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Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up

Background: Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predict...

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Autores principales: Freundt, Miriam, Kolat, Philipp, Friedrich, Christine, Salem, Mohamed, Gruenewald, Matthias, Elke, Gunnar, Pühler, Thomas, Cremer, Jochen, Haneya, Assad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8625674/
https://www.ncbi.nlm.nih.gov/pubmed/34830651
http://dx.doi.org/10.3390/jcm10225370
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author Freundt, Miriam
Kolat, Philipp
Friedrich, Christine
Salem, Mohamed
Gruenewald, Matthias
Elke, Gunnar
Pühler, Thomas
Cremer, Jochen
Haneya, Assad
author_facet Freundt, Miriam
Kolat, Philipp
Friedrich, Christine
Salem, Mohamed
Gruenewald, Matthias
Elke, Gunnar
Pühler, Thomas
Cremer, Jochen
Haneya, Assad
author_sort Freundt, Miriam
collection PubMed
description Background: Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predictive of undesirable outcome to help guide perioperative management. Methods: We performed retrospective analysis of 394 cases of AAAD who underwent repair in our institution between 2001 and 2018. A combined endpoint of parameters was defined as (1) 30-day versus hospital mortality, (2) new neurological deficit, (3) new acute renal insufficiency requiring postoperative renal replacement, and (4) prolonged mechanical ventilation with need for tracheostomy. Results: Total survival/ follow-up time averaged 3.2 years with follow-up completeness of 94%. Endpoint was reached by 52.8%. Those had higher EuroSCORE II (7.5 versus 5.5), higher incidence of coronary artery disease (CAD) (9.2% versus 3.2%), neurological deficit (ND) upon presentation (26.4% versus 11.8%), cardiopulmonary resuscitation (CPR) (14.4% versus 1.6%) and intubation (RF) before surgery (16.9% versus 4.8%). 7-day mortality was 21.6% versus 0%. Hospital mortality 30.8% versus 0%. Conclusions: This 15-year follow up shows, that unfavorable postoperative clinical outcome is related to ND, CAD, CPR and RF on arrival.
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spelling pubmed-86256742021-11-27 Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up Freundt, Miriam Kolat, Philipp Friedrich, Christine Salem, Mohamed Gruenewald, Matthias Elke, Gunnar Pühler, Thomas Cremer, Jochen Haneya, Assad J Clin Med Article Background: Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predictive of undesirable outcome to help guide perioperative management. Methods: We performed retrospective analysis of 394 cases of AAAD who underwent repair in our institution between 2001 and 2018. A combined endpoint of parameters was defined as (1) 30-day versus hospital mortality, (2) new neurological deficit, (3) new acute renal insufficiency requiring postoperative renal replacement, and (4) prolonged mechanical ventilation with need for tracheostomy. Results: Total survival/ follow-up time averaged 3.2 years with follow-up completeness of 94%. Endpoint was reached by 52.8%. Those had higher EuroSCORE II (7.5 versus 5.5), higher incidence of coronary artery disease (CAD) (9.2% versus 3.2%), neurological deficit (ND) upon presentation (26.4% versus 11.8%), cardiopulmonary resuscitation (CPR) (14.4% versus 1.6%) and intubation (RF) before surgery (16.9% versus 4.8%). 7-day mortality was 21.6% versus 0%. Hospital mortality 30.8% versus 0%. Conclusions: This 15-year follow up shows, that unfavorable postoperative clinical outcome is related to ND, CAD, CPR and RF on arrival. MDPI 2021-11-18 /pmc/articles/PMC8625674/ /pubmed/34830651 http://dx.doi.org/10.3390/jcm10225370 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Freundt, Miriam
Kolat, Philipp
Friedrich, Christine
Salem, Mohamed
Gruenewald, Matthias
Elke, Gunnar
Pühler, Thomas
Cremer, Jochen
Haneya, Assad
Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up
title Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up
title_full Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up
title_fullStr Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up
title_full_unstemmed Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up
title_short Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up
title_sort preoperative predictors of adverse clinical outcome in emergent repair of acute type a aortic dissection in 15 year follow up
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8625674/
https://www.ncbi.nlm.nih.gov/pubmed/34830651
http://dx.doi.org/10.3390/jcm10225370
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