Risk Analysis for Hospital Mortality in Patients With Acute Type A Aortic Dissection
Department of Cardiovascular Surgery, Fujisawa City Hospital, Fujisawa-city, Kanagawa, Japan. The Annals of thoracic surgery
(Impact Factor: 3.85).
10/2010; 90(4):1246-50. DOI: 10.1016/j.athoracsur.2010.05.069
Stanford type A acute aortic dissection is a fatal condition requiring emergency surgery. This study was designed to evaluate risk factors for hospital mortality in patients with Stanford type A acute aortic dissection.
We studied consecutive 301 patients (163 men and 138 women; mean age, 63.3 years) who underwent emergency surgery for Stanford type A acute aortic dissection from January 1997 through December 2007. The subjects were divided into two groups: patients who were discharged from the hospital, and those who died during hospitalization. Preoperative and operative clinical factors were compared between the groups.
Overall, 41 patients (13.6%) died during hospitalization. On univariate analysis, significant preoperative risk factors for hospital mortality were cardiopulmonary resuscitation, coagulopathy, renal dysfunction, elevated aspartate aminotransferase levels, myocardial ischemia, and lower-extremity ischemia. As for factors related to surgery, the duration of operation, cardiopulmonary bypass time, aortic cross-clamp time, and volume of blood transfusion were greater among patients who died during hospitalization than in those who were discharged from the hospital. On multivariate analysis, independent preoperative risk factors were cardiopulmonary resuscitation, renal dysfunction, and lower-extremity ischemia. Shock or cardiac tamponade were not risk factors.
Risk factors for hospital mortality in patients with Stanford type A acute aortic dissection were cardiopulmonary resuscitation, renal dysfunction, and lower-extremity ischemia.
Available from: Fausto Biancari
- "Six studies[2,5,6,8,10,12]reported on the immediate postoperative mortality in patients aged 80 years and older as well as in younger patients. Pooled analysis showed that patients >80 years old had a significantly higher risk of "
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ABSTRACT: The benefits of surgical treatment of type A aortic dissection (AAD) in patients aged 80 years and older are questioned by the perceived high operative risk of these patients. This issue has been investigated in the present meta-analysis of observational studies.
Studies on surgical repair of AAD in patients aged 80 years and older were identified up to January 2011. The results were expressed as pooled proportions with 95% confidence interval (95% CI).
Pooled analysis showed that patients aged 80 years and older included in six studies had a significantly higher risk of immediate postoperative mortality compared with younger patients (risk ratio 2.32, 95% CI 1.47-3.66, p<0.0001, pooled estimates 45.7% vs 19.5%). Analysis of data retrieved from nine studies reporting on the results of surgical treatment of AAD in a total of 308 patients aged 80 years and older showed a pooled mortality rate of 36.7% (95% CI 23.8-51.8%, 111/308 patients). The pooled stroke rate was 11.9% (95% CI 7.3-18.7%, 37/347 patients). Pooled analysis of data from two studies evaluating patients surgically or medically treated showed a non-significant reduced risk of immediate postoperative death after surgery (risk ratio 0.42, 95% CI 0.14-1.29, pooled estimates: 25.2% vs 59.0%).
Immediate postoperative survival rates after surgery for AAD in patients aged 80 years and older are satisfactory. These findings suggest a confident approach toward emergency repair of AAD in this fragile patient population. More data on the intermediate survival and quality of life of these patients are, however, needed to better establish the role of emergency surgery for AAD in octogenarians and nonagenarians.
Available from: Stephen Casey
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ABSTRACT: Problems in harmonic analysis and synthesis are intertwined with
their applications in signal and image processing. Developments in the
theory on the zeta functions, algorithms on generalizations of Euclidean
domains, and variations on equidistribution theory have led to
algorithms for several classes of problems in parameter estimation that
are general and very efficient. We present the theoretical
justifications for these algorithms, and discuss their use in the
analysis of periodic pulse trains
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ABSTRACT: The standard of performing emergent surgical repair for acute aortic dissection type A has been questioned in patients with previous cardiac surgery. The effects of previous cardiac surgery on the presentation and operative outcome of these patients is understudied.
Between 1998 and 2010, 190 patients were operated on for acute type A aortic dissection; there were 159 first cardiac operations (FCO) and 31 redo operations (REDO). Stepwise logistic regression analysis identified independent predictors of hospital mortality. Propensity score-matching yielded 31 FCOs who matched the REDOs with respect to age, sex, hypertension history, chronic obstructive pulmonary disease, and renal failure. The presentation, operative outcome, and complications were compared between the two groups.
Hospital mortality rate was 16.8% (32 of 190). Regression analysis identified mental status change (odds ratio [OR] = 5.9), hypertension (OR = 4.6), concomitant coronary artery bypass grafting (OR = 3), reoperation (OR = 2.9), and age of 70 years or older (OR = 2.8) as predictors of hospital mortality. After matching there was no difference between REDO and FCO groups in the presenting symptoms, but REDOs had a higher incidence of aortic rupture (29% [9 of 31] versus 3.2% [1 of 31]; p = 0.012). Cardiac tamponade was present in 3.2% (1 of 31) of REDOs versus 16.1% of FCOs (5 of 31; p = 0.195). Patients in the REDO group required more intraoperative blood transfusion, and had longer cardiopulmonary bypass time. Major complications occurred similarly between the two groups, except REDOs had worse renal function and a higher rate of sudden cardiac arrest (14.3% [4 of 28] versus 0; p = 0.045).
Although hospital mortality is higher among REDOs, it is still lower than the reported mortality for medical management, and major complications occurred at a rate similar to that of FCOs; hence, emergent surgery remains the prudent treatment.
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