BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(A...BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(AAD)and to correlate with the outcome,especially regarding renal function.To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center.We included all patients who underwent AAD repair from 2011-2017.Post-operative RML workup is part of the institutional protocol;studied patients were divided into two groups:Group 1 with RML(creatine kinase above cut-off levels 2500 U/L)and Group 2 without RML.The potential determinants of RML and impact on patient outcome,especially postoperative renal function,were studied.Other outcome parameters studied were markers of cardiac injury,length of ventilation,length of stay in the intensive care unit),and length of hospitalization.RESULTS Out of 33 patients studied,21 patients(64%)developed RML(Group RML),and 12 did not(Group non-RML).Demographic and intraoperative factors,notably body mass index,duration of surgery,and cardiopulmonary bypass,had no significant impact on the incidence of RML.Preoperative visceral/peripheral malperfusion,though not statistically significant,was higher in the RML group.A significantly higher incidence of renal complications,including de novo postoperative dialysis,was noticed in the RML group.Other morbidity parameters were also higher in the RML group.There was a significantly higher incidence of AKI in the RML group(90%)than in the non-RML group(25%).All four patients who required de novo dialysis belonged to the RML group.The peak troponin levels were significantly higher in the RML group.CONCLUSION In this study,we noticed a high incidence of RML after aortic dissection surgery,coupled with an adverse renal outcome and the need for post-operative dialysis.Prompt recognition and management of RML might improve the renal outcome.Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.展开更多
BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on pri...BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,and ScienceDirect identified five studies involving 2572 patients(1153 males and 1419 females).The primary outcome was hospital mortality.Secondary outcomes included reintervention rates,acute kidney injury(AKI),ischemic stroke,limb ischemia,and spinal cord ischemia.Odds ratios(OR)with 95%confidence intervals(CI)were calculated using a random-effects model.Heterogeneity was assessed using the I²statistic.RESULTS The primary outcome showed no significant difference between males and females for hospital mortality(OR:1.13,95%CI:0.81-1.59,P=0.47,I2=0).Among secondary outcomes,males had a significantly higher risk of AKI(OR:1.55,95%CI:1.21-2.00,P=0.0006,I²=0).No differences were observed for reintervention rates,ischemic stroke,limb ischemia,or spinal cord ischemia.CONCLUSION Male patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality,ischemic events,reintervention,and other complications.Future research should explore mechanisms and strategies to optimize outcomes.展开更多
Objective:To investigate the incidence of delirium in elderly patients with Stanford-type B aortic dissection and analyze its risk factors.Methods:A convenience sample of 767 elderly patients with Stanford-type B aort...Objective:To investigate the incidence of delirium in elderly patients with Stanford-type B aortic dissection and analyze its risk factors.Methods:A convenience sample of 767 elderly patients with Stanford-type B aortic dissection admitted to the ICU from January 2020 to December 2023 was selected.Data were collected using a delirium-related questionnaire and the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Results:The incidence of delirium in elderly Stanford B aortic dissection patients was 23.73%.Logistic regression analysis showed that gender,length of stay in the ICU,and duration of sedative drug use were independent risk factors for delirium in elderly patients(P<0.05).The model likelihood ratio test x^(2)=28.462,P<0.001;Hosmer-Lemeshow goodness-of-fit test x^(2)=0.715,P=0.878.Conclusion:The incidence of delirium in elderly patients with Stanford-type B aortic dissection is relatively low.Medical staff should conduct adequate and effective preoperative assessment according to the condition of elderly Stanford-type B aortic dissection patients,and use analgesic and sedative drugs reasonably to create a good treatment environment for patients,thereby minimizing the incidence of delirium in elderly patients with Stanford-type B aortic dissection as much as possible.展开更多
Objective To investigate the clinical predictors of malperfusion in patients with acute type A aortic dissection(ATAAD)and to construct a diagnostic model to identify high-risk individuals.Methods A retrospective anal...Objective To investigate the clinical predictors of malperfusion in patients with acute type A aortic dissection(ATAAD)and to construct a diagnostic model to identify high-risk individuals.Methods A retrospective analysis of 553 ATAAD patients from Tongji Hospital divided into malperfusion and non-malperfusion groups was conducted.Logistic regression was used to identify independent predictors of the outcome.Model performance via the Hosmer–Lemeshow test,decision curve analysis(DCA),the area under the receiver operating characteristic curve(AUC),sensitivity,specificity,and predictive values.Results Malperfusion was observed in 28.4%of ATAAD patients.Significant predictors included elevated lactate dehydrogenase(LDH)(OR:1.0019,95%CI:1.0002–1.0036,P=0.027),alanine aminotransferase(ALT)(OR:0.9936,95%CI:0.987–1.000,P=0.046)and estimated glomerular filtration rate(eGFR)(OR:0.9877,95%CI:0.977–0.998,P=0.021),suggesting roles for tissue ischemia and impaired renal or hepatic function.Other variables,such as D-dimer,uric acid,creatinine,and NT-proBNP,showed trends toward significance but did not reach the 0.05 threshold.The model demonstrated good calibration(Hosmer–Lemeshow P=0.318),moderate discriminatory power(AUC=0.725),high specificity(93.62%),and low sensitivity(26.75%).Conclusion The model based on routine biochemical markers provides a practical approach for the early identification of malperfusion in ATAAD patients.It shows strong specificity and clinical utility,although its limited sensitivity highlights the need for further refinement.Future improvements should focus on incorporating additional clinical or imaging data to increase diagnostic accuracy.展开更多
Background:The National Chest Pain Center Program(NCPCP)is a nationwide,quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China.The benefits of chest pain ...Background:The National Chest Pain Center Program(NCPCP)is a nationwide,quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China.The benefits of chest pain center(CPC)accreditation on acute coronary syndrome have been demonstrated.However,there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection(AAD).Methods:We conducted a retrospective observational study of patients with AAD from 1671 hospitals in China,using data from the NCPCP spanning the period from January 1,2016 to December 31,2022.The patients were divided into 2 groups:pre-accreditation and post-accreditation admissions.The outcomes examined included in-hospital mortality,misdiagnosis,and Stanford type A AAD surgery.Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes.Furthermore,we stratified the hospitals based on their geographical location(Eastern/Central/Western regions)or administrative status(provincial/non-provincial capital areas)to assess the impact of CPC accreditation on AAD patients across various regions.Results:The analysis encompassed a total of 40,848 patients diagnosed with AAD.The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis(12.1%vs.16.3%,P<0.001 and 2.9%vs.5.4%,P<0.001,respectively)as well as a notably higher rate of Stanford type A AAD surgery(61.1%vs.42.1%,P<0.001)compared with the pre-accreditation group.After adjusting for potential covariates,CPC accreditation was associated with substantially reduced risks of in-hospital mortality(adjusted OR=0.644,95%CI 0.599-0.693)and misdiagnosis(adjusted OR=0.554,95%CI 0.493-0.624),along with an increase in the proportion of patients undergoing Stanford type A AAD surgery(adjusted OR=1.973,95%CI 1.797-2.165).Following CPC accreditation,there were significant reductions in in-hospital mortality across various regions,particularly in Western regions(from 21.5%to 14.1%).Moreover,CPC accreditation demonstrated a more pronounced impact on in-hospital mortality in non-provincial cities compared to provincial cities(adjusted OR:0.607 vs.0.713).Conclusion:CPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.展开更多
Background and Objective The natural history of type B aortic intramural hematoma(IMH)is highly heterogeneous.A computational fluid dynamics(CFD)model can be utilized to calculate a range of data pertinent to flow dyn...Background and Objective The natural history of type B aortic intramural hematoma(IMH)is highly heterogeneous.A computational fluid dynamics(CFD)model can be utilized to calculate a range of data pertinent to flow dynamics,including flow rates,blood velocity,pressure,and wall shear stress.This study presents a series of CFD simulations that model the dynamic progression from type B aortic IMH to false lumen formation.Methods A 66-year-old male patient presenting with chest and back pain underwent aortic computed tomography angiography(CTA),and a 3D patient-specific model was constructed.To evaluate the hemodynamic environment,the velocity,pressure,time-averaged wall shear stress(TAWSS),and oscillatory shear index(OSI)were calculated.Results A modest quantity of slow flow and recirculation flow was observed in the vicinity of the ulcer-like protrusion(ULP).During the formation of the false lumen,low-velocity blood flow entered the false lumen and resulted in vortex flow.ULPs were located in the region with higher TAWSS,and some high OSIs were found on the ULPs.Conclusion This preliminary study suggests a potential association between the TAWSS or OSI and progression from type B aortic IMH to aortic dissection.展开更多
A comprehensive differential diagnosis is essential in the emergency department, even when patient presentations are atypical. Timely recognition of life-threatening conditions, such as aortic dissection, hinges on th...A comprehensive differential diagnosis is essential in the emergency department, even when patient presentations are atypical. Timely recognition of life-threatening conditions, such as aortic dissection, hinges on this critical diagnostic approach.展开更多
BACKGROUND Endovascular repair of aortic dissection is an effective method commonly used in the treatment of Stanford type B aortic dissection.Stent placement during the operation was one-time and could not be repeate...BACKGROUND Endovascular repair of aortic dissection is an effective method commonly used in the treatment of Stanford type B aortic dissection.Stent placement during the operation was one-time and could not be repeatedly adjusted during the operation.Therefore,it is of great significance for cardiovascular physicians to fully understand the branch status,position,angle,and other information regarding aortic arch dissection before surgery.AIM To provide more references for clinical cardiovascular physicians to develop treatment plans.METHODS Data from 153 patients who underwent endovascular repair of aortic dissection at our hospital between January 2021 and December 2022 were retrospectively collected.All patients underwent multi-slice spiral computed tomography angiography.Based on distinct post-image processing techniques,the patients were categorized into three groups:Multiplanar reconstruction(MPR)(n=55),volume reconstruction(VR)(n=46),and maximum intensity projection(MIP)(n=52).The detection rate of aortic rupture,accuracy of the DeBakey classification,rotation,and tilt angles of the C-arm during the procedure,dispersion after stent release,and the incidence of late complications were recorded and compared.RESULTS The detection rates of interlayer rupture in the MPR and VR groups were significantly higher than that in the MIP group(P<0.05).The detection rates of De-Bakey subtypesⅠ,Ⅱ,andⅢin the MPR group were higher than those in the MIP group,and the detection rate of typeⅢin the MPR group was significantly higher than that in the VR group(P<0.05).There was no statistically significant difference in the detection rates of typesⅠandⅡcompared to the VR group(P>0.05).The scatter rate of markers and the incidence of complications in the MPR group were significantly lower than those in the VR and MIP groups(P<0.05).CONCLUSION The application of MPR in the endovascular repair of aortic dissection has improved the detection rate of dissection rupture,the accuracy of anatomical classification,and safety.展开更多
BACKGROUND Aortic coarctation is a potentially fatal condition that is primarily treated surgically.Despite successful procedures,patients frequently experience postoperative anxiety and depression,which can hinder re...BACKGROUND Aortic coarctation is a potentially fatal condition that is primarily treated surgically.Despite successful procedures,patients frequently experience postoperative anxiety and depression,which can hinder recovery and worsen outcomes.Pharmacological interventions,such as 5-hydroxytryptamine(5-HT)and norepinephrine reuptake inhibitors,are commonly prescribed;however,their efficacy alone or in combination with non-invasive brain stimulation techniques,such as repetitive transcranial magnetic stimulation(TMS),remains unclear.AIM To assess the effect of medications and TMS on post-aortic surgery anxiety and depression.METHODS We analyzed the outcomes of 151 patients with anxiety and depression who were hospitalized for aortic dissection between January 2020 and September 2022.Using the random number table method,75 and 76 patients were allocated to the normal control and study groups,respectively.All the patients were treated using routine procedures.The control group was administered anti-anxiety and antidepression drugs,whereas the study group was treated with TMS in addition to these medications.The patients in both groups showed improvement after two courses of treatment.The Hamilton Anxiety Scale(HAMA)and the Hamilton Depression Scale(HAMD)were used to assess anxiety and depression,respectively.The serum levels of brain-derived neurotrophic factor(BDNF)and 5-HT were determined using enzyme-linked immunosorbent assay.The Pittsburgh Sleep Quality Index(PSQI)was used to estimate sleep quality,and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)was used to assess cognitive function.RESULTS The HAMD and HAMA scores reduced in 2 groups,with the study group achieving a lower level than control(P<0.05).In the control group,43 patients recovered,17 showed improvement,and 15 were deemed invalid.In the study group,52 recovered,20 improved,and four were invalid.The efficacy rate in study group was 94.74%compared to 80.00%in control(P<0.05).The BDNF and 5-HT levels increased in both groups,with higher levels observed in the experimental group(P<0.05).Moreover,the PSQI scores decreased in 2 groups,but were lower in the intervention group than control(P<0.05).The scores of the RBANS items increased,with the study group scoring higher than control(P<0.05).CONCLUSION Combining anti-anxiety and anti-depressive drugs with repetitive TMS after aortic surgery may enhance mood and treatment outcomes,offering a promising clinical approach.展开更多
BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulatio...BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulation.Postoperative descending aorta remodeling is closely linked to the false lumen area ratio(FLAR),defined as false lumen area/aortic area,as well as to the incidence of renal replacement therapy(RRT).AIM To investigate the effect of the updated arterial cannulation strategy on descending aortic remodeling.METHODS A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the study.Of these,209 received right AA cannulation and 234 received bilateral CA cannulation.The primary outcome was the change in FLAR,as calculated from computed tomography angiography in three segments of the descending aorta:Thoracic(S1),upper abdominal(S2),and lower abdominal(S3).Secondary outcomes were the incidence of RRT and the serum inflammation response,as observed by the levels of high sensitivity C reaction protein(hs-CRP)and Interleukin-6(IL-6).RESULTS The postoperative/preoperative ratio of FLAR in S2 and S3 was higher in the AA group compared to the CA group(S2:0.80±0.08 vs 0.75±0.07,P<0.001;S3:0.57±0.12 vs 0.50±0.12,P<0.001,respectively).The AA group also had a significantly higher incidence of RRT(19.1%vs 8.5%,P=0.001;odds ratio:2.533,95%CI:1.427-4.493)and higher levels of inflammation cytokines 24 h after the procedure[hr-CRP:117±17 vs 104±15 mg/L;IL-6:129(103,166)vs 83(69,101)pg/mL;both P<0.001]compared to the CA group.CONCLUSION The CA cannulation strategy was associated with better abdominal aorta remodeling after AAD repair compared to AA cannulation,as observed by a greater change in FLAR and lower incidence of RRT.展开更多
BACKGROUND The utility of D-dimer(DD)as a biomarker for acute aortic dissection(AD)is recognized.Yet,its predictive value for in-hospital mortality remains uncertain and subject to conflicting evidence.AIM To conduct ...BACKGROUND The utility of D-dimer(DD)as a biomarker for acute aortic dissection(AD)is recognized.Yet,its predictive value for in-hospital mortality remains uncertain and subject to conflicting evidence.AIM To conduct a meta-analysis of AD-related in-hospital mortality(ADIM)with elevated DD levels.METHODS We searched PubMed,Scopus,Embase,and Google Scholar for AD and ADIM literature through May 2022.Heterogeneity was assessed using I2 statistics and effect size(hazard or odds ratio)analysis with random-effects models.Sample size,study type,and patients’mean age were used for subgroup analysis.The significance threshold was P<0.05.RESULTS Thirteen studies(3628 patients)were included in our study.The pooled prevalence of ADIM was 20%(95%CI:15%-25%).Despite comparable demographic characteristics and comorbidities,elevated DD values were associated with higher ADIM risk(unadjusted effect size:1.94,95%CI:1.34-2.8;adjusted effect size:1.12,95%CI:1.05-1.19,P<0.01).Studies involving patients with a mean age of<60 years exhibited an increased mortality risk(effect size:1.43,95%CI:1.23-1.67,P<0.01),whereas no significant difference was observed in studies with a mean age>60 years.Prospective and larger sample size studies(n>250)demonstrated a heightened likelihood of ADIM associated with elevated DD levels(effect size:2.57,95%CI:1.30-5.08,P<0.01 vs effect size:1.05,95%CI:1.00-1.11,P=0.05,respectively).CONCLUSION Our meta-analysis shows elevated DD increases in-hospital mortality risk in AD patients,highlighting the need for larger,prospective studies to improve risk prediction models.展开更多
Aortic dissection is the deadliest disease of the cardiovascular system.Type B aortic dissection accounts for 30%-60%of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm...Aortic dissection is the deadliest disease of the cardiovascular system.Type B aortic dissection accounts for 30%-60%of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm repair(TEVAR).However,patients are prone to various complications after surgery,with central nervous system injury being the most common,which seriously affects their prognosis and increases the risk of disability and death.Therefore,exploring the risk factors of central nervous system injury after TEVAR can provide a basis for its prevention and control.AIM To investigate the risk factors for central nervous system injury after the repair of a thoracic endovascular aneurysm with type B aortic dissection.METHODS We enrolled 306 patients with type B aortic dissection who underwent TEVAR at our hospital between December 2019 and October 2022.The patients were categorized into injury(n=159)and non-injury(n=147)groups based on central nervous system injury following surgery.The risk factors for central nervous system injury after TEVAR for type B aortic dissection were screened by comparing the two groups.Multivariate logistic regression analysis was performed.RESULTS The Association between age,history of hypertension,blood pH value,surgery,mechanical ventilation,intensive care unit stay,postoperative recovery times on the first day after surgery,and arterial partial pressure of oxygen on the first day after surgery differed substantially(P<0.05).Multivariate logistic regression analysis indicated that age,surgery time,history of hypertension,duration of mechanical ventilation,and intensive care unit stay were independent risk factors for central nervous system injury after TEVAR of type B aortic dissection(P<0.05).CONCLUSION For high-risk patients with central nervous system injury after TEVAR of type B aortic dissection,early intervention measures should be implemented to lower the risk of neurological discomfort following surgery in high-risk patients with central nervous system injury after TEVAR for type B aortic dissection.展开更多
Background: Aortic dissection (AD) is one of the common causes of fatal chest pain in emergency medicine. The main and most common clinical manifestation is pain, with about 90% of patients experiencing sudden persist...Background: Aortic dissection (AD) is one of the common causes of fatal chest pain in emergency medicine. The main and most common clinical manifestation is pain, with about 90% of patients experiencing sudden persistent, tearing or cutting-like pain in the chest or back. However, there have also been reports of myocardial infarction, heart failure, renal failure, syncope, shock, stroke, paraplegia and other cases. Clinical misdiagnosis is common. Aim: Alert clinicians to aortic dissection with shock and chest tightness as the main clinical presentations. Case Presentation: Report on two cases of aortic dissection with syncope and shock as the main manifestations. Conclusion: Aortic dissection is a highly dangerous cardiovascular emergency with a high mortality rate. In clinical practice, awareness of the clinical manifestations of aortic dissection should be increased. Careful inquiry about medical history, attention to atypical clinical presentations of aortic dissection, thorough physical examination, and comprehensive diagnostic evaluation can improve the success rate of diagnosing aortic dissection.展开更多
Background Type A aortic dissection,as a cardiovascular emergency,is best treated with early surgical intervention.With advancements in surgical techniques and perioperative management,the clinical cure rate of surger...Background Type A aortic dissection,as a cardiovascular emergency,is best treated with early surgical intervention.With advancements in surgical techniques and perioperative management,the clinical cure rate of surgery has significantly improved.However,the probability of postoperative complications remains high,among which postoperative hepatic dysfunction is one of the common and serious complications affecting prognosis.The purpose of this study was to explore the risk factors associated with postoperative hepatic dysfunction in patients with type A aortic dissection,hoping to identify high-risk patients early,prevent postoperative hepatic dysfunction,and improve patient prognosis.Methods A retrospective analysis was conducted on patients diagnosed with Stanford type A aortic dissection and treated with Sun's procedure at Guangdong Provincial People's Hospital from January 1,2021,to October 1,2022.The Model for End-Stage Liver Disease excluding International Normalized Ratio(MELD-XI)score was used as the evaluation index for postoperative hepatic dysfunction(HD).MELD-XI scores from postoperative day 1 to 7 were collected.Statistical methods were employed to analyze the perioperative clinical data of the two groups of patients.Variables with statistical significance in univariate analysis were included in multivariate logistic regression analysis to identify independent risk factors associated with postoperative HD.Results A total of 241 patients diagnosed with Stanford type A aortic dissection and hospitalized for Sun's procedure treatment were selected using specific inclusion and exclusion criteria.All patients were divided into HD group(MELD-XI score≥12,n=108)and normal group(MELD-XI score<12,n=133),with a postoperative HD incidence rate of 44.81%.There were statistically significant differences(P<0.05)between the two groups in terms of whether the surgery was emergency,gender distribution,preoperative level of white blood cell count,alanine aminotransferase,aspartate aminotransferase,brain natriuretic peptide,high-sensitivity troponin T,and serum creatinine.Statistically significant differences(P<0.05)were also observed in surgical duration,cardiopulmonary bypass time,intraoperative and postoperative 24-hour red blood cell transfusion volume,intraoperative and postoperative 24-hour plasma transfusion volume,and intraoperative bleeding volume.Moreover,patients with postoperative hepatic dysfunction had longer mechanical ventilation time,longer intensive care unit(ICU)and total hospital stay,and higher probabilities of postoperative gastrointestinal bleeding,paraplegia,cerebral complications,re-thoracotomy for hemostasis,reintubation,and extracorporeal membrane oxygenation(ECMO)therapy(P<0.05).The probabilities of acute kidney injury and receiving hemodialysis treatment were also higher(P<0.05).Following multivariate regression analysis,preoperative white blood cell count(OR:1.169,95%CI:1.028-1.329,P=0.017),preoperative serum creat-inine(OR:1.045,95%CI:1.028-1.062,P<0.001),and intraoperative and postoperative 24-hour red blood cell transfusion volume(OR:1.146,95%CI:1.030-1.274,P=0.012)were identified as independent risk factors associated with postoperative hepatic dysfunction in patients with Stanford type A aortic dissection after Sun's procedure.Conclusions In this study,the incidence of postoperative hepatic dysfunction in patients with Stanford type A aortic dissection after Sun's procedure was relatively high,at 44.81%.The independent risk factors associated with postoperative hepatic dysfunction in patients with type A aortic dissection include preoperative white blood cell count,preoperative alanine aminotransferase,and intraoperative and postoperative 24-hour red blood cell transfusion volume.Postoperative hepatic dysfunction significantly affects the prognosis of patients with Stanford type A aortic dissection,increasing the duration of postoperative mechanical ventilation,postoperative hospitalization time,and the probability of postoperative acute kidney injury.展开更多
Background:Aortic dissection(AD)is a fatal cardiovascular disease for which the key involved genes are largely unknown.Here,we aimed to identify promising AD biomarkers from high-throughput RNA expressing data.Methods...Background:Aortic dissection(AD)is a fatal cardiovascular disease for which the key involved genes are largely unknown.Here,we aimed to identify promising AD biomarkers from high-throughput RNA expressing data.Methods:In the GSE98770 dataset,differentially expressed mRNAs(DE-mRNAs)and microRNAs(DE-microRNAs)were identified through differentially expressed gene analysis and gene set enrichment analysis.The regulatory network between DE-mRNAs and DE-microRNAs was established,and hub genes were identified with Cytoscape.Relationships between hub genes and AD were confirmed in the Comparative Toxicogenomics Database(CTD).Potential key transcription factors were discovered with Cytoscape.Hub gene verification was performed by qPCR and immunofluorescence analyses of human specimens.Results:DE-mRNAs and DE-microRNAs were identified.Four mRNAs and microRNA-1321(miR-1321)were found to have the most connections with other genes.CBL was connected to the most genes and interacted with miR-1321,which was also connected to the most genes among the DE-microRNAs.In addition,CBL was associated with AD in the CTD.Among the top five transcription factors potentially regulating CBL transcription,only HOXB13 was a DE-mRNA.The findings were further successfully verified in human specimens.Conclusion:CBL,which may be transcriptionally regulated by HOXB13 and post-transcriptionally regulated by miR-1321,was identified as the most promising potential biomarker for AD.展开更多
Rationale:Aortic dissection is a life-threatening medical emergency associated with high morbidity and mortality.Preoperative mesenteric malperfusion increases the surgical risk and mortality in patients with type B a...Rationale:Aortic dissection is a life-threatening medical emergency associated with high morbidity and mortality.Preoperative mesenteric malperfusion increases the surgical risk and mortality in patients with type B aortic dissection.For DeBakey type III B patients involving most of the thoracoabdominal aorta,endovascular treatment to improve true lumen perfusion may have limited benefits.Organ reperfusion on-time is crucial.Patient concerns:A 38-year-old man was admitted with sudden severe upper abdominal pain.Emergency CTA of the entire aorta revealed an aortic dissection with an entry tear in the descending aortic arch involving the celiac trunk,superior mesenteric artery,bilateral common iliac arteries and right external iliac artery,with thrombosis in the superior mesenteric artery.Diagnoses:The patient was diagnosed with DeBakey type III aortic dissection with mesenteric artery embolism.Enhanced chest CT showed the entry tear location and involvement of major arteries.Angiography confirmed partial blood flow in the superior mesenteric artery.Interventions:The patient underwent endovascular aortic stent-graft implantation through the left femoral artery,covering the descending aortic arch and sealing the entry tear.Postoperatively,the patient received intensive care,including ventilatory support,CRRT,anti-infection therapy,vasoactive drugs and lumbar cistern drainage.Outcomes:Two weeks postoperatively,the patient developed massive black stools,indicative of intestinal obstruction and necrosis.Exploratory laparotomy revealed ischemic necrosis and rupture of the stomach,small intestine,and colon.Despite surgical efforts,the patient’s condition deteriorated,leading to death from severe infection,acid-base imbalance and multiple organ failure.展开更多
Background: Aortic dissection (AD) is a relatively rare but dreadful illness, often accompanied by severe, sharp (or tearing) back pain or anterior chest pain, as well as acute hemodynamic compromise. Painless dissect...Background: Aortic dissection (AD) is a relatively rare but dreadful illness, often accompanied by severe, sharp (or tearing) back pain or anterior chest pain, as well as acute hemodynamic compromise. Painless dissection has also been reported in rare cases and might be misdiagnosed due to its atypical symptoms leading to catastrophic outcomes. Case presentation: The patient was admitted to the hospital due to right limb weakness with speech inability for more than 10 hours. In the routine cardiac ultrasound examination, the avulsion intimal echo was found in the initial segment of the descending aorta. The rupture range was about 11 mm, and the lumen was separated into real and false lumen. Further computed tomography angiography (CTA) examination confirmed the major arterial dissection (De Bakey Type I). Conclusion: We report a case of painless aortic dissection with active carotid artery thrombosis diagnosed by ultrasound and CTA, and to improve the understanding of painless aortic dissection by reviewing relevant domestic and foreign literature.展开更多
BACKGROUND Aortic dissection(AD)is a life-threatening condition with a high mortality rate without immediate medical attention.Early diagnosis and appropriate treatment are critical in treating patients with AD.In the...BACKGROUND Aortic dissection(AD)is a life-threatening condition with a high mortality rate without immediate medical attention.Early diagnosis and appropriate treatment are critical in treating patients with AD.In the emergency department,patients with AD commonly present with classic symptoms of unanticipated severe chest or back pain.However,it is worth noting that atypical symptoms of AD are easily misdiagnosed.CASE SUMMARY A 51-year-old woman was first diagnosed with scapulohumeral periarthritis due to left shoulder pain.After careful examination of her previous medical history and contrast-enhanced computed tomography angiography,the patient was diagnosed with a new type A AD after chronic type B dissection in the ascending aorta.The patient was successfully treated with surgical replacement of the dissected aortic arch and remains in good health.CONCLUSION New retrograde type A AD after chronic type B dissection is relatively rare.It is worth noting that a physician who has a patient with suspected AD should be vigilant.Both patient medical history and imaging tests are crucial for a more precise diagnosis.展开更多
<strong>Background and Aim:</strong> Reports on recovery from Stanford type A aortic dissection (TAAD) leading to cardiopulmonary arrest (CPA) are few. In retrograde TAAD (r-TAAD) cases, some authors repor...<strong>Background and Aim:</strong> Reports on recovery from Stanford type A aortic dissection (TAAD) leading to cardiopulmonary arrest (CPA) are few. In retrograde TAAD (r-TAAD) cases, some authors reported the efficacy of thoracic endovascular aortic repair (TEVAR). However, only a few reports chose TEVAR for the treatment of r-TAAD resulting in cardiac arrest before hospital arrival. We report a case of r-TAAD presenting with cardiac arrest before hospital arrival not indicated for surgery but TEVAR as treatment. <strong>Case: </strong>A 65-year-old woman with a history of Marfan syndrome presented to the emergency department after a CPA. Sequential return of spontaneous circulation was achieved 27 min after CPA. Contrast-enhanced computed tomography showed retrograde r-TAAD with an entry tear to the false lumen in the thoracic descending aorta. Therefore, thoracic endovascular aortic repair (TEVAR) was performed with r-TAAD. Afterward, the clinical course was stabilized. This patient suggests that TEVAR is an effective option for the treatment of patients with hemodynamically unstable r-TAAD, even after CPA. <strong>Conclusion:</strong> TEVAR can lead to a successful recovery from cardiac arrest due to r-TAAD.展开更多
Objective Acute aortic dissection （AAD） is a catastrophic event with high early mortality rate, but to date, no data on the incidence of AAD in China's Mainland is available. This study aimed to estimate the inc...Objective Acute aortic dissection （AAD） is a catastrophic event with high early mortality rate, but to date, no data on the incidence of AAD in China's Mainland is available. This study aimed to estimate the incidence of AAD in China and characterize the clinical profile, management and in-hospital outcomes of this vascular event. Methods We used the China Health Insurance Research Data （the CHIRA Data） 2011 which comprises all inpatient hospital records （300,886） during the period of Jan. 1st 2011 to Dec. 31 2011 of 3,335,000 randomly sampled beneficiaries （1,718,500 men and 1,616,500 women） from 25 cities and counties in different economic-geographic regions of China's Mainland. Patients with acute aortic dissection were identified according to International Classification of Disease 10m Revision （ICD-10） of I71.0, The estimated incidence of AAD was calculated using the equation： estimated incidence = 2.0 × （40% × hospital admission rate） ＋ 60% × hospital admission rate. Results The hospital admission rate was 2.0/100,000 （65/3,325,000, 95% CI： 1.2-2.8）. The estimated annual incidence of AAD was 2.8/100,000 （95% CI： 1.9-3.6） and was higher in male than in female （3.7 vs. 1.5, P 〈 0.001）. The mean age was 58.9 ± 13.4 years. During the mean hospital stay of 23 ±6 days, the overall in-hospital mortality was 13.9% （9/65）. Conclusions Our study showed relatively lower but not negligible incidence and in-hospital mortality of AAD in the mainland of China. The mean age of patients with AAD in Chinese was younger than that reported by researches from west countries, while the male to female incidence ratio is similar to those reported by other studies.展开更多
基金Supported by Hamad Medical Corporation,No.MRC-01-18-073.
文摘BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(AAD)and to correlate with the outcome,especially regarding renal function.To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center.We included all patients who underwent AAD repair from 2011-2017.Post-operative RML workup is part of the institutional protocol;studied patients were divided into two groups:Group 1 with RML(creatine kinase above cut-off levels 2500 U/L)and Group 2 without RML.The potential determinants of RML and impact on patient outcome,especially postoperative renal function,were studied.Other outcome parameters studied were markers of cardiac injury,length of ventilation,length of stay in the intensive care unit),and length of hospitalization.RESULTS Out of 33 patients studied,21 patients(64%)developed RML(Group RML),and 12 did not(Group non-RML).Demographic and intraoperative factors,notably body mass index,duration of surgery,and cardiopulmonary bypass,had no significant impact on the incidence of RML.Preoperative visceral/peripheral malperfusion,though not statistically significant,was higher in the RML group.A significantly higher incidence of renal complications,including de novo postoperative dialysis,was noticed in the RML group.Other morbidity parameters were also higher in the RML group.There was a significantly higher incidence of AKI in the RML group(90%)than in the non-RML group(25%).All four patients who required de novo dialysis belonged to the RML group.The peak troponin levels were significantly higher in the RML group.CONCLUSION In this study,we noticed a high incidence of RML after aortic dissection surgery,coupled with an adverse renal outcome and the need for post-operative dialysis.Prompt recognition and management of RML might improve the renal outcome.Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.
文摘BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,and ScienceDirect identified five studies involving 2572 patients(1153 males and 1419 females).The primary outcome was hospital mortality.Secondary outcomes included reintervention rates,acute kidney injury(AKI),ischemic stroke,limb ischemia,and spinal cord ischemia.Odds ratios(OR)with 95%confidence intervals(CI)were calculated using a random-effects model.Heterogeneity was assessed using the I²statistic.RESULTS The primary outcome showed no significant difference between males and females for hospital mortality(OR:1.13,95%CI:0.81-1.59,P=0.47,I2=0).Among secondary outcomes,males had a significantly higher risk of AKI(OR:1.55,95%CI:1.21-2.00,P=0.0006,I²=0).No differences were observed for reintervention rates,ischemic stroke,limb ischemia,or spinal cord ischemia.CONCLUSION Male patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality,ischemic events,reintervention,and other complications.Future research should explore mechanisms and strategies to optimize outcomes.
基金Philosophy and Social Sciences Research Project of the Hubei Provincial Department of Education(Project No.:23D108)。
文摘Objective:To investigate the incidence of delirium in elderly patients with Stanford-type B aortic dissection and analyze its risk factors.Methods:A convenience sample of 767 elderly patients with Stanford-type B aortic dissection admitted to the ICU from January 2020 to December 2023 was selected.Data were collected using a delirium-related questionnaire and the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Results:The incidence of delirium in elderly Stanford B aortic dissection patients was 23.73%.Logistic regression analysis showed that gender,length of stay in the ICU,and duration of sedative drug use were independent risk factors for delirium in elderly patients(P<0.05).The model likelihood ratio test x^(2)=28.462,P<0.001;Hosmer-Lemeshow goodness-of-fit test x^(2)=0.715,P=0.878.Conclusion:The incidence of delirium in elderly patients with Stanford-type B aortic dissection is relatively low.Medical staff should conduct adequate and effective preoperative assessment according to the condition of elderly Stanford-type B aortic dissection patients,and use analgesic and sedative drugs reasonably to create a good treatment environment for patients,thereby minimizing the incidence of delirium in elderly patients with Stanford-type B aortic dissection as much as possible.
文摘Objective To investigate the clinical predictors of malperfusion in patients with acute type A aortic dissection(ATAAD)and to construct a diagnostic model to identify high-risk individuals.Methods A retrospective analysis of 553 ATAAD patients from Tongji Hospital divided into malperfusion and non-malperfusion groups was conducted.Logistic regression was used to identify independent predictors of the outcome.Model performance via the Hosmer–Lemeshow test,decision curve analysis(DCA),the area under the receiver operating characteristic curve(AUC),sensitivity,specificity,and predictive values.Results Malperfusion was observed in 28.4%of ATAAD patients.Significant predictors included elevated lactate dehydrogenase(LDH)(OR:1.0019,95%CI:1.0002–1.0036,P=0.027),alanine aminotransferase(ALT)(OR:0.9936,95%CI:0.987–1.000,P=0.046)and estimated glomerular filtration rate(eGFR)(OR:0.9877,95%CI:0.977–0.998,P=0.021),suggesting roles for tissue ischemia and impaired renal or hepatic function.Other variables,such as D-dimer,uric acid,creatinine,and NT-proBNP,showed trends toward significance but did not reach the 0.05 threshold.The model demonstrated good calibration(Hosmer–Lemeshow P=0.318),moderate discriminatory power(AUC=0.725),high specificity(93.62%),and low sensitivity(26.75%).Conclusion The model based on routine biochemical markers provides a practical approach for the early identification of malperfusion in ATAAD patients.It shows strong specificity and clinical utility,although its limited sensitivity highlights the need for further refinement.Future improvements should focus on incorporating additional clinical or imaging data to increase diagnostic accuracy.
基金supported by the National Key Research and Development Program of China(2023YFC2506500,2021YFC2500500)the Program of Shanghai Academic Research Leader(22XD1423300)the National Natural Science Foundation of China(T2288101,82370357,82100470)。
文摘Background:The National Chest Pain Center Program(NCPCP)is a nationwide,quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China.The benefits of chest pain center(CPC)accreditation on acute coronary syndrome have been demonstrated.However,there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection(AAD).Methods:We conducted a retrospective observational study of patients with AAD from 1671 hospitals in China,using data from the NCPCP spanning the period from January 1,2016 to December 31,2022.The patients were divided into 2 groups:pre-accreditation and post-accreditation admissions.The outcomes examined included in-hospital mortality,misdiagnosis,and Stanford type A AAD surgery.Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes.Furthermore,we stratified the hospitals based on their geographical location(Eastern/Central/Western regions)or administrative status(provincial/non-provincial capital areas)to assess the impact of CPC accreditation on AAD patients across various regions.Results:The analysis encompassed a total of 40,848 patients diagnosed with AAD.The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis(12.1%vs.16.3%,P<0.001 and 2.9%vs.5.4%,P<0.001,respectively)as well as a notably higher rate of Stanford type A AAD surgery(61.1%vs.42.1%,P<0.001)compared with the pre-accreditation group.After adjusting for potential covariates,CPC accreditation was associated with substantially reduced risks of in-hospital mortality(adjusted OR=0.644,95%CI 0.599-0.693)and misdiagnosis(adjusted OR=0.554,95%CI 0.493-0.624),along with an increase in the proportion of patients undergoing Stanford type A AAD surgery(adjusted OR=1.973,95%CI 1.797-2.165).Following CPC accreditation,there were significant reductions in in-hospital mortality across various regions,particularly in Western regions(from 21.5%to 14.1%).Moreover,CPC accreditation demonstrated a more pronounced impact on in-hospital mortality in non-provincial cities compared to provincial cities(adjusted OR:0.607 vs.0.713).Conclusion:CPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.
文摘Background and Objective The natural history of type B aortic intramural hematoma(IMH)is highly heterogeneous.A computational fluid dynamics(CFD)model can be utilized to calculate a range of data pertinent to flow dynamics,including flow rates,blood velocity,pressure,and wall shear stress.This study presents a series of CFD simulations that model the dynamic progression from type B aortic IMH to false lumen formation.Methods A 66-year-old male patient presenting with chest and back pain underwent aortic computed tomography angiography(CTA),and a 3D patient-specific model was constructed.To evaluate the hemodynamic environment,the velocity,pressure,time-averaged wall shear stress(TAWSS),and oscillatory shear index(OSI)were calculated.Results A modest quantity of slow flow and recirculation flow was observed in the vicinity of the ulcer-like protrusion(ULP).During the formation of the false lumen,low-velocity blood flow entered the false lumen and resulted in vortex flow.ULPs were located in the region with higher TAWSS,and some high OSIs were found on the ULPs.Conclusion This preliminary study suggests a potential association between the TAWSS or OSI and progression from type B aortic IMH to aortic dissection.
文摘A comprehensive differential diagnosis is essential in the emergency department, even when patient presentations are atypical. Timely recognition of life-threatening conditions, such as aortic dissection, hinges on this critical diagnostic approach.
基金Supported by Qinghai Province Medical and Health Technology Project,No.2021-wjzdx-88.
文摘BACKGROUND Endovascular repair of aortic dissection is an effective method commonly used in the treatment of Stanford type B aortic dissection.Stent placement during the operation was one-time and could not be repeatedly adjusted during the operation.Therefore,it is of great significance for cardiovascular physicians to fully understand the branch status,position,angle,and other information regarding aortic arch dissection before surgery.AIM To provide more references for clinical cardiovascular physicians to develop treatment plans.METHODS Data from 153 patients who underwent endovascular repair of aortic dissection at our hospital between January 2021 and December 2022 were retrospectively collected.All patients underwent multi-slice spiral computed tomography angiography.Based on distinct post-image processing techniques,the patients were categorized into three groups:Multiplanar reconstruction(MPR)(n=55),volume reconstruction(VR)(n=46),and maximum intensity projection(MIP)(n=52).The detection rate of aortic rupture,accuracy of the DeBakey classification,rotation,and tilt angles of the C-arm during the procedure,dispersion after stent release,and the incidence of late complications were recorded and compared.RESULTS The detection rates of interlayer rupture in the MPR and VR groups were significantly higher than that in the MIP group(P<0.05).The detection rates of De-Bakey subtypesⅠ,Ⅱ,andⅢin the MPR group were higher than those in the MIP group,and the detection rate of typeⅢin the MPR group was significantly higher than that in the VR group(P<0.05).There was no statistically significant difference in the detection rates of typesⅠandⅡcompared to the VR group(P>0.05).The scatter rate of markers and the incidence of complications in the MPR group were significantly lower than those in the VR and MIP groups(P<0.05).CONCLUSION The application of MPR in the endovascular repair of aortic dissection has improved the detection rate of dissection rupture,the accuracy of anatomical classification,and safety.
文摘BACKGROUND Aortic coarctation is a potentially fatal condition that is primarily treated surgically.Despite successful procedures,patients frequently experience postoperative anxiety and depression,which can hinder recovery and worsen outcomes.Pharmacological interventions,such as 5-hydroxytryptamine(5-HT)and norepinephrine reuptake inhibitors,are commonly prescribed;however,their efficacy alone or in combination with non-invasive brain stimulation techniques,such as repetitive transcranial magnetic stimulation(TMS),remains unclear.AIM To assess the effect of medications and TMS on post-aortic surgery anxiety and depression.METHODS We analyzed the outcomes of 151 patients with anxiety and depression who were hospitalized for aortic dissection between January 2020 and September 2022.Using the random number table method,75 and 76 patients were allocated to the normal control and study groups,respectively.All the patients were treated using routine procedures.The control group was administered anti-anxiety and antidepression drugs,whereas the study group was treated with TMS in addition to these medications.The patients in both groups showed improvement after two courses of treatment.The Hamilton Anxiety Scale(HAMA)and the Hamilton Depression Scale(HAMD)were used to assess anxiety and depression,respectively.The serum levels of brain-derived neurotrophic factor(BDNF)and 5-HT were determined using enzyme-linked immunosorbent assay.The Pittsburgh Sleep Quality Index(PSQI)was used to estimate sleep quality,and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)was used to assess cognitive function.RESULTS The HAMD and HAMA scores reduced in 2 groups,with the study group achieving a lower level than control(P<0.05).In the control group,43 patients recovered,17 showed improvement,and 15 were deemed invalid.In the study group,52 recovered,20 improved,and four were invalid.The efficacy rate in study group was 94.74%compared to 80.00%in control(P<0.05).The BDNF and 5-HT levels increased in both groups,with higher levels observed in the experimental group(P<0.05).Moreover,the PSQI scores decreased in 2 groups,but were lower in the intervention group than control(P<0.05).The scores of the RBANS items increased,with the study group scoring higher than control(P<0.05).CONCLUSION Combining anti-anxiety and anti-depressive drugs with repetitive TMS after aortic surgery may enhance mood and treatment outcomes,offering a promising clinical approach.
基金Supported by Huanhua Talent for Discipline Backbone of Sichuan Provincial People’s Hospital,No.SY2022017Science Fund for Distinguished Young Scholars of Sichuan Province,No.2021JDJQ0041+1 种基金Sichuan Science and Technology Program,No.2020YFQ0060National Natural Science and Technology Foundation of China,No.81800274.
文摘BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulation.Postoperative descending aorta remodeling is closely linked to the false lumen area ratio(FLAR),defined as false lumen area/aortic area,as well as to the incidence of renal replacement therapy(RRT).AIM To investigate the effect of the updated arterial cannulation strategy on descending aortic remodeling.METHODS A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the study.Of these,209 received right AA cannulation and 234 received bilateral CA cannulation.The primary outcome was the change in FLAR,as calculated from computed tomography angiography in three segments of the descending aorta:Thoracic(S1),upper abdominal(S2),and lower abdominal(S3).Secondary outcomes were the incidence of RRT and the serum inflammation response,as observed by the levels of high sensitivity C reaction protein(hs-CRP)and Interleukin-6(IL-6).RESULTS The postoperative/preoperative ratio of FLAR in S2 and S3 was higher in the AA group compared to the CA group(S2:0.80±0.08 vs 0.75±0.07,P<0.001;S3:0.57±0.12 vs 0.50±0.12,P<0.001,respectively).The AA group also had a significantly higher incidence of RRT(19.1%vs 8.5%,P=0.001;odds ratio:2.533,95%CI:1.427-4.493)and higher levels of inflammation cytokines 24 h after the procedure[hr-CRP:117±17 vs 104±15 mg/L;IL-6:129(103,166)vs 83(69,101)pg/mL;both P<0.001]compared to the CA group.CONCLUSION The CA cannulation strategy was associated with better abdominal aorta remodeling after AAD repair compared to AA cannulation,as observed by a greater change in FLAR and lower incidence of RRT.
文摘BACKGROUND The utility of D-dimer(DD)as a biomarker for acute aortic dissection(AD)is recognized.Yet,its predictive value for in-hospital mortality remains uncertain and subject to conflicting evidence.AIM To conduct a meta-analysis of AD-related in-hospital mortality(ADIM)with elevated DD levels.METHODS We searched PubMed,Scopus,Embase,and Google Scholar for AD and ADIM literature through May 2022.Heterogeneity was assessed using I2 statistics and effect size(hazard or odds ratio)analysis with random-effects models.Sample size,study type,and patients’mean age were used for subgroup analysis.The significance threshold was P<0.05.RESULTS Thirteen studies(3628 patients)were included in our study.The pooled prevalence of ADIM was 20%(95%CI:15%-25%).Despite comparable demographic characteristics and comorbidities,elevated DD values were associated with higher ADIM risk(unadjusted effect size:1.94,95%CI:1.34-2.8;adjusted effect size:1.12,95%CI:1.05-1.19,P<0.01).Studies involving patients with a mean age of<60 years exhibited an increased mortality risk(effect size:1.43,95%CI:1.23-1.67,P<0.01),whereas no significant difference was observed in studies with a mean age>60 years.Prospective and larger sample size studies(n>250)demonstrated a heightened likelihood of ADIM associated with elevated DD levels(effect size:2.57,95%CI:1.30-5.08,P<0.01 vs effect size:1.05,95%CI:1.00-1.11,P=0.05,respectively).CONCLUSION Our meta-analysis shows elevated DD increases in-hospital mortality risk in AD patients,highlighting the need for larger,prospective studies to improve risk prediction models.
文摘Aortic dissection is the deadliest disease of the cardiovascular system.Type B aortic dissection accounts for 30%-60%of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm repair(TEVAR).However,patients are prone to various complications after surgery,with central nervous system injury being the most common,which seriously affects their prognosis and increases the risk of disability and death.Therefore,exploring the risk factors of central nervous system injury after TEVAR can provide a basis for its prevention and control.AIM To investigate the risk factors for central nervous system injury after the repair of a thoracic endovascular aneurysm with type B aortic dissection.METHODS We enrolled 306 patients with type B aortic dissection who underwent TEVAR at our hospital between December 2019 and October 2022.The patients were categorized into injury(n=159)and non-injury(n=147)groups based on central nervous system injury following surgery.The risk factors for central nervous system injury after TEVAR for type B aortic dissection were screened by comparing the two groups.Multivariate logistic regression analysis was performed.RESULTS The Association between age,history of hypertension,blood pH value,surgery,mechanical ventilation,intensive care unit stay,postoperative recovery times on the first day after surgery,and arterial partial pressure of oxygen on the first day after surgery differed substantially(P<0.05).Multivariate logistic regression analysis indicated that age,surgery time,history of hypertension,duration of mechanical ventilation,and intensive care unit stay were independent risk factors for central nervous system injury after TEVAR of type B aortic dissection(P<0.05).CONCLUSION For high-risk patients with central nervous system injury after TEVAR of type B aortic dissection,early intervention measures should be implemented to lower the risk of neurological discomfort following surgery in high-risk patients with central nervous system injury after TEVAR for type B aortic dissection.
文摘Background: Aortic dissection (AD) is one of the common causes of fatal chest pain in emergency medicine. The main and most common clinical manifestation is pain, with about 90% of patients experiencing sudden persistent, tearing or cutting-like pain in the chest or back. However, there have also been reports of myocardial infarction, heart failure, renal failure, syncope, shock, stroke, paraplegia and other cases. Clinical misdiagnosis is common. Aim: Alert clinicians to aortic dissection with shock and chest tightness as the main clinical presentations. Case Presentation: Report on two cases of aortic dissection with syncope and shock as the main manifestations. Conclusion: Aortic dissection is a highly dangerous cardiovascular emergency with a high mortality rate. In clinical practice, awareness of the clinical manifestations of aortic dissection should be increased. Careful inquiry about medical history, attention to atypical clinical presentations of aortic dissection, thorough physical examination, and comprehensive diagnostic evaluation can improve the success rate of diagnosing aortic dissection.
文摘Background Type A aortic dissection,as a cardiovascular emergency,is best treated with early surgical intervention.With advancements in surgical techniques and perioperative management,the clinical cure rate of surgery has significantly improved.However,the probability of postoperative complications remains high,among which postoperative hepatic dysfunction is one of the common and serious complications affecting prognosis.The purpose of this study was to explore the risk factors associated with postoperative hepatic dysfunction in patients with type A aortic dissection,hoping to identify high-risk patients early,prevent postoperative hepatic dysfunction,and improve patient prognosis.Methods A retrospective analysis was conducted on patients diagnosed with Stanford type A aortic dissection and treated with Sun's procedure at Guangdong Provincial People's Hospital from January 1,2021,to October 1,2022.The Model for End-Stage Liver Disease excluding International Normalized Ratio(MELD-XI)score was used as the evaluation index for postoperative hepatic dysfunction(HD).MELD-XI scores from postoperative day 1 to 7 were collected.Statistical methods were employed to analyze the perioperative clinical data of the two groups of patients.Variables with statistical significance in univariate analysis were included in multivariate logistic regression analysis to identify independent risk factors associated with postoperative HD.Results A total of 241 patients diagnosed with Stanford type A aortic dissection and hospitalized for Sun's procedure treatment were selected using specific inclusion and exclusion criteria.All patients were divided into HD group(MELD-XI score≥12,n=108)and normal group(MELD-XI score<12,n=133),with a postoperative HD incidence rate of 44.81%.There were statistically significant differences(P<0.05)between the two groups in terms of whether the surgery was emergency,gender distribution,preoperative level of white blood cell count,alanine aminotransferase,aspartate aminotransferase,brain natriuretic peptide,high-sensitivity troponin T,and serum creatinine.Statistically significant differences(P<0.05)were also observed in surgical duration,cardiopulmonary bypass time,intraoperative and postoperative 24-hour red blood cell transfusion volume,intraoperative and postoperative 24-hour plasma transfusion volume,and intraoperative bleeding volume.Moreover,patients with postoperative hepatic dysfunction had longer mechanical ventilation time,longer intensive care unit(ICU)and total hospital stay,and higher probabilities of postoperative gastrointestinal bleeding,paraplegia,cerebral complications,re-thoracotomy for hemostasis,reintubation,and extracorporeal membrane oxygenation(ECMO)therapy(P<0.05).The probabilities of acute kidney injury and receiving hemodialysis treatment were also higher(P<0.05).Following multivariate regression analysis,preoperative white blood cell count(OR:1.169,95%CI:1.028-1.329,P=0.017),preoperative serum creat-inine(OR:1.045,95%CI:1.028-1.062,P<0.001),and intraoperative and postoperative 24-hour red blood cell transfusion volume(OR:1.146,95%CI:1.030-1.274,P=0.012)were identified as independent risk factors associated with postoperative hepatic dysfunction in patients with Stanford type A aortic dissection after Sun's procedure.Conclusions In this study,the incidence of postoperative hepatic dysfunction in patients with Stanford type A aortic dissection after Sun's procedure was relatively high,at 44.81%.The independent risk factors associated with postoperative hepatic dysfunction in patients with type A aortic dissection include preoperative white blood cell count,preoperative alanine aminotransferase,and intraoperative and postoperative 24-hour red blood cell transfusion volume.Postoperative hepatic dysfunction significantly affects the prognosis of patients with Stanford type A aortic dissection,increasing the duration of postoperative mechanical ventilation,postoperative hospitalization time,and the probability of postoperative acute kidney injury.
基金supported by grants from the Guangzhou Basic and Applied Basic Research Foundation(202201010940)National Natural Science Foundation of China(82200306)Guangdong Basic and Applied Basic Research Foundation(2021A1515111092).
文摘Background:Aortic dissection(AD)is a fatal cardiovascular disease for which the key involved genes are largely unknown.Here,we aimed to identify promising AD biomarkers from high-throughput RNA expressing data.Methods:In the GSE98770 dataset,differentially expressed mRNAs(DE-mRNAs)and microRNAs(DE-microRNAs)were identified through differentially expressed gene analysis and gene set enrichment analysis.The regulatory network between DE-mRNAs and DE-microRNAs was established,and hub genes were identified with Cytoscape.Relationships between hub genes and AD were confirmed in the Comparative Toxicogenomics Database(CTD).Potential key transcription factors were discovered with Cytoscape.Hub gene verification was performed by qPCR and immunofluorescence analyses of human specimens.Results:DE-mRNAs and DE-microRNAs were identified.Four mRNAs and microRNA-1321(miR-1321)were found to have the most connections with other genes.CBL was connected to the most genes and interacted with miR-1321,which was also connected to the most genes among the DE-microRNAs.In addition,CBL was associated with AD in the CTD.Among the top five transcription factors potentially regulating CBL transcription,only HOXB13 was a DE-mRNA.The findings were further successfully verified in human specimens.Conclusion:CBL,which may be transcriptionally regulated by HOXB13 and post-transcriptionally regulated by miR-1321,was identified as the most promising potential biomarker for AD.
基金Jining City Key R&D Program Projects(Project No.:2023YXNS155)。
文摘Rationale:Aortic dissection is a life-threatening medical emergency associated with high morbidity and mortality.Preoperative mesenteric malperfusion increases the surgical risk and mortality in patients with type B aortic dissection.For DeBakey type III B patients involving most of the thoracoabdominal aorta,endovascular treatment to improve true lumen perfusion may have limited benefits.Organ reperfusion on-time is crucial.Patient concerns:A 38-year-old man was admitted with sudden severe upper abdominal pain.Emergency CTA of the entire aorta revealed an aortic dissection with an entry tear in the descending aortic arch involving the celiac trunk,superior mesenteric artery,bilateral common iliac arteries and right external iliac artery,with thrombosis in the superior mesenteric artery.Diagnoses:The patient was diagnosed with DeBakey type III aortic dissection with mesenteric artery embolism.Enhanced chest CT showed the entry tear location and involvement of major arteries.Angiography confirmed partial blood flow in the superior mesenteric artery.Interventions:The patient underwent endovascular aortic stent-graft implantation through the left femoral artery,covering the descending aortic arch and sealing the entry tear.Postoperatively,the patient received intensive care,including ventilatory support,CRRT,anti-infection therapy,vasoactive drugs and lumbar cistern drainage.Outcomes:Two weeks postoperatively,the patient developed massive black stools,indicative of intestinal obstruction and necrosis.Exploratory laparotomy revealed ischemic necrosis and rupture of the stomach,small intestine,and colon.Despite surgical efforts,the patient’s condition deteriorated,leading to death from severe infection,acid-base imbalance and multiple organ failure.
文摘Background: Aortic dissection (AD) is a relatively rare but dreadful illness, often accompanied by severe, sharp (or tearing) back pain or anterior chest pain, as well as acute hemodynamic compromise. Painless dissection has also been reported in rare cases and might be misdiagnosed due to its atypical symptoms leading to catastrophic outcomes. Case presentation: The patient was admitted to the hospital due to right limb weakness with speech inability for more than 10 hours. In the routine cardiac ultrasound examination, the avulsion intimal echo was found in the initial segment of the descending aorta. The rupture range was about 11 mm, and the lumen was separated into real and false lumen. Further computed tomography angiography (CTA) examination confirmed the major arterial dissection (De Bakey Type I). Conclusion: We report a case of painless aortic dissection with active carotid artery thrombosis diagnosed by ultrasound and CTA, and to improve the understanding of painless aortic dissection by reviewing relevant domestic and foreign literature.
文摘BACKGROUND Aortic dissection(AD)is a life-threatening condition with a high mortality rate without immediate medical attention.Early diagnosis and appropriate treatment are critical in treating patients with AD.In the emergency department,patients with AD commonly present with classic symptoms of unanticipated severe chest or back pain.However,it is worth noting that atypical symptoms of AD are easily misdiagnosed.CASE SUMMARY A 51-year-old woman was first diagnosed with scapulohumeral periarthritis due to left shoulder pain.After careful examination of her previous medical history and contrast-enhanced computed tomography angiography,the patient was diagnosed with a new type A AD after chronic type B dissection in the ascending aorta.The patient was successfully treated with surgical replacement of the dissected aortic arch and remains in good health.CONCLUSION New retrograde type A AD after chronic type B dissection is relatively rare.It is worth noting that a physician who has a patient with suspected AD should be vigilant.Both patient medical history and imaging tests are crucial for a more precise diagnosis.
文摘<strong>Background and Aim:</strong> Reports on recovery from Stanford type A aortic dissection (TAAD) leading to cardiopulmonary arrest (CPA) are few. In retrograde TAAD (r-TAAD) cases, some authors reported the efficacy of thoracic endovascular aortic repair (TEVAR). However, only a few reports chose TEVAR for the treatment of r-TAAD resulting in cardiac arrest before hospital arrival. We report a case of r-TAAD presenting with cardiac arrest before hospital arrival not indicated for surgery but TEVAR as treatment. <strong>Case: </strong>A 65-year-old woman with a history of Marfan syndrome presented to the emergency department after a CPA. Sequential return of spontaneous circulation was achieved 27 min after CPA. Contrast-enhanced computed tomography showed retrograde r-TAAD with an entry tear to the false lumen in the thoracic descending aorta. Therefore, thoracic endovascular aortic repair (TEVAR) was performed with r-TAAD. Afterward, the clinical course was stabilized. This patient suggests that TEVAR is an effective option for the treatment of patients with hemodynamically unstable r-TAAD, even after CPA. <strong>Conclusion:</strong> TEVAR can lead to a successful recovery from cardiac arrest due to r-TAAD.
文摘Objective Acute aortic dissection （AAD） is a catastrophic event with high early mortality rate, but to date, no data on the incidence of AAD in China's Mainland is available. This study aimed to estimate the incidence of AAD in China and characterize the clinical profile, management and in-hospital outcomes of this vascular event. Methods We used the China Health Insurance Research Data （the CHIRA Data） 2011 which comprises all inpatient hospital records （300,886） during the period of Jan. 1st 2011 to Dec. 31 2011 of 3,335,000 randomly sampled beneficiaries （1,718,500 men and 1,616,500 women） from 25 cities and counties in different economic-geographic regions of China's Mainland. Patients with acute aortic dissection were identified according to International Classification of Disease 10m Revision （ICD-10） of I71.0, The estimated incidence of AAD was calculated using the equation： estimated incidence = 2.0 × （40% × hospital admission rate） ＋ 60% × hospital admission rate. Results The hospital admission rate was 2.0/100,000 （65/3,325,000, 95% CI： 1.2-2.8）. The estimated annual incidence of AAD was 2.8/100,000 （95% CI： 1.9-3.6） and was higher in male than in female （3.7 vs. 1.5, P 〈 0.001）. The mean age was 58.9 ± 13.4 years. During the mean hospital stay of 23 ±6 days, the overall in-hospital mortality was 13.9% （9/65）. Conclusions Our study showed relatively lower but not negligible incidence and in-hospital mortality of AAD in the mainland of China. The mean age of patients with AAD in Chinese was younger than that reported by researches from west countries, while the male to female incidence ratio is similar to those reported by other studies.
