Postoperative hypoxemia for patients undergoing Stanford type A aortic dissection

Clinically,it is widely recognized that surgical treatment is the preferred and reliable option for Stanford type A aortic dissection.Stanford type A aortic dissection is an emergent and serious cardiovascular disease characterized with an acute onset,poor prognosis,and high mortality.However,the incidences of postoperative complications are relatively higher due to the complexity of the disease and its intricate procedure.It has been considered that hypoxemia,one of the most common postoperative complications,plays an important role in having a worse clinical prognosis.Therefore,the effective intervention of postoperative hypoxemia is significant for the improved prognosis of patients with Stanford type A aortic dissection.

Admission white blood cell count predicts short-term clinical outcomes in patients with uncomplicated Stanford type B acute aortic dissection

Objectives Inflammation has been shown to be related with acute aortic dissection （AAD）. The present study aimed to evaluate the association of white blood cell counts （WI3Cc） on admission with both in-hospital and long-term all-cause mortality in patients with uncom- plicated Stanford type B AAD. Methods From 2008 to 2010, a total of 377 consecutive patients with uncomplicated type B AAD were enrolled and then followed up. Clinical data and WBCc on admission were collected. The primary end points were in-hospital death and long-term all-cause death. Results The in-hospital death rate was 4.2%, and the long-term all-cause mortality rate was 6.9% during a median follow-up of 18.9 months. WBCc on admission was identified as a risk factor for in-hospital death by univariate Cox regression analysis as both a continuous variable and a categorical variable using a cut off of 11.0 × 109 cell/L （all P 〈 0.05）. After adjusting for age, sex and other risk factors, elevated admission WBCc was still a significant predictor for in-hospital death as both a continuous variable [hazard ratio （HR）： 1.052, 95% CI： 1.024-1.336, P = 0.002] and a categorical variable using a cut off of 11.0 × 109 cell/L （HR： 2.056, 95% CI： 1.673-5.253, P = 0.034）. No relationship was observed between WBCc on admission and long-term all-cause death. Conclusions Our results indicate that elevated WBCc upon admission might be used as a predictor for increased risk of in-hospital death in uncomplicated type B AAD. There might be no predictive value of WBCc for the long-term survival of type B AAD.

Clinical Value of rhBNP in the Treatment of Patients with Stanford Type B Aortic Dissection

Objective:To determine the clinical value of rhBNP in the treatment of patients with Stanford type B aortic dissection.Methods:From June 2018 to October 2021,162 patients with Stanford type B aortic dissection were selected from the Cardiology Department of Henan Provincial Chest Hospital and randomly divided into two groups:control group(81 patients)and observation group(81 patients).The patients in the control group were treated with conventional therapy.On the basis of the control group,the patients in the observation group were treated with rhBNP.The cardiac function,renal function,pulmonary function,and inflammatory indices before and after treatment for 72 hours,as well as the incidence of adverse reactions between the two groups were compared.Results:After treatment,the cardiac function(LVEF and NT-pro BNP),renal function(urine output for 24 hours,SCr,and Cys-C),pulmonary function(PaO_(2),SPO_(2),and PaO_(2)/FiO_(2)),and inflammatory(IL-6,hsCRP,and MCP-1)indices of the observation group improved significantly compared to those of the control group(p<0.05).Conclusion:rhBNP can improve cardiac function,renal function,and pulmonary function,as well as alleviate inflammation in patients with Stanford type B aortic dissection.Hence,in the treatment of patients with Stanford type B aortic dissection,rhBNP provides multi-organ protection.

Progress in Diagnosis and Endoscopic Treatment of Stanford B Penetrating Aortic Ulcers

Penetrating aortic ulcers is rare in clinical practice,and it is necessary to intervene in this type of aortic perforating ulcer because it can be accompanied by major arterial dissection and intermural hematoma.With the widespread application and technical advancement of follow-up thoracic aortic endovascular repair(TEVAR),endovascular treatment has become the first choice for symptomatic aortic perforating ulcers.In this review,we will review the diagnosis,diagnosis and endovascular treatment of aortic perforating ulcer.

Strategy of dealing with left subclavian artery in total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection

Objective To summarize the experiences of ligating left subclavian artery ( LSA ) in total arch peplacement and stented elephant trunk implantation for Stanford type A aortic dissection patients with difficulty in exposing the LSA. Methods Total arch replacement and stented elephant trunk implantation were performed on 79 consecutive

Thoracic Endovascular Aortic Repair for Cardiopulmonary Arrest Due to Aortic Dissection

Background and Aim: 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. Case: 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. Conclusion: TEVAR can lead to a successful recovery from cardiac arrest due to r-TAAD.

Analysis of risk factors for major in-hospital complications of acute Stanford type B aortic dissection

Background Few studies with small sample sizes have investigated the correlations between related factors and aortic dissection （AD） complications. There is lack of systematic observation on type or stage specific AD pa- tients, such as the Stanford type B acute aortic dissection （AAD） patients with high risk of complications in hospi- tal. Methods We registered consecutive 105 Stanford type B AAD patients, and the admission day were less than 2 weeks of onset. The correlations of major complications with general clinical information, laboratory tests and treatments were analyzed. Result Among 105 cases of Stanford type B AAD patients, 46.7% cases had ma- jor complications and 8.6% patients died. The Receiver Operating Characteristic curve （ROC curve） analysis showed that the D-dimer 〉 500 μg/L was the best cut-off value to predict major complications （sensitivity 67%, specificity 79%, C-statistic was 0.69, P = 0.001）. In the univariate analysis of related factors for major complica- tions, the D-dimer 〉 500 μg/L（P = 0.0001）, NT-proBNP（P = 0.048）, Scr（P = 0.039）, age ≥ 60 year（P = 0.012）, history of hypertension and endovascular aortic repair（EVAR） in combination with carotid artery bypass （CAB） （P = 0.027） had statistically significant. After adjusting for other predictors of major complications, Logis- tic regression analysis revealed that the D-dimer 〉 500 μg/L （odds ratio： 6.14, 95% confidence interval： 1.94-19.1, P = 0.002） and age≥ 60 years （odds ratio：4.074, 95% confidence interval： 1.252-13.259, P = 0.02] were indepen- dent risk factors. While EVAR （odds ratio： 0.181, 95% confidence interval： 0.34-0.968, P = 0.046） and EVAR in combination with CAB treatments （odds ratio： 0.123, 95% confidence interval： 0.029-0.513, P = 0.004） were pro- tective factors for major complications. Conclusion D-dimer 〉 500 μg/L and age≥60 years are independent risk factors for patients with in-hospital occurrence of major complications. While EVAR or EVAR combined CAB treatment can reduce the occurrence of major complications.

Risk factors analysis for in-hospital death of acute Stanford type B aortic dissection

Background Data is limited regarding the correlation between related factors and in-hospital death of Stan- ford type B acute aortic dissection （AAD）. Methods We registered consecutive Stanford type B AAD patients, who were in the Guangdong Cardiovascular Institute of Guangdong General Hospital from October 2010 to August 2011, and the onset day to admission day were less than or equal to 2 weeks. We collected in-hospital mortality, history of disease, laboratory parameters, some biochemical markers tests, treatment and so on, analyzed the relationship between risk factors and mortality. Results One hundred and five Stanford B AAD patients were enrolled, 9 patients died, accounting for 8.6%. There are 24 patients treated with medicine, and 4 cases finally died. Endovascular aortic repair （EVAR） 62 cases, 2 cases died. EVAR combined carotid artery bypass （CAB） 19 cases, and 3 cases died. Among the three treatments, there was no significant difference in statistics （P = 0.063）. Compared with the survivors, the death group had higher D-dimer （P = 0.016） and NT-proBNP （P = 0.014） level, and more patients with myocardial infarction （P = 0.007）, hypotension or shock （P = 0.019）, a- cute renal failure （P = 0.005）, nervous system related events （P 〈 0.001 ）. After adjusting for other predictors of in-hospital death, logistic regression analysis shows that the nervous system related events （odds ratio： 21.648; 95% CI： 1.228-381.704, P = 0.036 is the independent risk factor for death. Conclusions D-dimer, hypotension or shock, acute renal failure, nervous system related events are associated with hospitalization death of Stanford type B AAD patients, while nervous system related events is an independent risk factor for in-hospital death.

Perioperative nursing of multidisciplinary emergency surgery for a late-term pregnancy with acute Stanford type A aortic dissection

To summarize a case of late pregnancy complicated with acute Stanford type A aortic dissection who underwent multidisciplinary treatment perioperative nursing experience in emergency surgery. The patient was 37weeks of intrauterine pregnancy and suffered from sudden chest pain. The emergency admission was diagnosed with aortic dissection(Stanford A type), and the condition was dangerous and life-threatening. After preoperative multidisciplinary combined systematic comprehensive disease assessment and comprehensive surgical emergency plan was formulated, do a good job of effective psychological counseling and operation cooperation education,nursing cooperation during intraoperative anesthesia and nursing focus of multidisciplinary combined surgical treatment, postoperative prevention of massive bleeding, puerperium infection and a series of effective nursing measures, no perioperative period occurred nursing complications. The newborn survived, the patient recovered and was discharged from the hospital, and returned to the hospital for re-examination with normal indicators and good physical condition.