Risk factors of mortality and morbidity after surgical procedure for Stanford type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CHU Junmin , WEI Jinhua , CHANG Qian , ZHANG Haitao

Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100037, P.R. China;

Corresponding author：

CHU Junmin, Email: chujunmin@sina.com

Keywords：

Stanford type A aortic dissection; mortality; morbidity; risk factor; surgical treatment

DOI：

10.7507/1007-4848.201605051

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To assess the independent risk factors of in-hospital mortality and morbidity after surgical procedure for Stanford type A aortic dissection (TAAD). Methods Between May 2013 and May 2015, 341 TAAD patients were treated with surgical procedure in Fu Wai Hospital. There were 246 males and 95 females with a mean age of 47.42±11.54 years (range 29-73 years). Among them, 87 patients suffered severe complications or death after the procedure (complication group) and the other 254 patients recovered well without any severe complications (no complication group). Perioperative clinical data were compared between the two groups. Results Mean age of patients in the complication group was significantly higher than that of the no complication group (49.91±11.22 yearsvs. 46.57±11.54 years,P=0.019). The incidence of preoperative ischemic organ injury in the complication group was significantly higher than that in the no complication group: cerebral ischemia (18.4%vs. 5.9%,P=0.001), spinal cord injury (16.1%vs. 4.7%,P=0.001), acute kidney injury (31.0%vs. 10.6%,P=0.000). The incidence of branch vessels involvement in the complication group was significantly higher than that in the no complication group: coronary artery involvement (52.9%vs. 17.1%,P=0.000), supra-aortic vessels involvement (73.6%vs. 53.9%,P=0.001), celiac artery involvement (37.9%vs. 22.0%,P=0.003), mesenteric artery involvement (18.4%vs. 9.8%,P=0.030), and unilateral or bilateral renal artery involvement (27.6%vs. 9.8%,P=0.000). Surgical time of patients in the complication group was significantly longer than that of the no complication group, including cardiopulmonary bypass time (205.05±63.65 minvs. 167.67±50.24 min,P<0.05) and cross-clamp time (108.11±34.79 minvs. 90.75±27.33 min,P<0.05). Multiple regression analysis found that age, preoperative concomitant cerebral ischemic injury, preoperative concomitant acute renal injury, preoperative limb sensory and/or motor dysfunction, coronary artery involvement, cardiopulmonary bypass time were independent risk factors of postoperative death and severe complications in TAAD patients. However, risk of postoperative mortality and morbidity significantly decreased after the concomitant coronary artery bypass graft [OR=0.167 (0.060, 0.467),P=0.001]. Conclusion The high risk factors of postoperative complication in TAAD patients are explored to provide an important clinical basis for preoperative identification of patients at high risk and we need pay more attention to the prevention of these postoperative complications.

Citation： CHU Junmin, WEI Jinhua, CHANG Qian, ZHANG Haitao. Risk factors of mortality and morbidity after surgical procedure for Stanford type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(3): 211-216. doi: 10.7507/1007-4848.201605051 Copy

1.	Hirst Jr AE, Johns Jr V, Kime Jr SW. Dissecting aneurysm of the aorta: a review of 505 cases. Med Baltim, 1958, 37(3): 217-279.
2.	Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
3.	Anagnostopoulos CE, Prabhakar MJ, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol, 1972, 30(3): 263-273.
4.	Vohra HA, Modi A, Barlow CW, et al. Repair of acute type A aortic dissection: results in 100 patients. Asian Cardiovasc Thorac Ann, 2012, 20(2): 160-167.
5.	Apaydin AZ, Buket S, Posacioglu H, et al. Perioperative risk factors for mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2002, 74(6): 2034-2039.
6.	Santini F, Montalbano G, Casali G, et al. Clinical presentation is the main predictor of in-hospital death for patients with acute type A aortic dissection admitted for surgical treatment: a 25 years’ experience. Int J Cardiol, 2007, 115(3): 305-311.
7.	Keiji Uchida, Norihisa Karube, Shota Yasuda, et al. Pathophysiology and surgical treatment of type A acute aortic dissection. Ann Vasc Dis, 2016, 9(3): 160-167.
8.	Amano J, Kuwano H, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2011: Annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg, 2013, 61(10): 578-607.
9.	Easo J, Weigang E, Holzl PP, et al. Influence of operative strategy for the aortic arch in DeBakey type I aortic dissection: analysis of the German Registry for Acute Aortic Dissection Type A. J Thorac Cardiovasc Surg, 2012, 144(3): 617-623.
10.	Bekkers JA, Raap GB, Takkenberg JJ, et al. Acute type A aortic dissection: long-term results and reoperations. Eur J Cardiothorac Surg, 2013, 43(2): 389-396.
11.	Glower DD, Speier RH, White WD, et al. Management and long-term outcome of aortic dissection. Ann Surg, 1991, 214(1): 31-41.
12.	Pansini S, Gagliardotto PV, Pompei E, et al. Early and late risk factors in surgical treatment of acute type A aortic dissection. Ann Thorac Surg, 1998, 66(3): 779-784.
13.	Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
14.	Trimarchi S, Eagle KA, Nienaber CA, et al. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg, 2010, 140(4): 784-789.
15.	Pacini D, Leone A, Belotti LM, et al. Acute type A aortic dissection: significance of multiorgan malperfusion. Eur J Cardiothorac Surg, 2013, 43(4): 820-826.
16.	Bashir M, Field M, Shaw M, et al. influences on early and medium-term survival following surgical repair of the aortic arch. Aorta (Stamford), 2014, 2(2): 56-73.
17.	Ko T, Higashitani M, Sato A, et al. Impact of acute kidney injury on early to long-term outcomes in patients who underwent surgery for type A acute aortic dissection. Am J Cardiol, 2015, 116(3): 463-468.
18.	Conzelmann LO, Weigang E, Mehlhorn U, et al. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg, 2016, 49(2): 44-52.
19.	Geirsson A, Szeto WY, Pochettino A, et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg, 2007, 32(2): 255-262.
20.	Girdauskas E, Kuntze T, Borger MA, et al. Surgical risk of preoperative malperfusion in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(6): 1363-1369.
21.	Augoustides JG, Szeto WY, Desai ND, et al. Classification of acute type A dissection: focus on clinical presentation and extent. Eur J Cardiothorac Surg, 2011, 39(4): 519-522.
22.	Orihashi K. Acute type a aortic dissection: for further improvement of outcomes. Ann Vasc Dis, 2012, 5(3): 310-320.
23.	Tang YF, Zhang GX, Liao ZL, et al. Surgical treatment of coronary malperfusion with acute type A aortic dissection. Chin Med J (Engl), 2016, 129(8): 1000-1002.
24.	Lentini S, Perrotta S. Aortic dissection with concomitant acute myocardial infarction: From diagnosis to management. J Emerg Trauma Shock, 2011, 4(2): 273-278.
25.	Narayan P, Rogers CA, Caputo M, et al. Influence of concomitant coronary artery bypass graft on outcome of surgery of the ascending aorta/arch. Heart, 2007, 93(2): 232-237.
26.	Imoto K, Uchida K, Karube N, et al. Risk analysis and improvement of strategies in patients who have acute type A aortic dissection with coronary artery dissection. Eur J Cardiothorac Surg, 2013, 44(3): 419-425.
27.	Ma WG, Zheng J, Dong SB, et al. Sun’s procedure of total arch replacement using a tetrafurcated graft with stented elephant trunk implantation: analysis of early outcome in 398 patients with acute type A aortic dissection. Ann Cardiothorac Surg, 2013, 2(5): 621-628.
28.	Ma WG, Zhang W, Wang LF, et al. Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period. J Thorac Cardiovasc Surg, 2016, 151(6): 1581-1592.

1. Hirst Jr AE, Johns Jr V, Kime Jr SW. Dissecting aneurysm of the aorta: a review of 505 cases. Med Baltim, 1958, 37(3): 217-279.
2. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
3. Anagnostopoulos CE, Prabhakar MJ, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol, 1972, 30(3): 263-273.
4. Vohra HA, Modi A, Barlow CW, et al. Repair of acute type A aortic dissection: results in 100 patients. Asian Cardiovasc Thorac Ann, 2012, 20(2): 160-167.
5. Apaydin AZ, Buket S, Posacioglu H, et al. Perioperative risk factors for mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2002, 74(6): 2034-2039.
6. Santini F, Montalbano G, Casali G, et al. Clinical presentation is the main predictor of in-hospital death for patients with acute type A aortic dissection admitted for surgical treatment: a 25 years’ experience. Int J Cardiol, 2007, 115(3): 305-311.
7. Keiji Uchida, Norihisa Karube, Shota Yasuda, et al. Pathophysiology and surgical treatment of type A acute aortic dissection. Ann Vasc Dis, 2016, 9(3): 160-167.
8. Amano J, Kuwano H, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2011: Annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg, 2013, 61(10): 578-607.
9. Easo J, Weigang E, Holzl PP, et al. Influence of operative strategy for the aortic arch in DeBakey type I aortic dissection: analysis of the German Registry for Acute Aortic Dissection Type A. J Thorac Cardiovasc Surg, 2012, 144(3): 617-623.
10. Bekkers JA, Raap GB, Takkenberg JJ, et al. Acute type A aortic dissection: long-term results and reoperations. Eur J Cardiothorac Surg, 2013, 43(2): 389-396.
11. Glower DD, Speier RH, White WD, et al. Management and long-term outcome of aortic dissection. Ann Surg, 1991, 214(1): 31-41.
12. Pansini S, Gagliardotto PV, Pompei E, et al. Early and late risk factors in surgical treatment of acute type A aortic dissection. Ann Thorac Surg, 1998, 66(3): 779-784.
13. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
14. Trimarchi S, Eagle KA, Nienaber CA, et al. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg, 2010, 140(4): 784-789.
15. Pacini D, Leone A, Belotti LM, et al. Acute type A aortic dissection: significance of multiorgan malperfusion. Eur J Cardiothorac Surg, 2013, 43(4): 820-826.
16. Bashir M, Field M, Shaw M, et al. influences on early and medium-term survival following surgical repair of the aortic arch. Aorta (Stamford), 2014, 2(2): 56-73.
17. Ko T, Higashitani M, Sato A, et al. Impact of acute kidney injury on early to long-term outcomes in patients who underwent surgery for type A acute aortic dissection. Am J Cardiol, 2015, 116(3): 463-468.
18. Conzelmann LO, Weigang E, Mehlhorn U, et al. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg, 2016, 49(2): 44-52.
19. Geirsson A, Szeto WY, Pochettino A, et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg, 2007, 32(2): 255-262.
20. Girdauskas E, Kuntze T, Borger MA, et al. Surgical risk of preoperative malperfusion in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(6): 1363-1369.
21. Augoustides JG, Szeto WY, Desai ND, et al. Classification of acute type A dissection: focus on clinical presentation and extent. Eur J Cardiothorac Surg, 2011, 39(4): 519-522.
22. Orihashi K. Acute type a aortic dissection: for further improvement of outcomes. Ann Vasc Dis, 2012, 5(3): 310-320.
23. Tang YF, Zhang GX, Liao ZL, et al. Surgical treatment of coronary malperfusion with acute type A aortic dissection. Chin Med J (Engl), 2016, 129(8): 1000-1002.
24. Lentini S, Perrotta S. Aortic dissection with concomitant acute myocardial infarction: From diagnosis to management. J Emerg Trauma Shock, 2011, 4(2): 273-278.
25. Narayan P, Rogers CA, Caputo M, et al. Influence of concomitant coronary artery bypass graft on outcome of surgery of the ascending aorta/arch. Heart, 2007, 93(2): 232-237.
26. Imoto K, Uchida K, Karube N, et al. Risk analysis and improvement of strategies in patients who have acute type A aortic dissection with coronary artery dissection. Eur J Cardiothorac Surg, 2013, 44(3): 419-425.
27. Ma WG, Zheng J, Dong SB, et al. Sun’s procedure of total arch replacement using a tetrafurcated graft with stented elephant trunk implantation: analysis of early outcome in 398 patients with acute type A aortic dissection. Ann Cardiothorac Surg, 2013, 2(5): 621-628.
28. Ma WG, Zhang W, Wang LF, et al. Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period. J Thorac Cardiovasc Surg, 2016, 151(6): 1581-1592.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors of mortality and morbidity after surgical procedure for Stanford type A aortic dissection

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content