Analysis of Risk Factors of Preoperative Sudden Death of Patients with Type A Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FAN Fudong , ZHANG Jie , WU Zhong , ZHOU Qing , WANG Qiang , WANG Dongjin.

Department of Cardiothoracic Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, P. R. China;

Corresponding author：

Keywords：

Type A aortic dissection; 　Sudden death; 　Logistic regression

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Objective　To analysis correlation factors for preoperative sudden death of patients with type A aortic dissection in order to determine clinical management strategy.?Methods?We retrospectively analyzed clinical data of 52 patients with type A aortic dissection who were admitted in Department of Cardiothoracic Surgery of the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2003 to January 2010. According to the presence of preoperative death, all the patients were divided into two groups, 9 patients in the preoperative sudden death （PSD）group including 7 males and 2 females with their mean age of 52.0±12.1 years；43 patients in the control group including 31 males and 12 females with their mean age of 51.5±10.9 years. Univariate and multivariate logistic regression analysis were used for analysis of preoperative factors related to sudden death.?Results?Univariate analysis result showed 7 candidate variables：body mass index （BMI, Wald χ2=2.150, P=0.143）, time of onset （Wald χ2=2.711, P= 0.100）, total cholesterol （TC, Wald χ2=1.444, P=0.230）, low density lipoprotein cholesterol （L-C, Wald χ2=1.341, P=0.247）, aortic insufficiency （AI, Wald χ2=2.093, P=0.148）, aortic sinus involvement （Wald χ2=3.386, P=0.066）and false lumen thrombosis （Wald χ2=7.743, P=0.005）. Multivariate logistic regression analysis showed that BMI （Wald χ2=4.215, P=0.040, OR=1.558）and aortic sinus involvement （Wald χ2=4.592, P=0.032, OR=171.166 ）were preoperative risk factors for sudden death, and thrombosed false lumen （Wald χ2=5.097, P=0.024, OR=0.011）was preoperative protective factor for sudden death.?Conclusion?Type A aortic dissection patients with large BMI and/or aortic sinus involvement should receive operation more urgently than others and patients with thrombosed false lumen may have relatively low risk of preoperative sudden death.

Citation： FAN Fudong,ZHANG Jie,WU Zhong,ZHOU Qing,WANG Qiang,WANG Dongjin.. Analysis of Risk Factors of Preoperative Sudden Death of Patients with Type A Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 502-506. doi: Copy

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14.	Bilfinger TV. Acute aortic dissection：microenvironmental regulation. Med Sci Monit， 2010， 16 （7）：RA143-RA146.
15.	Zhang X， Shen YH， Lemaire SA. Thoracic aortic dissection：are matrix metalloproteinases involved?? Vascular， 2009， 17 （3）：147-157.
16.	David TE. Aortic root aneurysms：remodeling or composite replacement?? Ann Thorac Surg， 1997， 64 （5）：1564-1568.
17.	宋光民，崔经纬，胡盛寿，等. 主动脉根部生理固定方法的建立. 中国胸心血管外科临床杂志， 2006， 13 （5）：322-325.

1. experience. Rev Esp Cardiol， 2008， 61 （10）：1050-1060.
2. 　Miyahara S， Mukohara N， Fukuzumi M， et al. Long-term follow-up of acute type B aortic dissection：ulcer-like projections in thrombosed false lumen play a role in late aortic events. J Thorac Cardiovasc Surg， 2011， 142 （2）：e25-e31.
3. 　Kawahito K， Adachi H， Yamaguchi A， et al. Preoperative risk factors for hospital mortality in acute type A aortic dissection. Ann Thorac Surg， 2001， 71 （4）：1239-1243.
4. 　Martín CE， Forteza A， Pérez E， et al. Predictors of mortality and reoperation in acute type-a aortic dissection surgery：18 years of.
5. 　Sakakura K， Kubo N， Ako J， et al. Determinants of in-hospital death and rupture in patients with a Stanford B aortic dissection. Circ J， 2007， 71 （10）：1521-1524.
6. 　Hirst AE Jr， Johns VJ Jr， Kime SW Jr. Dissecting aneurysm of the aorta：a review of 505 cases. Medicine， 1958， 37 （3）：217-279.
7. 　Golledge J， dissection EA. Acute aortic dissection. Lancet， 2008， 372 （9632）：55-66.
8. 　Dissection CA. Chief editor. In：Cardiac Surgery in the Adult. 3rd ed. 2008. 1200-1204.
9. 　刘宏杰. Logistic回归模型使用注意事项和结果表达. 中国公共卫生， 2001， 17 （5）：85-86.
10. 　Greenland S， Mickey RM. Re：“the impact of confounder selection criteria on effect estimation”. Am J Epidemiol， 1989， 130 （5）：1066.
11. 　Hatakeyama T， Shigematsu H， Muto T. Risk factors for rupture of abdominal aortic aneurysm based on three-dimensional study. J Vasc Surg， 2001， 33 （3）：453-461.
12. 　孙娜，刘秀娟，梁晓辉. 主动脉夹层破裂危险因素的三维CT分析. 中国急救医学， 2007， 27 （5）：420-422.
13. 　Ishii T， Asuwa N， Collagen IN. elastin degradation by matrix metalloproteinases， tissue inhibitors of matrix metalloproteinase in aortic dissection. Hum Pathol， 2000， 31 （6）：640-646.
14. 　Bilfinger TV. Acute aortic dissection：microenvironmental regulation. Med Sci Monit， 2010， 16 （7）：RA143-RA146.
15. 　Zhang X， Shen YH， Lemaire SA. Thoracic aortic dissection：are matrix metalloproteinases involved?? Vascular， 2009， 17 （3）：147-157.
16. 　David TE. Aortic root aneurysms：remodeling or composite replacement?? Ann Thorac Surg， 1997， 64 （5）：1564-1568.
17. 　宋光民，崔经纬，胡盛寿，等. 主动脉根部生理固定方法的建立. 中国胸心血管外科临床杂志， 2006， 13 （5）：322-325.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of Risk Factors of Preoperative Sudden Death of Patients with Type A Aortic Dissection

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