Preoperative risk factors for the onset of acute Stanford type A aortic dissection in a multicenter study: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Yuduo ¹ , GONG Ming ¹ , SUN Lizhong ¹ , HUANG Lianjun ¹ , LIU Yongmin ¹ , ZHU Junming ¹ , GU Tianxiang ² , FAN Ruixin ³ , QIAN Ximing ⁴ ,  ZHANG Hongjia ¹

1. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Vascular Disease Diagnosis and Treatment Center, Beijing, 100029, P. R. China;
2. Department of Cardiac Surgery, The First Affiliated Hospital of China Medical University, Shenyang, 110001, P. R. China;
3. Department of Cardiac Surgery, Guangdong Provincial Institute of Cardiovascular Diseases, Guangzhou, 510080, P. R. China;
4. Department of Cardiac Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, P. R. China;

Corresponding author：

ZHANG Hongjia, Email: zhanghongjia722@ccmu.edu.cn

Keywords：

Acute Stanford type A aortic dissection; risk factors; multi-center study

DOI：

10.7507/1007-4848.202102055

Video：

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Objective To evaluate the preoperative risk factors for acute Stanford type A aortic dissection (ASTAAD) patients in our country by collecting multi-center data.Methods We consecutively enrolled 700 patients who underwent surgery for ASTAAD in the multi-center hospital database from January 2018 to January 2020. According to the ascending aorta size (AAS), the patients were divided into two groups: a group AAS≥55 mm and a group AAS<55 mm. Univariate and multivariate logistic regression analyses were used to investigate the related preoperative risk factors for the onset of ASTAAD.Results According to the exclusion criteria, a total of 621 patients were finally enrolled, including 453 males and 168 females with an average age of 48.24±11.51 years, and 509 (81.94%) patients had AAS<55 mm. Univariate and multivariate statistical analyses showed that smoking, hypertension, preoperative cardiac troponin I, and left ventricular ejection fraction were related to the occurrence of ASTAAD. The mortality rate of the patient during hospitalization was 13.04% (81 patients).Conclusion In clinical practice, various preoperative risk factors affect ASTAAD patients, which should be paid attention to. Comprehensive evaluation and an individualized analysis of patients and timely prevention and intervention improve patients' survival rate.

Citation： WU Yuduo, GONG Ming, SUN Lizhong, HUANG Lianjun, LIU Yongmin, ZHU Junming, GU Tianxiang, FAN Ruixin, QIAN Ximing, ZHANG Hongjia. Preoperative risk factors for the onset of acute Stanford type A aortic dissection in a multicenter study: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(8): 986-991. doi: 10.7507/1007-4848.202102055 Copy

1.	Tien M, Ku A, Martinez-Acero N, et al. The Penn classification predicts hospital mortality in acute stanford type A and type B aortic dissections. J Cardiothorac Vasc Anesth, 2020, 34(4): 867-873.
2.	Wen M, Han Y, Ye J, et al. Peri-operative risk factors for in-hospital mortality in acute type A aortic dissection. J Thorac Dis, 2019, 11(9): 3887-3895.
3.	Mayor S. Death after cardiac surgery is chiefly due to patient risk factors, study finds. BMJ, 2015, 351: h5821.
4.	Rhee R, Gupta A, Vechvitvarakul S, et al. Risk factors predictive of unfavorable distal aortic remodeling after surgical repair of type A thoracic aortic dissection. J Cardiovasc Surg (Torino), 2020, 61(3): 323-331.
5.	Dong N, Jiang W, Yin P, et al. Predictors of long-term outcome of isolated surgical aortic valve replacement in aortic regurgitation with reduced left ventricular ejection fraction and extreme left ventricular dilatation. Am J Cardiol, 2020, 125(9): 1385-1390.
6.	Thurau J, Habazettl H, El Al Md AA, et al. Left ventricular systolic dysfunction in patients with type-A aortic dissection is associated with 30-day mortality. J Cardiothorac Vasc Anesth, 2019, 33(1): 51-57.
7.	Stewart A, Chikwe J. Thinking beyond the tube graft: Using malperfusion as a guide to define treatment of type A dissection. J Am Coll Cardiol, 2015, 65(24): 2636-2637.
8.	Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type A aortic dissection. Circulation, 2002, 105(2): 200-206.
9.	Leontyev S, Légaré JF, Borger MA, et al. Creation of a scorecard to predict in-hospital death in patients undergoing operations for acute type A aortic dissection. Ann Thorac Surg, 2016, 101(5): 1700-1706.
10.	Sun LZ, Qi RD, Chang Q, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: Experience with 107 patients. J Thorac Cardiovasc Surg, 2009, 138(6): 1358-1362.
11.	Russo CF, Mariscalco G, Santé P. Acute aortic dissection type A: From the past to the present. G Ital Cardiol (Rome), 2016, 17(11): 908-914.
12.	Chioncel O, Iliescu VA. Aortic dissections. The battle starts in the front line. Int J Cardiol, 2020, 300: 115-116.
13.	姜文剑, 刘扬, 余长遥, 等. 单纯升主动脉扩张患者手术指征的探讨. 中国胸心血管外科临床杂志, 2019, 26(11): 1113-1118.
14.	Pape LA, Tsai TT, Isselbacher EM, et al. Aortic diameter > or = 5. 5 cm is not a good predictor of type A aortic dissection: Observations from the International Registry of Acute Aortic Dissection (IRAD). Circulation, 2007, 116(10): 1120-1127.
15.	Mansour AM, Peterss S, Zafar MA, et al. Prevention of aortic dissection suggests a diameter shift to a lower aortic size threshold for intervention. Cardiology, 2018, 139(3): 139-146.
16.	Khurrami L, Møller JE, Dahl JS, et al. The association between aortic valve calcification, cardiovascular risk factors, and cardiac size and function in a general population. Int J Cardiovasc Imaging, 2021, 37(2): 711-722.
17.	石烽, 王志维. 主动脉夹层发病相关危险因素分析. 中华老年心脑血管病杂志, 2020, 22(1): 28-31.
18.	Baguet JP, Chavanon O, Sessa C, et al. European Society of Hypertension scientific newsletter: Hypertension and aortic diseases. J Hypertens, 2012, 30(2): 440-443.
19.	Latorre M, Humphrey JD. Numerical knockouts —In silico assessment of factors predisposing to thoracic aortic aneurysms. PLoS Comput Biol, 2020, 16(10): e1008273.
20.	Lee JH, Cho Y, Cho YH, et al. Incidence and mortality rates of thoracic aortic dissection in Korea —Inferred from the nationwide health insurance claims. J Korean Med Sci, 2020, 35(40): e360.
21.	Wu HP, Lin MJ. Central aortic pressure and long-term outcome in hypertensive patients undergoing percutaneous coronary intervention. Sci Rep, 2020, 10(1): 17420.
22.	Sayed A, Munir M, Bahbah EI. Aortic dissection: A review of the pathophysiology, management & prospective advances. Curr Cardiol Rev, 2021, 17(4): e230421186875.
23.	Yang G, Peng W, Zhou Y, et al. Characteristics and prognosis of acute type A aortic dissection with negative D-dimer result. Am J Emerg Med, 2020, 38(9): 1820-1824.
24.	Langer NB, Ando M, Simpson M, et al. Influence of left ventricular ejection fraction on morbidity and mortality after aortic root replacement. J Thorac Cardiovasc Surg, 2019, 158(4): 984-991.
25.	Yuan X, Mitsis A, Tang Y, et al. The IRAD and beyond: What have we unravelled so far? Gen Thorac Cardiovasc Surg, 2019, 67(1): 146-153.
26.	Howard DP, Banerjee A, Fairhead JF, et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford vascular study. Circulation, 2013, 127(20): 2031-2037.

1. Tien M, Ku A, Martinez-Acero N, et al. The Penn classification predicts hospital mortality in acute stanford type A and type B aortic dissections. J Cardiothorac Vasc Anesth, 2020, 34(4): 867-873.
2. Wen M, Han Y, Ye J, et al. Peri-operative risk factors for in-hospital mortality in acute type A aortic dissection. J Thorac Dis, 2019, 11(9): 3887-3895.
3. Mayor S. Death after cardiac surgery is chiefly due to patient risk factors, study finds. BMJ, 2015, 351: h5821.
4. Rhee R, Gupta A, Vechvitvarakul S, et al. Risk factors predictive of unfavorable distal aortic remodeling after surgical repair of type A thoracic aortic dissection. J Cardiovasc Surg (Torino), 2020, 61(3): 323-331.
5. Dong N, Jiang W, Yin P, et al. Predictors of long-term outcome of isolated surgical aortic valve replacement in aortic regurgitation with reduced left ventricular ejection fraction and extreme left ventricular dilatation. Am J Cardiol, 2020, 125(9): 1385-1390.
6. Thurau J, Habazettl H, El Al Md AA, et al. Left ventricular systolic dysfunction in patients with type-A aortic dissection is associated with 30-day mortality. J Cardiothorac Vasc Anesth, 2019, 33(1): 51-57.
7. Stewart A, Chikwe J. Thinking beyond the tube graft: Using malperfusion as a guide to define treatment of type A dissection. J Am Coll Cardiol, 2015, 65(24): 2636-2637.
8. Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type A aortic dissection. Circulation, 2002, 105(2): 200-206.
9. Leontyev S, Légaré JF, Borger MA, et al. Creation of a scorecard to predict in-hospital death in patients undergoing operations for acute type A aortic dissection. Ann Thorac Surg, 2016, 101(5): 1700-1706.
10. Sun LZ, Qi RD, Chang Q, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: Experience with 107 patients. J Thorac Cardiovasc Surg, 2009, 138(6): 1358-1362.
11. Russo CF, Mariscalco G, Santé P. Acute aortic dissection type A: From the past to the present. G Ital Cardiol (Rome), 2016, 17(11): 908-914.
12. Chioncel O, Iliescu VA. Aortic dissections. The battle starts in the front line. Int J Cardiol, 2020, 300: 115-116.
13. 姜文剑, 刘扬, 余长遥, 等. 单纯升主动脉扩张患者手术指征的探讨. 中国胸心血管外科临床杂志, 2019, 26(11): 1113-1118.
14. Pape LA, Tsai TT, Isselbacher EM, et al. Aortic diameter > or = 5. 5 cm is not a good predictor of type A aortic dissection: Observations from the International Registry of Acute Aortic Dissection (IRAD). Circulation, 2007, 116(10): 1120-1127.
15. Mansour AM, Peterss S, Zafar MA, et al. Prevention of aortic dissection suggests a diameter shift to a lower aortic size threshold for intervention. Cardiology, 2018, 139(3): 139-146.
16. Khurrami L, Møller JE, Dahl JS, et al. The association between aortic valve calcification, cardiovascular risk factors, and cardiac size and function in a general population. Int J Cardiovasc Imaging, 2021, 37(2): 711-722.
17. 石烽, 王志维. 主动脉夹层发病相关危险因素分析. 中华老年心脑血管病杂志, 2020, 22(1): 28-31.
18. Baguet JP, Chavanon O, Sessa C, et al. European Society of Hypertension scientific newsletter: Hypertension and aortic diseases. J Hypertens, 2012, 30(2): 440-443.
19. Latorre M, Humphrey JD. Numerical knockouts —In silico assessment of factors predisposing to thoracic aortic aneurysms. PLoS Comput Biol, 2020, 16(10): e1008273.
20. Lee JH, Cho Y, Cho YH, et al. Incidence and mortality rates of thoracic aortic dissection in Korea —Inferred from the nationwide health insurance claims. J Korean Med Sci, 2020, 35(40): e360.
21. Wu HP, Lin MJ. Central aortic pressure and long-term outcome in hypertensive patients undergoing percutaneous coronary intervention. Sci Rep, 2020, 10(1): 17420.
22. Sayed A, Munir M, Bahbah EI. Aortic dissection: A review of the pathophysiology, management & prospective advances. Curr Cardiol Rev, 2021, 17(4): e230421186875.
23. Yang G, Peng W, Zhou Y, et al. Characteristics and prognosis of acute type A aortic dissection with negative D-dimer result. Am J Emerg Med, 2020, 38(9): 1820-1824.
24. Langer NB, Ando M, Simpson M, et al. Influence of left ventricular ejection fraction on morbidity and mortality after aortic root replacement. J Thorac Cardiovasc Surg, 2019, 158(4): 984-991.
25. Yuan X, Mitsis A, Tang Y, et al. The IRAD and beyond: What have we unravelled so far? Gen Thorac Cardiovasc Surg, 2019, 67(1): 146-153.
26. Howard DP, Banerjee A, Fairhead JF, et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford vascular study. Circulation, 2013, 127(20): 2031-2037.

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