Federal Institute of Technology, Switzerland
| | - Stephan D Kurz
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany
- Institute for Anaesthesiology, German Heart Center Berlin, Germany
- Department of Cardiovascular Surgery, Charité – Universitätsmedizin Berlin, Germany
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29
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Abstract
Introduction Cocaine use is known to be associated with an increased risk for vascular diseases. It is likely to trigger or increase the risk for an aortic dissection. We conducted an analysis of 45 cases of cocaine-related aortic dissection to further characterize the clinical features and outcomes of this patient cohort. Methods Our study cohort of 45 patients consisted of 11 cases from our institutional database and 34 published case reports. Results The observed cases of acute aortic dissection related to cocaine use showed a high proportion of young (41.3±8.67 years) and male (88.9%) patients. Most of the cases (75%) were classified as Stanford type A. Also, in 75% of the cases, cocaine use was prevalent for more than one year. Median time from last cocaine use to onset of symptoms was one hour. In-hospital mortality was 21.4%, while additional 11.9% of the cases died before arriving at the hospital. Conclusion Acute aortic dissection related to cocaine use occurs in predominantly young male patients and has a dismal outcome when compared to all comer series.
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Affiliation(s)
- Dustin Greve
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joana Funke
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Tiam Khairi
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Matteo Montagner
- German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Christoph Starck
- German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Berlin Germany DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany.,Swiss Federal Institute of Technology Department of Health Science and Technology Zurich Switzerland Department of Health Science and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Michel Pompeu B O Sá
- Universidade de Pernambuco (UPE) Pronto-Socorro Cardiológico de Pernambuco (PROCAPE) Division of Cardiovascular Surgery Recife Brazil Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Universidade de Pernambuco (UPE), Recife, Brazil
| | - Stephan D Kurz
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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30
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Reutersberg B, Salvermoser M, Trenner M, Geisbüsch S, Zimmermann A, Eckstein HH, Kuehnl A. Hospital Incidence and In-Hospital Mortality of Surgically and Interventionally Treated Aortic Dissections: Secondary Data Analysis of the Nationwide German Diagnosis-Related Group Statistics From 2006 to 2014. J Am Heart Assoc 2020; 8:e011402. [PMID: 30975011 PMCID: PMC6507201 DOI: 10.1161/jaha.118.011402] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Population‐based data about the incidence and mortality of patients with aortic dissections (ADs) are sparse. Therefore, the hospital incidence and in‐hospital mortality of patients undergoing open or endovascular surgery for type A ADs (TAADs) and type B ADs (TBADs) in Germany were analyzed on a nationwide basis between 2006 and 2014. Methods and Results A secondary data analysis of the nationwide diagnosis‐related group statistics, compiled by the German Federal Statistical Office, was performed for patients who were surgically/interventionally treated for AD (International Classification of Diseases, Tenth Revision, German Modification [ICD‐10‐GM] codes I71.00‐I71.07; n=20 533). By using specific procedure codes, a distinction between TAAD (n=14 911/72.6%) and TBAD (n=5622/27.4%) could be made. The standardized hospital incidence of surgically/interventionally treated AD was 2.7/100 000 per year, comprising 2.0/100 000 per year for TAAD and 0.7/100 000 per year for TBAD. The in‐hospital mortality of TAAD was 19.5%; and of TBAD, 9.3%. Both the incidence and in‐hospital mortality increased over the 9‐year period. The share of endovascularly treated TBAD increased steadily during the same time interval. A multilevel multivariable analysis revealed that, for TAAD, age and comorbidity were significantly associated with a higher mortality risk. The latter was also true for TBAD. Sex was not significantly associated with mortality. A significant association between higher annual center volume and mortality was found for TAAD, but not for TBAD. Conclusions This is the first report on hospital incidence and mortality for surgically/interventionally treated AD on a nationwide basis. Overall, in Germany, hospital incidence and mortality of TAAD and TBAD increased over time. In addition, TAAD is performed more safely in high‐volume centers. See Editorial Svensson
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Affiliation(s)
- Benedikt Reutersberg
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Michael Salvermoser
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Matthias Trenner
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Sarah Geisbüsch
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Alexander Zimmermann
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Hans-Henning Eckstein
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Andreas Kuehnl
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
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31
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Etz CD, Haunschild J, Girdauskas E, Della Corte A, Fedak PWM, Schäfers HJ, Sundt TM, Borger MA. Surgical management of the aorta in BAV patients. Prog Cardiovasc Dis 2020; 63:475-481. [PMID: 32640281 DOI: 10.1016/j.pcad.2020.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
Patients with a bicuspid aortic valve (BAV) frequently develop aneurysms of the aortic root and tubular ascending aorta. Aneurysms of the aortic arch, in the absence of concomitant aortopathies, are much less common. According to the 2018 American Association of Thoracic Surgery consensus guidelines on BAV-related aortopathy, prophylactic surgical aortic repair / replacement is recommended starting at a maximum aortic diameter of 50 mm in patients with risk factors. Concomitant aortic surgery is also recommended at an aortic diameter of 45 mm in those patients with other indications for cardiac surgery (most commonly aortic valve procedures). The ultimate goal of prophylactic aortic surgery is the prevention of aortic catastrophes, e.g. aortic rupture or acute aortic dissection, which are associated with high morbidity and mortality. The surgical technique used - in elective and emergency cases - depends on the involvement and nature of the aortic valve disease, as well as the extent of aortic aneurysm formation. The current review focusses on the surgical management of the aortic root, tubular ascending aorta, and proximal aortic arch in BAV patients. Despite the abovementioned recommendations, many BAV patients develop acute aortic syndromes below the recommended aortic diameter thresholds. Further research is therefore required in order to identify high-risk BAV subgroups that would benefit from earlier surgical repair.
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Affiliation(s)
- Christian D Etz
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Paul W M Fedak
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, Canada
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
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32
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Wundram M, Falk V, Eulert-Grehn JJ, Herbst H, Thurau J, Leidel BA, Göncz E, Bauer W, Habazettl H, Kurz SD. Incidence of acute type A aortic dissection in emergency departments. Sci Rep 2020; 10:7434. [PMID: 32366917 PMCID: PMC7198509 DOI: 10.1038/s41598-020-64299-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/14/2020] [Indexed: 11/10/2022] Open
Abstract
Due to the symptoms, patients with acute type A aortic dissection are first seen by the ambulance service and diagnosed at the emergency department. How often an aortic dissection occurs in an emergency department per year has been studied. The incidence in the emergency department may be used as a quality marker of differential diagnostics of acute chest pain. A multi-institutional retrospective study with the municipal Berlin hospital chain Vivantes and its Department of Pathology and the Charité - University Medicine Berlin was performed. From the Berlin Hospital Society, the annual numbers of publicly insured emergency patients were obtained. Between 2006 and 2016, 631 aortic dissections were identified. The total number of patients treated in the emergency departments (n = 12,790,577) was used to calculate the “emergency department incidence.” The autopsy data from six clinics allowed an estimate on how many acute type A aortic dissections remained undetected. Across all Berlin hospitals, the emergency department incidence of acute type A aortic dissection was 5.24 cases in 100,000 patients per year. In tertiary referral hospitals and, particularly, in university hospitals the respective incidences were markedly higher (6.7 and 12.4, respectively). Based on the autopsy results, about 50% of the acute type A aortic dissection may remain undetected, which would double the reported incidences. Among different hospital types the emergency department incidences of acute type A aortic dissection vary between 5.93/100,000 and 24.92/100,000. Aortic dissection; Incidence; Emergency Department; Epidemiology
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Affiliation(s)
- Maximilian Wundram
- Deutsches Herzzentrum Berlin, Institute for Anaesthesiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Volkmar Falk
- Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiovascular Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, 13353, Berlin, Germany
| | - Jaime-Jürgen Eulert-Grehn
- Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, 13353, Berlin, Germany
| | - Hermann Herbst
- Vivantes Klinikum Neukölln, Department of Pathology, 13407, Berlin, Germany
| | - Jana Thurau
- Deutsches Herzzentrum Berlin, Institute for Anaesthesiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernd A Leidel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Department of Emergency Medicine, 12200, Berlin, Germany
| | - Eva Göncz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Department of Emergency Medicine, 13353, Berlin, Germany
| | - Wolfgang Bauer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Department of Emergency Medicine, 12200, Berlin, Germany
| | - Helmut Habazettl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Charitéplatz 1, Berlin, 10117, Germany
| | - Stephan D Kurz
- Deutsches Herzzentrum Berlin, Institute for Anaesthesiology, Augustenburger Platz 1, 13353, Berlin, Germany. .,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiovascular Surgery, Augustenburger Platz 1, 13353, Berlin, Germany. .,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Charitéplatz 1, Berlin, 10117, Germany.
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Abstract
ZusammenfassungAkute Aortensyndrome sind in der Versorgung äußerst zeitkritische Ereignisse, die letztendlich nur in einer hoch spezialisierten medizinischen Einrichtung definitiv versorgt werden können. Um Leben und Gesundheit der Notfallpatienten zu erhalten, steht der schnellstmögliche Transport unter Inanspruchnahme von Sonderrechten mit dem nächsten geeigneten Rettungsmittel im Vordergrund. Die Disposition eines erst später verfügbaren Intensivtransportwagens ist aus medizinrechtlicher Sicht als höchst bedenklich anzusehen.
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Affiliation(s)
| | - Volkmar Falk
- Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin
| | | | - Mike Peters
- Institut für Rechtsmedizin, Charité – Universitätsmedizin Berlin
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35
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36
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Zschaler S, Schmidt G, Kurz SD. Aortentelefon: the Berlin project aiming for shorter response times and sharper diagnostic accuracy in acute type A aortic dissection. Cardiovasc Diagn Ther 2019; 8:811-813. [PMID: 30740329 DOI: 10.21037/cdt.2018.09.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Silke Zschaler
- Deutsches Herzzentrum Berlin, Institute for Anesthesiology, Berlin, Germany
| | - Gerard Schmidt
- Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
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Breuer F, Rossaint R, Beckers SK. Neurologisches Defizit, Brustschmerz und Kreislaufinstabilität als Warnhinweise auf eine akute Aortendissektion. Notf Rett Med 2019; 22:415-9. [DOI: 10.1007/s10049-018-0560-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Forensic routine consists of more than just the classical legal medicine described in textbooks. It is often crucial to answer forensic questions that involve numerous interfaces with other medical disciplines. These interdisciplinary questions that arise in routine autopsy proceedures can also be addressed scientifically, despite decreasing autopsy numbers. Forensic medicine is not only able to generate epidemiologically relevant data, but can also contribute to the establishment of new treatment pathways based on forensic data ("preventive pathology"), at least for certain autopsy sub-populations. In particular, this applies to cases that present prior to hospitalization, particularly with regard to emergency medical and cardiological issues.
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Affiliation(s)
- Claas T Buschmann
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Legal Medicine and Forensic Sciences, Berlin, Germany.
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Zschaler S, Schmidt G, Kukucka M, Syrmas G, Zaschke L, Kurz SD. How to prevent inadvertent emergency anticoagulation in acute type A aortic dissection: when in doubt, don't. Cardiovasc Diagn Ther 2018; 8:805-810. [PMID: 30740328 DOI: 10.21037/cdt.2018.10.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Inadvertent emergency anticoagulation in patients with acute type A aortic dissection (ATAAD) has been sparsely reported. There are case reports bringing this potential critical incident to attention, however, little is known about the number of undetected and unreported cases. We approach this issue based on a case report of inadvertent emergency anticoagulation in ATAAD and attempt to shed light on aspects that may have contributed to the critical incident: The challenge of distinguishing an ATAAD from an acute coronary syndrome (ACS) and the potential underestimation of incidents of ATAAD. We also discuss errors and biases in medical decision making, and provide suggestions that may help raise awareness of how ATAAD can be mimicking ACS in clinical practice.
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Affiliation(s)
- Silke Zschaler
- Institute for Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Gerard Schmidt
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Marian Kukucka
- Institute for Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Georg Syrmas
- Department of Emergency Medicine, Campus Benjamin Franklin (CBF), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa Zaschke
- Institute for Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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Thurau J, Habazettl H, El Al Md AA, Mladenow A, Zaschke L, Adam Md U, Kuppe H, Wundram M, Kukucka M, Kurz Md SD. Left Ventricular Systolic Dysfunction in Patients With Type-A Aortic Dissection Is Associated With 30-Day Mortality. J Cardiothorac Vasc Anesth 2018; 33:51-57. [PMID: 30177474 DOI: 10.1053/j.jvca.2018.07.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this study was to analyze preoperative and postoperative echocardiographic parameters in patients with type-A acute aortic dissection (ATAAD) and to analyze whether impaired preoperative left ventricular function was associated with short- and long-term survival. To enable multivariable analysis, established risk factors of ATAAD were analyzed as well. DESIGN Retrospective single-center study. SETTING The German Heart Center Berlin. PARTICIPANTS The retrospective data of 512 patients with ATAAD who were treated between 2006 and 2014 were analyzed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Preoperative versus postoperative left ventricular ejection fraction (LVEF), right ventricular ejection fraction, left ventricular end-diastolic diameter, and right ventricular end-diastolic diameter were not significantly different, and the mean values were within the reference ranges. Because of the surgical intervention, incidences and severities of aortic regurgitation and pericardial effusion decreased. In multivariable logistic analysis, the authors identified age (odds ratio [OR] 1.04, p < 0.001), preoperative LVEF ≤35% (OR 2.20, p = 0.003), any ischemia (Penn non-Aa) (OR 2.15, p < 0.001), and longer cardiopulmonary bypass time (OR 1.04, p < 0.001) as independent predictors of 30-day mortality. Cardiopulmonary resuscitation, tamponade, or shock, and pre-existing cardiac disease, were not predictors of death. CONCLUSION After surgery, aortic insufficiency and pericardial effusion decreased, whereas cardiac functional parameters did not change. Severe LV dysfunction was identified as a new independent predictor of 30-day mortality.
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Affiliation(s)
- Jana Thurau
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Institute of Physiology, Berlin, Germany
| | - Helmut Habazettl
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Institute of Physiology, Berlin, Germany.
| | - Alaa Abd El Al Md
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Alexander Mladenow
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Lisa Zaschke
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Institute of Physiology, Berlin, Germany
| | - Uyanga Adam Md
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Institute of Physiology, Berlin, Germany
| | - Hermann Kuppe
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Maximilian Wundram
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Institute of Physiology, Berlin, Germany
| | - Marian Kukucka
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Stephan D Kurz Md
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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Adam U, Habazettl H, Graefe K, Kuppe H, Wundram M, Kurz SD. Health-related quality of life of patients after surgery for acute Type A aortic dissection. Interact Cardiovasc Thorac Surg 2018; 27:48-53. [DOI: 10.1093/icvts/ivy036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/21/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Uyanga Adam
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Institute of Physiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Helmut Habazettl
- Institute of Physiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Katharina Graefe
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Hermann Kuppe
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Maximilian Wundram
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Institute of Physiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Stephan Dominik Kurz
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Institute of Physiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Singh S, Nautiyal A. Aortic Dissection and Aortic Aneurysms Associated with Fluoroquinolones: A Systematic Review and Meta-Analysis. Am J Med 2017; 130:1449-1457.e9. [PMID: 28739200 DOI: 10.1016/j.amjmed.2017.06.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Our objective was to evaluate the association between fluoroquinolone use and aortic dissection or aortic aneurysm in a systematic review and meta-analysis. METHODS We searched Medline, Embase, and Scopus from inception to February 15, 2017. We selected controlled studies for inclusion if they reported data on aortic dissection and aortic aneurysm associated with fluoroquinolones exposure versus no exposure. Data were extracted by 2 independent reviewers, with disagreements resolved through further discussion. We assessed the quality of studies using the Newcastle-Ottawa Scale for observational studies and the strength of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. The odds ratios (ORs) from observational studies were pooled using the fixed-effect inverse variance method, and statistical heterogeneity was assessed using the I2 statistic. RESULTS After a review of 714 citations, we included 2 observational studies in the meta-analysis. Current use of fluoroquinolones was associated with a statistically significantly increased risk of aortic dissection (OR, 2.79; 95% confidence interval [CI], 2.31-3.37; I2 = 0%) and aortic aneurysm (OR, 2.25; 95% CI, 2.03-2.49; I2 = 0%) in a fixed-effects meta-analysis. The unadjusted OR estimates and sensitivity analysis using a random-effects model showed similar results. We rated the strength of evidence to be of moderate quality. The number needed to treat to harm for aortic aneurysm for elderly patients aged more than 65 years who were current users of fluoroquinolones was estimated to be 618 (95% CI, 518-749). CONCLUSIONS Evidence from a small number of studies suggests that exposure to fluoroquinolones is consistently associated with a small but significantly increased risk of aortic dissection and aortic aneurysm.
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Affiliation(s)
- Sonal Singh
- Department of Medicine, University of Massachusetts Medical School, Worcester, Mass.
| | - Amit Nautiyal
- Department of Medicine, Albany Medical College, Albany, NY
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Zheng S, Shao S, Qiao Z, Chen X, Piao C, Yu Y, Gao F, Zhang J, Du J. Clinical Parameters and Gut Microbiome Changes Before and After Surgery in Thoracic Aortic Dissection in Patients with Gastrointestinal Complications. Sci Rep 2017; 7:15228. [PMID: 29123168 PMCID: PMC5680333 DOI: 10.1038/s41598-017-15079-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 10/20/2017] [Indexed: 01/07/2023] Open
Abstract
Thoracic aortic dissection (TAAD) is one of the most common types of aortic diseases. Although surgery remains the main method of treatment, the high rate of postoperative gastrointestinal complications significantly influences the effects of surgery and the recovery process. Moreover, the mechanisms underlying this disease remain unclear. To address these problems, we examined changes in the gut microbiota in 40 thoracic aortic dissection patients with abdominal complications after surgery. Levels of white blood cells (WBC), neutrophile granulocytes (NE), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were higher in all patients after surgery. Levels of inflammatory cytokines, including interleukin (IL)-2, IL-6, IL-8, and IL-10, were also higher after surgery. A metagenome analysis revealed that levels of Oscillibacter, Anaerotruncus, Alistipes, and Clostridium difficile were higher after the operation. The abundance of functional genes, such as the spermidine/putrescine transport system permease protein, the flagellar motor switch protein, and branched-chain amino acid transport system proteins, was also higher post-surgery. These changes likely contribute to diarrhea, bloating, gastrointestinal bleeding, and other abdominal complications after surgery, and our research opens up new treatment possibilities for patients suffering from abdominal complications after surgical treatment.
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Affiliation(s)
- Shuai Zheng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, 100029, China.,The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Shulin Shao
- Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Zhiyu Qiao
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Beijing, 100029, China
| | - Xue Chen
- Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Chunmei Piao
- Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, 100029, China.,The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Ying Yu
- Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Feng Gao
- Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Jie Zhang
- Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
| | - Jie Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China. .,Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, 100029, China. .,The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China.
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