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Clinical Analysis of Risk Factors for Mortality in Type A Acute Aortic Dissection: A Single Study From China

Objective: Acute type A aortic dissection (ATAAD) is a fatal condition that requires emergency surgery. The aim of the present study was to determine pre- and intra-operative risk factors for in-hospital mortality in patients with ATAAD. Methods: Consecutive 313 patients with ATAAD who underwent eme...

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Autores principales: Yuan, Hongliang, Sun, Zhenxing, Zhang, Yongxing, Wu, Wenqian, Liu, Manwei, Yang, Yali, Wang, Jing, Lv, Qing, Zhang, Li, Li, Yuman, Xie, Mingxing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8599949/
https://www.ncbi.nlm.nih.gov/pubmed/34805301
http://dx.doi.org/10.3389/fcvm.2021.728568
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author Yuan, Hongliang
Sun, Zhenxing
Zhang, Yongxing
Wu, Wenqian
Liu, Manwei
Yang, Yali
Wang, Jing
Lv, Qing
Zhang, Li
Li, Yuman
Xie, Mingxing
author_facet Yuan, Hongliang
Sun, Zhenxing
Zhang, Yongxing
Wu, Wenqian
Liu, Manwei
Yang, Yali
Wang, Jing
Lv, Qing
Zhang, Li
Li, Yuman
Xie, Mingxing
author_sort Yuan, Hongliang
collection PubMed
description Objective: Acute type A aortic dissection (ATAAD) is a fatal condition that requires emergency surgery. The aim of the present study was to determine pre- and intra-operative risk factors for in-hospital mortality in patients with ATAAD. Methods: Consecutive 313 patients with ATAAD who underwent emergency surgery at our hospital from February 2012 to February 2017 were enrolled in our study. Univariate and multivariate logistic regression analysis were performed to identify the pre-operative and intra-operative risk factors for in-hospital mortality. Results: Of the 313 patients, 32 patients (10.2%) died. Compared with survivors, non-survivors had higher heart rate, serum potassium level and EuroSCORE II, and higher incidence of moderate to severe pericardial effusion, supra-aortic vessels involvement, myocardial ischemia and lower-extremity ischemia. As for surgery-related factors, the duration of surgery and cardiopulmonary bypass time were longer in non-survivors than survivors. In addition, non-survivors were more likely to undergo coronary-artery bypass graft compared with survivors. On multivariate analysis, elevated plasma potassium level (OR: 43.0, 95% CI: 3.8–51.5, p < 0.001), high incidence of supra-aortic vessels involvement (OR: 4.4, 95% CI: 1.5–7.0, p = 0.008) and lower-extremity ischemia (OR: 4.9, 95% CI: 1.6–6.9; p = 0.009), and longer duration of surgery (OR 6.0, 95% CI: 1.8–18.7, p = 0.000) and cardiopulmonary bypass time (OR: 3.7, 95% CI: 1.3–9.3, p = 0.001) were independently predictive of higher mortality in patients with ATAAD. Conclusions: Supra-aortic vessels involvement, lower-extremity ischemia and elevated plasma potassium level are independent predictors of mortality in patients with ATAAD. A significant decrease in duration of surgery and cardiopulmonary bypass time is helpful to improve survival of patients.
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spelling pubmed-85999492021-11-19 Clinical Analysis of Risk Factors for Mortality in Type A Acute Aortic Dissection: A Single Study From China Yuan, Hongliang Sun, Zhenxing Zhang, Yongxing Wu, Wenqian Liu, Manwei Yang, Yali Wang, Jing Lv, Qing Zhang, Li Li, Yuman Xie, Mingxing Front Cardiovasc Med Cardiovascular Medicine Objective: Acute type A aortic dissection (ATAAD) is a fatal condition that requires emergency surgery. The aim of the present study was to determine pre- and intra-operative risk factors for in-hospital mortality in patients with ATAAD. Methods: Consecutive 313 patients with ATAAD who underwent emergency surgery at our hospital from February 2012 to February 2017 were enrolled in our study. Univariate and multivariate logistic regression analysis were performed to identify the pre-operative and intra-operative risk factors for in-hospital mortality. Results: Of the 313 patients, 32 patients (10.2%) died. Compared with survivors, non-survivors had higher heart rate, serum potassium level and EuroSCORE II, and higher incidence of moderate to severe pericardial effusion, supra-aortic vessels involvement, myocardial ischemia and lower-extremity ischemia. As for surgery-related factors, the duration of surgery and cardiopulmonary bypass time were longer in non-survivors than survivors. In addition, non-survivors were more likely to undergo coronary-artery bypass graft compared with survivors. On multivariate analysis, elevated plasma potassium level (OR: 43.0, 95% CI: 3.8–51.5, p < 0.001), high incidence of supra-aortic vessels involvement (OR: 4.4, 95% CI: 1.5–7.0, p = 0.008) and lower-extremity ischemia (OR: 4.9, 95% CI: 1.6–6.9; p = 0.009), and longer duration of surgery (OR 6.0, 95% CI: 1.8–18.7, p = 0.000) and cardiopulmonary bypass time (OR: 3.7, 95% CI: 1.3–9.3, p = 0.001) were independently predictive of higher mortality in patients with ATAAD. Conclusions: Supra-aortic vessels involvement, lower-extremity ischemia and elevated plasma potassium level are independent predictors of mortality in patients with ATAAD. A significant decrease in duration of surgery and cardiopulmonary bypass time is helpful to improve survival of patients. Frontiers Media S.A. 2021-11-04 /pmc/articles/PMC8599949/ /pubmed/34805301 http://dx.doi.org/10.3389/fcvm.2021.728568 Text en Copyright © 2021 Yuan, Sun, Zhang, Wu, Liu, Yang, Wang, Lv, Zhang, Li and Xie. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Yuan, Hongliang
Sun, Zhenxing
Zhang, Yongxing
Wu, Wenqian
Liu, Manwei
Yang, Yali
Wang, Jing
Lv, Qing
Zhang, Li
Li, Yuman
Xie, Mingxing
Clinical Analysis of Risk Factors for Mortality in Type A Acute Aortic Dissection: A Single Study From China
title Clinical Analysis of Risk Factors for Mortality in Type A Acute Aortic Dissection: A Single Study From China
title_full Clinical Analysis of Risk Factors for Mortality in Type A Acute Aortic Dissection: A Single Study From China
title_fullStr Clinical Analysis of Risk Factors for Mortality in Type A Acute Aortic Dissection: A Single Study From China
title_full_unstemmed Clinical Analysis of Risk Factors for Mortality in Type A Acute Aortic Dissection: A Single Study From China
title_short Clinical Analysis of Risk Factors for Mortality in Type A Acute Aortic Dissection: A Single Study From China
title_sort clinical analysis of risk factors for mortality in type a acute aortic dissection: a single study from china
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8599949/
https://www.ncbi.nlm.nih.gov/pubmed/34805301
http://dx.doi.org/10.3389/fcvm.2021.728568
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