Stanford type-A Dissection Research Articles

Predictors and mortality of new onset postoperative atrial fibrillation after STAAD surgery: a retrospective cohort study.

Data on new onset postoperative atrial fibrillation (POAF) after Stanford type A dissection (STAAD) surgery was limited. This study aimed to detect the risk factors for developing POAF after STAAD procedures and the association between POAF and in-hospital mortality. A total of 1354 patients who underwent surgical treatment for STAAD in Beijing Anzhen hospital were enrolled in this single-center retrospective study from January 2015 to October 2020. POAF were defined as atrial fibrillation/flutter requiring treatment after surgery procedure. Logistic model was conducted to detect the predictors of POAF, and inverse probability of treatment weighting (IPTW) and subgroup analysis were used to compare the mortality of POAF and non-POAF groups. There were 176 patients (13.0%) diagnosed with POAF according to the definition. Multivariate logistics analyses revealed that advanced age [odds ratio (OR), 1.07; 95% CI: 1.05-1.08; P <0.001)], creatinine (OR, 1.00; 95% CI: 1.00-1.01; P =0.001) and cross-clamp time (OR, 1.00; 95% CI: 1.00-1.01; P =0.021) were independent risk factors of developing POAF in STAAD patients. POAF patients were associated with significantly higher in-hospital mortality compared with non-POAF patients (6.5 vs. 19.9%, OR, 3.60; 95% CI: 2.30-5.54; P <0.001), IPTW and subgroup analysis had reached consistent conclusions. The incidence of POAF was 13.0% after STAAD surgery, advanced age, creatinine, and cross-clamp time were independent risk factors of developing POAF in STAAD patients. POAF is associated with increased mortality after STAAD procedures.

Monocyte to high-density lipoprotein ratio at hospital admission predicts intrahospital mortality in patients with Stanford type-A dissection.

Immune inflammatory mechanisms have crucial roles not only in the presence but also in the progression of aortic dissection (AD). Monocyte count to high-density lipoprotein ratio (MHR) has recently emerged as an indicator of inflammation and oxidative stress. Thus, we aimed to examine the prognostic value of MHR in patients with AD. A total of 204 consecutive patients with Stanford type-A dissection who managed surgically were retrospectively enrolled in the present study. Recruited patients were divided into two groups according to the occurrence of intrahospital death; Group 1 consisted of 165 patients who were discharged alive, and Group 2 consisted of 39 patients who died during index hospitalization. Two groups were compared with respect to baseline clinical data and admission laboratory parameters including MHR. The mean age of the Group 1 was 55.2 ± 12.3 years, while the mean age of the Group 2 was 60.6 ± 10.8 years (p = .012). The patients who were discharged alive (Group 1) had significantly lower MHR than the deceased patients (Group 2) (0.02099 ± 0.00140 vs. 0.02848 ± 0.01513, p = .004). At receiver operating characteristics curve analysis, MHR = 0.020699 had 67% sensitivity and 59% specificity in predicting intrahospital mortality among patients with AD. In multivariate analysis, MHR was found to be an independent risk factor of intrahospital mortality among those (β = 1.094, p = .011). MHR is an inexpensive and easily calculated biomarker, which is useful to predict intrahospital mortality in patients with Stanford type-A dissection who managed surgically.

Embolization of the false lumen using IMPEDE-FX embolization plugs as part of treatment of an infrarenal post-dissection aneurysm: a case report

BackgroundThis case report demonstrates the value of IMPEDE-FX plugs in an embolization procedure of a false lumen of an infrarenal post-dissection aneurysm.Case presentationA 69-year-old patient was treated with mitral valve replacement, complicated by a Stanford type-A dissection. After 9 years he presented with an enlarging infrarenal post-dissection aneurysm. The false lumen was embolized using multiple IMPEDE-FX plugs as part of the treatment in addition to embolization of the inferior mesenteric artery and overstenting of the re-entry in the right iliac artery. At 15 months the CTA showed a fully thrombosed false lumen and remodeling of the true lumen.ConclusionsThe false lumen of an infrarenal post-dissection aneurysm can successfully be embolized using IMPEDE-FX embolization plugs as part of the treatment strategy. Prospective trials on patients with non-thrombosed false lumina are indicated.

TİP-A AORT DİSSEKSİYONU CERRAHİ TEDAVİSİNDE ANTEGRAD VE RETROGRAD SEREBRAL PERFÜZYONUN KARŞILAŞTIRMASI

OBJECTIVES:&#x0D; Substantial improvement has been observed in the surgical treatment of Type-A aortic dissections in parallel with the developments in cerebral perfusion techniques. Introduction of antegrade (ACP) and retrograde (RCP) cerebral perfusion techniques with deep hypothermic total circulatory arrest (HTCA) significantly decreased neurological complications which are the most important cause of morbidity and early mortality. The incidence of temporary (TND) or permanent neurological dysfunction (PND) is still between 5.5 – 33.3%. The cerebral perfusion method is effective on this ratio, as well as factors such as age, presence of co-morbidities, emergency, diameter of the aortic arch and the ascending aorta segment that is replaced. &#x0D; METHODS:&#x0D; In this study we have compared the operative and clinical outcomes of patients with Stanford Type-A dissection whom we operated by using antegrade and retrograde cerebral perfusion. We have also investigated which perfusion method is superior to the other, the determinants of mortality and complication rates according to the groups in order to find the determinants of mortality, and to evaluate the complication rates. The data of 115 patients who were operated for acute, subacute or chronic Stanford Type A dissection and intramural hematoma (IMH) between January 2001 – March 2013 were retrospectively evaluated.&#x0D; RESULTS: &#x0D; No significant differences in CPB, XC, TCA, ACP, total amount of post-operative drainage, requirement of blood products, ventilation time, duration of ICU stay, hospital stay, and early mortality rates were found in our evaluation of findings and outcomes of patients in whom we either used the ACP or the RCP technique. In the multivariate analysis determinants of mortality were preoperative presence of hypertension, diabetes mellitus, extremity malperfusion, duration of CPB, and postoperative renal complications.&#x0D; CONCLUSIONS: &#x0D; The results of our study and results of others in the medical literature regarding techniques for brain protection in open ascending and aortic arch surgery have suggested that the most effective approach to decrease the neurological complications and to obtain better outcomes may be to decrease the duration of perfusion to the possible extent.

Outcome Predictors in Patients Presenting With Acute Aortic Dissection.

To investigate the role of thyroid hormones and other factors in acute aortic dissection and an association with in-hospital adverse events. A retrospective analysis. A university-affiliated cardiac center. A total of 151 patients with aortic dissection admitted to the authors' hospital between January 2011 and May 2015. None. The total in-hospital mortality rate was 12.6%. Triiodothyronine (T3) level was lower in nonsurviving than surviving patients (0.8±0.3 v 1.0±0.4 nmol/L, p<0.05). T3 independently predicted in-hospital mortality (hazard ratio [HR] 0.07, 95% CI 0.01-0.43, p<0.01) and in-hospital acute renal failure (HR 0.22, 0.05-0.89, p<0.05) for all patients. Other independent predictors of in-hospital mortality were pericardial effusion (HR 8.18, 2.11-31.67, p<0.01), conservative treatment (HR 82.12, 12.49-540.09, p<0.01) and Stanford type-A aortic dissection (HR 3.86, 1.06-14.09, p<0.05). Inpatient conservative treatment, T3 (HR 0.01, 0.00-0.18, p<0.01) as well as pericardial effusion (HR 11.80, 2.46-56.59, p<0.01), Stanford type-A dissection (HR 22.35, 3.15-158.40, p<0.01), and in-hospital acute renal failure (HR 16.95, 2.04-140.86, p<0.01) were predictors for in-hospital mortality. In nonconservatively treated patients, T3 (HR 0.02, 0.00-0.88, p<0.05) as well as cardiac care unit stay (HR 0.74, 0.59-0.94, p<0.01) and postoperative acute renal failure (HR 21.32, 3.07-147.88, p<0.01) were predictors for in-hospital mortality. T3 was downregulated in acute aortic dissection. Low T3 level was a risk factor for in-hospital death and acute renal failure in patients with acute aortic dissection.

Combined Cesarean Delivery and Repair of Acute Ascending and Aortic Arch Dissection at 32 Weeks of Pregnancy

n a r AHEALTHY 35-YEAR-OLD gravida 2 para 1 woman at 32 3 weeks’ gestational age was admitted to an outside ospital for an acute onset of chest pain that began that day at er baby shower. Owing to an episode of transient hypoxemia, he was worked up for pulmonary embolism. Computed tomoraphic examination was negative for pulmonary embolism but id show a Stanford type-A dissection. Before this admission, he pregnancy was uneventful and included a normal transthoacic echocardiogram (echocardiography was performed owing o a history suggestive of connective tissue disease). The paient was transferred to the authors’ institution, where an emerency cesarean section was performed, and a healthy male nfant was delivered. The infant’s birth was followed by immediate aortic repair nd aortic valve resuspension. Postoperatively, the patient and er newborn infant underwent genetic testing that was diagostic for Marfan syndrome. This case report discusses the anagement of aortic dissection in pregnancy and Marfan yndrome.

Intimal flap movement in aortic Stanford type-A dissection visualized by 64-slice computed tomography

Intimal flap movement in aortic Stanford type-A dissection visualized by 64-slice computed tomography

Demonstration of Multislice Computed Tomography of Graft Destruction and Rupture to the Pericardium After Replacement of Ascending Aorta for Stanford Type-A Dissection

A 57-year-old man went to a hospital complaining of chest pain and was diagnosed with a Stanford Type-A aortic dissection that continued through the aortic arch and descending aorta to the whole abdominal aorta. He therefore underwent graph replacement of the ascending aorta. After 1 month, he experienced dyspnea and came to our hospital. Chest x-ray revealed cardiac enlargement. Transthoracic echocardiogram revealed massive pericardial effusion (PE) but no cardiac tamponade. An enhanced multislice computed tomography …

The value of transesophageal echocardiography for endovascular graft stenting of the ascending aorta

YPERTENSION, CONGENITAL valvular abnormalities like bicuspid and unicuspid aortic valves, and the Marfan syndrome are important risk factors for the development of intrathoracic aortic aneurysms. 1 In descending aortic aneurysms, endovascular stenting has become an accepted alternative to open repair in high-risk patients with severe comorbidities. 2,3 In this case report, the authors describe a patient with a Stanford type A dissecting ascending aortic aneurysm undergoing endovascular stenting, illustrating the important contribution of transesophageal echocardiography (TEE) during the procedure. CASE REPORT An 87-year-old female patient with a history of hypertension and anxiety disorder was admitted for treatment of an ascending aortic aneurysm diagnosed after an acute episode of chest pain radiating to the back. Normal electrocardiogram and cardiac enzymes ruled out a myocardial infarction. A spiral computed tomography angiogram showed severe atherosclerotic degeneration, extensive intramural hematoma from the aortic root to the level of the celiac axis, and a Stanford type-A dissection of the ascending aorta with the primary intimal tear in the distal ascending aorta. The ascending aorta was dilated to 5-cm diameter including the hematoma, and the presence of fluid in the mediastinum and pericardium suggested a contained rupture. She was admitted to the intensive care unit to achieve blood pressure control with intravenous esmolol and sodium nitroprusside. The following day, she remained hemodynamically stable with overall good end-organ perfusion. The patient refused a surgical intervention but agreed to undergo stent placement. After induction of general anesthesia, a transesophageal echoprobe was placed. The aortic valve appeared to be trileaflet with moderate regurgitation. The diameter was 2.5 cm at the annulus and 3.3 cm at the sinotubular junction. The ascending aorta had a diameter of 4.2 cm with an intramural hematoma on the anterior wall extending to the right coronary artery (Fig 1) and an intimal flap extending to the aortic arch and descending aorta. The mitral and tricuspid valves were normal. Pericardial and bilateral pleural effusions were found, whereas the myocardial contractility was estimated to be within normal limits. The right brachial and femoral arteries were cannulated, and under TEE guidance, using color flow and the angiomode, a guide wire was passed from the brachial artery entry site to the aortic arch and down to the descending aorta (Fig 2), snared, and pulled out through the vascular sheath in the right common femoral artery. An arch aortogram was performed with a pigtail catheter in the ascending aorta to confirm the position of the guide wire in the true lumen. Afterward, a 10 40 mm stent graft was advanced into the ascending aorta over the guide wire and positioned just distal to the coronary arteries. After confirmation of the optimal position of the stent in the ascending aorta with contrast injections, its deployment was monitored with TEE and fluoroscopy (Fig 3). The patency of the right and left main coronary arteries was verified, and the absence of flow in the false lumen was confirmed with TEE (Fig 4). An arch aortogram showed that the dissection was successfully excluded.