Successful repair of acute type A aortic dissection during pregnancy at 16th gestational week with maternal and fetal survival: A case report and review of the literature

BACKGROUND Aortic dissection during pregnancy is a rare but life-threatening event for mothers and fetuses. It often occurs in the third trimester of pregnancy and the postpartum period. Most patients have connective tissue diseases such as Marfan syndrome. Thus, the successful repair of a sporadic aortic dissection with maternal and fetal survival in the early second trimester is extremely rare. CASE SUMMARY A 28-year-old woman without Marfan syndrome presented with chest pain at the 16th gestational week. Aortic computed tomographic angiography confirmed an acute type A aortic dissection (TAAD) with aortic arch and descending aorta involvement. Preoperative fetal ultrasound confirmed that the fetus was stable in the uterus. The patient underwent total arch replacement with a frozen elephant trunk using moderate hypothermic circulatory arrest with the fetus in situ. The patient recovered uneventfully and continued to be pregnant after discharge. At the 38^th gestational week, she delivered a healthy female infant by cesarean section. After 2.5 years of follow-up, the patient is uneventful and the child’s development is normal. CONCLUSION A fetus in the second trimester may have a high possibility of survival and healthy growth after aortic arch surgery.

Development and validation of a nomogram for postoperative severe acute kidney injury in acute type A aortic dissection

BACKGROUND Postoperative acute kidney injury(AKI) is a major complication associated with increased morbidity and mortality after surgery for acute type A aortic dissection(AAAD). To the best of our knowledge, risk prediction models for AKI following AAAD surgery have not been reported. The goal of the present study was to develop a prediction model to predict severe AKI after AAAD surgery.METHODS A total of 485 patients who underwent AAAD surgery were enrolled and randomly divided into the training cohort(70%) and the validation cohort(30%). Severe AKI was defined as AKI stage Ⅲ following the Kidney Disease: Improving Global Outcomes criteria. Preoperative variables, intraoperative variables and postoperative data were collected for analysis. Multivariable logistic regression analysis was performed to select predictors and develop a nomogram in the study cohort. The final prediction model was validated using the bootstrapping techniques and in the validation cohort.RESULTS The incidence of severe AKI was 23.0%(n = 78), and 14.7%(n = 50) of patients needed renal replacement treatment.The hospital mortality rate was 8.3%(n = 28), while for AKI patients, the mortality rate was 13.1%, which increased to 20.5% for severe AKI patients. Univariate and multivariate analyses showed that age, cardiopulmonary bypass time, serum creatinine, and D-dimer were key predictors for severe AKI following AAAD surgery. The logistic regression model incorporated these predictors to develop a nomogram for predicting severe AKI after AAAD surgery. The nomogram showed optimal discrimination ability, with an area under the curve of 0.716 in the training cohort and 0.739 in the validation cohort. Calibration curve analysis demonstrated good correlations in both the training cohort and the validation cohort.CONCLUSIONS We developed a prognostic model including age, cardiopulmonary bypass time, serum creatinine, and D-dimer to predict severe AKI after AAAD surgery. The prognostic model demonstrated an effective predictive capability for severe AKI, which may help improve risk stratification for poor in-hospital outcomes after AAAD surgery.

Limited vs. extended repair for acute type I aortic dissection: long-term outcomes over a decade in Beijing Anzhen Hospital

To the Editor:For patients with acute DeBakey type laortic dissection,ascending aortic or hemiarch replacement can reduce the surgical time and save lives in critical situations.However,residual distal dissection increases the risk of dilatation,rupture,and death.[1] In contrast,total aortic arch replacement(TAR)with frozen elephant trunk(FET)implantation can minimize the need for re-intervention,[2] but may increase the risk of operative mortality,stroke,paraplegia,and other complications.Currently,the ques-tion of the optimal surgical strategy for acute DeBakey type I aortic dissection remains controversial owing to the scarcity of long-term follow-up data and the technical diversities among different institutions.