TAZ Is Related to Postoperative In-Hospital Mortality of Acute Type A Aortic Dissection.

Wenjian Jiang,Yuanfei Zhao,Hongjia Zhang,Yuan Xue,Haibin Li

doi:10.3389/fcvm.2020.587996

Abstract

Background: Surgical repair of acute type A aortic dissection (ATAAD) has high risk and mortality, and there are few biomarkers of postoperative in-hospital mortality until now. This study investigated the association between WW domain–containing transcription regulator protein 1 (TAZ) and the postoperative in-hospital mortality of ATAAD patients.Methods: This is a retrospective cohort study. Data and blood samples were collected from 95 consecutive patients with ATAAD who underwent surgeries in our hospital from July 1, 2016, to December 31, 2016. The data collection included all the risk factors introduced by the modified EuroSCORE (European System for Cardiac Operative Risk Evaluation). The predictors of postoperative in-hospital death were confirmed by univariate regression analysis. Multivariable logistic regressions were used to analyze the association of the preoperative plasma level of TAZ and the postoperative in-hospital mortality of ATAAD patients. In addition, we used the generalized additive model to identify non-linear relationships.Results: Three models were used in the multivariable logistic regression analysis of the relationship between the preoperative plasma level of TAZ and postoperative in-hospital death. In the crude model, the preoperative plasma level of TAZ showed a positive correlation with postoperative in-hospital death [odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.01–1.74, P = 0.04]. In adjusted model I and adjusted model II, similar results were found (OR = 1.35, 95% CI: 1.01–1.80, P = 0.04 and OR = 1.35, 95% CI: 1.01–1.81, P = 0.04). The risk of postoperative in-hospital death in the preoperative plasma level of the TAZ≥12.70 ng/mL group was 10.08 times (OR = 10.08, 95% CI: 1.63–62.37; P = 0.01) that of the preoperative plasma level of the TAZ <12.70 ng/mL group.Conclusions: The high preoperative plasma level of TAZ suggested poor surgical prognosis for ATAAD patients. The patients with a preoperative plasma level of TAZ ≥ 12.7 ng/ml had much higher postoperative in-hospital mortality.

Highlights

Aortic dissection (AD), especially the acute type A aortic dissection (ATAAD) with dissected ascending aorta, is the most life-threatening vascular disease [1, 2]
We found that age, gender, BMI, systolic blood pressure, diastolic blood pressure, heart rate, hypertension, smoking history, recent myocardial infarction, previous cardiac surgery, cardiac tamponade, left ventricular ejection fraction (LVEF), serum creatinine, critical preoperative state, unstable angina, d-dimer, platelet, fibrinogen, c-reactive protein, troponin I, ascending aorta diameter, pleural effusion, pericardial effusion, coronary arteries involved, cardiopulmonary bypass time, and cross-clamp time were not associated with postoperative in-hospital death in this cohort (Table 2)
We found that clearly disrupted elastic lamellae of variable widths softened the ECM of the ascending aortic wall, possibly inducing Hippo pathway, which promoted the development ATAAD [8]

Summary

Introduction

Aortic dissection (AD), especially the acute type A aortic dissection (ATAAD) with dissected ascending aorta, is the most life-threatening vascular disease [1, 2]. There has been a significant decline in the in-hospital surgical mortality rate of patients presenting with ATAAD with the advancement of related technology, surgical repair remains high risk and has a high mortality rate (3.09–30.00%), which deters most aortic surgeons [2, 5, 6]. Some preoperative presentations, such as malperfusion phenomena, are considered predictive factors for postoperative mortality [2]. This study investigated the association between WW domain–containing transcription regulator protein 1 (TAZ) and the postoperative in-hospital mortality of ATAAD patients

Methods

Results

Conclusion