Perioperative Risk Factors for Post-operative Pneumonia after Type A Acute Aortic Dissection Surgery

Objective Type A acute aortic dissection(TAAAD)is a dangerous and complicated condition with a high death rate before hospital treatment.Patients who are fortunate to receive prompt surgical treatment still face high in-hospital mortality.A series of post-operative complications further affects the prognosis.Post-operative pneumonia(POP)also leads to great morbidity and mortality.This study aimed to identify the prevalence as well as the risk factors for POP in TAAAD patients and offer references for clinical decisions to further improve the prognosis of patients who survived the surgical procedure.Methods The study enrolled 89 TAAAD patients who underwent surgical treatment in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei province,China from December 2020 to July 2021 and analyzed the perioperative data and outcomes of these patients.Logistic regression analyses were used to identify the risk factors for POP.Results In the study,31.5%of patients developed POP.Patients with POP had higher proportions of severe oxygenation damage,pneumothorax,reintubation,tracheotomy,renal replacement therapy,arrhythmia,gastrointestinal bleeding,and longer duration of mechanical ventilation,fever,ICU stay,and length of stay(all with P<0.05).The in-hospital mortality was 2.3%.Smoking,preoperative white blood cells,and intraoperative transfusion were the independent risk factors for POP in TAAAD.Conclusion Patients who underwent TAAAD surgery suffered poorer outcomes when they developed POP.Furthermore,patients with risk factors should be treated with caution.

High-density Lipoprotein Cholesterol and In-hospital Mortality in Patients with Acute Aortic Dissection

The association between high-density lipoprotein cholesterol（HDL-C） and mortality in patients with acute aortic dissection（AAD） is unclear. From January 2007 to January 2014, a total of 928 consecutive AAD patients who were admitted within 48 h after the onset of symptoms were enrolled in the study. Patients were divided into two groups according to whether serum HDL-C level was below the normal lower limit or not. The Cox proportional hazard regression model was used to identify the predictive value of HDL-C for in-hospital mortality in patients with AAD. As compared with normal HDL-C group（n=585）, low HDL-C group（n=343） had lower levels of systolic blood pressure and hemoglobin and higher levels of leukocyte, alanine aminotransferase, blood glucose, blood urea nitrogen, creatinine and urea acid. Low HDL-C group had significantly higher in-hospital mortality than normal HDL-C group（21.6% vs. 12.6%, log-rank=10.869, P=0.001）. After adjustment for baseline variables including demographics and biologic data, the increased risk of in-hospital mortality in low HDL-C group was substantially attenuated and showed no significant difference（adjusted hazard ratio, 1.23; 95% confidence interval, 0.86–1.77; P=0.259）. Low HDL-C is strongly but not independently associated with in-hospital mortality in patients with AAD.

Combined cesarean delivery and repair of acute aortic dissection at 34 weeks of pregnancy during COVID-19 outbreak:A case report

BACKGROUND Since the outbreak of the coronavirus disease 2019(COVID-19)pandemic,the exclusion of a patient from COVID-19 should be performed before surgery.However,patients with type A acute aortic dissection(AAD)during pregnancy can seriously endanger the health of either the mother or fetus that requires emergency surgical treatment without the test for COVID-19.CASE SUMMARY A 38-year-old woman without Marfan syndrome was admitted to the hospital because of chest pain in the 34th week of gestation.She has diagnosed as having a Stanford type-A AAD involving an aortic arch and descending aorta via aortic computed tomographic angiography.The patient was transferred to the isolated negative pressure operating room in one hour and underwent cesarean delivery and ascending aorta replacement.All medical staff adopted third-level medical protection measures throughout the patient transfer and surgical procedure.After surgery,the patient was transferred to the isolated negative pressure intensive care unit ward.The nucleic acid test and anti-COVID-19 immunoglobulin(Ig)G and IgM were performed and were negative.The patient and infant were discharged without complication nine days later and recovered uneventfully.CONCLUSION The results indicated that the procedure that we used is feasible in patients with a combined cesarean delivery and surgery for Stanford type-A AAD during the COVID-19 outbreak,which was mainly attributed to rapid multidisciplinary consultation,collaboration,and quick decision-making.

Acute Aortic Dissection in Third Trimester Pregnancy with Well Controlled Hypertension

We describe a 32-year-old pregnant woman at 31 + 6 weeks of gestation who presented to a tertiary-care hospital with headache and back pain. She was found to have a sign of tear about 1.3 cm away from the aortic valve, and the torn intima extended upward to the ascending aorta and the descending part of the aortic arch. She delivered a live male neonate via cesarean delivery. She had a history of hypertension with oral Labetalol 50 mg twice times daily. At the very beginning of the onset, physicians in the emergency room wouldn’t be aware of the symptoms of aortic dissections, as well as atypical presentations which include anterior chest pain or chest pain radiating to the back. She was only received anti-hypertension management, until her symptoms of back pain aggravated, and an aortic dissection was confirmed by ultrasound and CT angiography. Then she received a mechanical aortic valve replacement. After 51 days of treatment, she was discharged and recovered without any complications. Aortic dissection in pregnancy is a rare disease. We recommend transthoracic echocardiography every 1 to 2 months to monitor the diameter of the ascending aorta during pregnancy in which patients with hypertension problems or other risk factors of aneurysm and perform the CT angiography scan to confirm aortic dissection in a pregnant or postpartum woman with suspicious pain symptoms. It is essential that multidisciplinary approach in which teams must urgently collaborate to ensure the protection life of both mother and baby.

The Anzhen Risk Scoring System for Acute Type A Aortic Dissection:A Prospective Observational Study Protocol

Introduction:Acute type A aortic dissection(ATAAD)is a catastrophic disease with fatal outcomes.Malperfusion syndrome(MPS)is a serious complication of ATAAD,with an incidence of 20–40%.Many studies have shown that MPS is the main risk factor for poor ATAAD prognosis.However,a risk scoring system for ATAAD based on MPS is lacking.Here,we designed a risk scoring system for ATAAD to assess mortality through quantitative assessment of relevant organ malperfusion and subsequently develop rational treatment strategies.Methods and analysis:This was a prospective observational study.Patients’perioperative clinical data were col-lected to establish a database of ATAAD(N≥3000)and determine whether these patients had malperfusion complica-tions.The Anzhen risk scoring system was established on the basis of organ malperfusion by using a random forest survival model and a logistics model.The better method was then chosen to establish a revised risk scoring system.Ethics and dissemination:This study received ethical approval from the Ethics Committees of Beijing Anzhen Hospital,Capital Medical University(KS2019034-1).Patient consent was waived because biological samples were not collected,and no patient rights were violated.Findings will be disseminated at scientific conferences and in peer-reviewed publications.

Preliminary characterization of acute aortic dissection in the mainland of China

Objective To explore the differences in the characteristics of acute aortic dissection （AAD） among less and more economically developed countries with various cultures and races. Data sources Reports from the International Registry of Acute Aortic Dissection （IRAD） and the mainland of China （MC） were collected by searching the PubMed Database and the Chinese Journal Full-text Database from January 2000 to March 2009. Study selection Those reports from IRAD and MC containing larger numbers of cases and complete patients＇ information were selected, which focused on concrete issues of diagnosing or managing AAD were excluded if they were not able to reflect the overall characteristics of this condition. And the data from the article containing the largest number oatients reDorted bv the same medical center in MC were taken into statistics.

Relationship between intralobar pulmonary sequestration and type A aortic dissection:A case report

BACKGROUND Pulmonary sequestrations often lead to serious complications such as infections,tuberculosis,fatal hemoptysis,cardiovascular problems,and even malignant degeneration,but it is rarely documented with medium and large vessel vasculitis,which is likely to result in acute aortic syndromes.CASE SUMMARY A 44-year-old man with a history of acute Stanford type A aortic dissection status post-reconstructive surgery five years ago.The contrast-enhanced computed tomography of the chest at that time had also revealed an intralobar pulmonary sequestration in the left lower lung region,and the angiography also presented perivascular changes with mild mural thickening and wall enhancement,which indicated mild vasculitis.The intralobar pulmonary sequestration in the left lower lung region was long-term unprocessed,which was probably associated with his intermittent chest tightness since no specific medical findings were detected but only positive sputum culture with mycobacterium avium-intracellular complex and Aspergillus.We performed uniportal video-assisted thoracoscopic surgery with wedge resection of the left lower lung.Hypervascularity over the parietal pleura,engorgement of the bronchus due to a moderate amount of mucus,and firm adhesion of the lesion to the thoracic aorta were histopathologically noticed.CONCLUSION We hypothesized that a long-term pulmonary sequestration-related bacterial or fungal infection can result in focal infectious aortitis gradually,which may threateningly aggravate the formation of aortic dissection.

Acute ischemic Stroke combined with Stanford type A aortic dissection:A case report and literature review

BACKGROUND Acute aortic dissection(AAD)is a high mortality disease that can lead to acute ischemic strokes(AIS).Some of the patients with AAD combined with AIS initially present with neurological symptoms,which can easily lead to missed or delayed AAD diagnosis.This is attributed to the lack of physician awareness or the urgency of patient thrombolysis.Intravenous administration of thrombolytic therapy(IVT)for AAD is associated with poor prognostic outcomes.We report a patient with AIS combined with AAD who developed a massive cerebral infarction after receiving IVT for a missed AAD diagnosis.CASE SUMMARY A 49-year-old man was admitted to a local hospital with an acute onset of leftsided limb weakness accompanied by slurred speech.The patient had a history of hypertension that was not regularly treated with medication.Physical examination revealed incomplete mixed aphasia and left limb hemiparesis.Cranial computed tomography(CT)scan showed bilateral basal ganglia and lateral ventricular paraventricular infarct lesions.The patient was diagnosed with AIS and was administered with IVT.After IVT,patient’s muscle strength and consciousness deteriorated.From the local hospital,he was referred to our hospital for further treatment.Emergency head and neck CT angiography(CTA)scans were performed.Results showed multiple cerebral infarctions,and aortic dissection in the ascending aorta,innominate artery,as well as in the right common carotid artery.Then,the CTA of thoracoabdominal aorta was performed,which revealed a Stanford type A aortic dissection and aortic dissection extending from the aortic root to the left external iliac artery.Laceration was located in the lesser curvature of the aortic arch.AAD complicated with AIS was considered,and the patient was immediately subjected to cardiovascular surgery for treatment.The next day,the patient underwent aortic arch and ascending aortic replacement and aortic valvuloplasty.CONCLUSION Clinical manifestations for AAD combined with AIS are diverse.Some patients may not exhibit typical chest or back pains.Therefore,patients should be carefully evaluated to exclude AAD before administering IVT in order to avoid adverse consequences.

Surgery for Acute Stanford Type A Aortic Dissection in an Inner City Community Hospital: Single Surgeon’s Experience

Objective: An inverse relationship between volume and mortality in some cardiothoracic surgical procedures has been previously established, leading to suggestions that acute aortic dissection should not be operated in community or low volume heart centers. We therefore reviewed our experience to compare with published data. Methods: Retrospective review of 27 patients who underwent proximal aortic surgery by a single surgeon at an inner city community hospital between May 2004 and April 2015. 16 patients, mean age 51.7 ± 13.6 years old, 75.0% males underwent emergency surgery for acute Stanford type A aortic dissection, while 9 with root or ascending aortic aneurysm, mean age 50.3 ± 15.0 years old, 88.9% males had elective proximal aortic surgery. 2 patients with arch aneurysm were excluded. Results: Four (25.0%) patients with acute dissection were in Penn class A, 3 (18.7%) Penn B, 3 (18.7%) Penn C and 6 (37.5%) Penn B+C. 10 (62.5%) patients underwent emergency root replacement with 60.0% (6/10) mortality all related to malperfusion including 2 patients with bloody stools, while 6 (37.5%) underwent supracoronary graft replacement with 16.6% (1/6) mortality from cardiac tamponade. The 5-year survival was 89.0%. In patients with aortic aneurysm, 8 (88.9%) underwent elective root replacement and 1 (11.1%) supracoronary graft replacement with zero mortality. Conclusion: Supracoronary graft replacement is performed for the majority of uncomplicated acute type A dissections and can be undertaken by the average general cardiac surgeon with acceptable results. Visceral malperfusion especially when associated with bloody stools portends a poor prognosis, and aortic dissection should be excluded in any Marfan patient presenting with acute abdomen. Delaying intervention in attempting transfer to a tertiary hospital can potentially increase preoperative mortality, known to rise with each passing hour from onset of acute dissection. Patients presenting therefore to community hospitals should probably undergo surgery there to avoid complications associated with delay.

Endovascular stent-grafts for acute and chronic type B aortic dissection: comparison of clinical outcomes

Within the recent months, endovascular repair of aortic aneurysms has become a rather interesting alternative to patients considering open surgery. In the past, the procedure was typically and more solely reserved to a selected group of elderly patients with several co-morbidities.……

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.

Role of plasma C-reactive protein and white blood cell count in predicting in-hospital clinical events of acute type A aortic dissection

Background A few recent studies have reported that inflammation is associated with the prognosis of acute aortic dissection （AD）. There is, however, no systemic investigation regarding the role of plasma C-reactive protein （CRP） and white blood cell （WBC） levels in predicting in-hospital clinical events of acute type AAD. Methods The levels of high-sensitivity CRP and WBC counts were systemically determined after admission in 36 patients with acute type A AD. The variations of plasma CRP and WBC levels in different time windows （admission, 1, 2, 3, 4, 6, 8 days） in patients with acute type AAD were analyzed between patients with events and without events. Results During hospitalization, five patients died, and increased levels of CRP and WBC were found in patients died with acute type A AD compared with patients survived （P 〈0.01, respectively）. Medical treatment may significantly decrease inflammatory response in survived patients with acute type A AD. Additionally, patients with complication of pleural effusion showed higher CRP and WBC levers （P=0.046, P=-0.018, respectively）. Lower WBC levels were found in survived patients treated medically （P=-0.001）. Moreover, mean CRP and WBC levels had positive correlations with aortic diameter （r=0.364, P--0.000; r=0.333, P=0.000, respectively） and age （r=0.270, P=0.000, respectively）, while negative correlations with the time from onset of symptoms to hospital admission （r= -0.229, P=0.000, r= -0.200, P=0.002, respectively）. Univariate analysis showed that age 〉65 years, CRP zl 2.05 rag/L, WBC 〉12.16×10^9/L, aortic diameter 〉48 mm, pleural effusion and diastolic blood pressure 〉105 mmHg were associated with hospital mortality. While CRP 〉12.05 mg/L, WBC ≥12.16×10^9/L, aortic diameter 〉48 mm were strongly associated with hospital mortality in multiple Logistic regression analysis. Conclusions The results suggested that CRP and WBC were preferred markers for predicting the clinical events in patients with acute type A AD, especially death during hospitalization. Therefore, further study enrolling larger cohort, prospective study would be warranted.

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.

Clinical profiles and outcomes of acute type A aortic dissection and intramural hematoma in the current era: lessons from the first registry of aortic dissection in China

Background::Acute type A aortic dissection(ATAAD)and acute type A intramural hematoma(ATAIMH)are life-threatening diseases with high mortality.To better understand their clinical features in the Chinese population,we analyzed the data from the first Registry of Aortic Dissection in China(Sino-RAD)to promote the understanding and management of the diseases.Methods::All patients with ATAAD and ATAIMH enrolled in Sino-RAD from January 1,2012 to December 31,2016 were involved.The data of patients’selection,history,symptoms,management,outcomes,and postoperation complications were analyzed in the study.The continuous variables were compared using the Student’s t test for normal distributions and the Mann-Whitney U test for non-normal distributions.Categorical variables were compared using the Chi-square test or Fisher exact test.Results::A total of 1582 patients with ATAAD and 130 patients with ATAIMH were included.The mean age of all patients was 48.4 years.Patients with ATAAD were significantly younger than patients with ATAIMH(48.9 years vs.55.6 years,P<0.001).For the total cohort,males were dominant,but the male ratio of patients with ATAAD was significantly higher compared to those with ATAIMH(P=0.01).The time range from the onset of symptom to hospitalization was 2.0 days.More patients of ATAIMH had hypertension than that of ATAAD(82.3%vs.67.6%,P<0.05).Chest and back pain were the most common clinical symptoms.Computerized tomography(CT)was the most common initial diagnostic imaging modality.84.7%received surgical treatment and in-hospital mortality was 5.3%.Patients with ATAAD mainly received surgical treatment(89.6%),while most patients with ATAIMH received medical treatment(39.2%)or endovascular repair(35.4%).Conclusions::Our study suggests that doctors should comprehensively use clinical examination and genetic background screening for patients with ATAAD and ATAIMH and further shorten the time range from symptoms onset to intervention,achieving early diagnosis and treatment,thereby reducing the mortality rate of patients with aortic dissection in China.We should standardize the procedures of aortic dissection treatment and improve people’s understanding.Meanwhile,the curing and transferring efficiency should also be improved.

Effect on surgery outcomes owing to the interval between onset of symptoms and surgery of patients with acute type A aortic dissection

Background:This study aimed to identify whether the interval from onset of symptoms to surgery affects the outcomes of surgery in patients with acute type A aortic dissection(AAAD).Methods:This study retrospectively examined 249 patients with AAAD who underwent Sun’s procedure.All patients were divided into 2 groups,hyperacute and acute,according to the interval from onset of symptoms to surgery.The primary endpoint was all-cause early mortality,and the secondary endpoint was early reoperation.Results:The surgery time,cardiopulmonary bypass time,clamp time,and selective cerebral perfusion time were not significantly different between the 2 groups.The intensive care unit length of stay and duration of mechanical ventilation of the 2 groups were 185.50hours versus 185.00hours(P=0.970)and 41.50hours versus 44.00hours(P=0.678),respectively.There were 52 early deaths:29 in the hyperacute group and 23 in the acute group(21.6%vs.20.0%,P=0.751).The incidence of reoperation was 0.7% and 0.9%(P>0.999),respectively.The incidence rates of postoperative acute heart failure(AHF),acute respiratory failure(ARF),nervous dysfunction,and acutekidney injury were37.3% versus 25.2%(P=0.041),51.5%versus51.3%(P=0.976),13.4% versus 7.0%(P=0.096),and 37.3% versus 37.4%(P=0.990),respectively.Multivariable analysis indicated that surgery in the hyperacute phase might be an independent risk factor for AHF(OR:1.765;95%CI:1.021–3.052;P=0.042).Conclusion:Surgery in the hyperacute phase of AAAD was associated with postoperative AHF.Therefore,early medical management or interventional therapy for complications before surgery performed by experienced surgeons is recommended,especially in the hyperacute phase.

Predictive value of age,creatinine,and ejection fraction(ACEF)score for in-hospital mortality and major adverse events in patients with acute type A aortic dissection

Background Patients with decreased cardiac and renal function,as well as old age suffer from poor outcomes when undergoing cardiac surgery.The aim of this study was to evaluate the association of age,creatinine and ejection fraction(ACEF)score with in-hospital prognosis of patients with the acute type A aortic dissection(ATAAD).Methods From September 2017 to June 2021,a total of 435 ATAAD patients undergoing open surgery repair were enrolled,and classified into low ACEF(ACEF score<0.91,n=286)and high ACEF group(ACEF score≥0.91,n=149)according to the optimal cutoff value of 0.91.Logistic regression analysis was performed to investigate the association between ACEF score with adverse events.Results Thirty-five(8.0%)patients were excluded and 94(21.6%)developed in-hospital major adverse clinical events(MACEs)during hospitalization.The in-hospital mortality in high ACEF group was significantly higher than in low ACEF group(13.4%vs.5.2%,P=0.003).The in-hospital MACE rate was also significantly higher in patients with high ACEF score(high ACEF group:27.5%vs.low ACEF group:18.5%,P=0.031).Multivariable logistic analysis revealed that ACEF score was an independent indicator for in-hospital mortality[odds ratio(OR):5.66,95%confidence interval(CI):1.43-22.48,P=0.014]and in-hospital MACEs(OR:3.44,95%CI:1.30-9.15,P=0.013).Conclusions Elevated ACEF score was an independent predictor for in-hospital mortality and MACEs in patients with ATAAD undergoing open surgery repair,which might provide additional risk stratification.

Case Report of Esophageal Rupture, Empyema, and Aortic Dissection Potentially Caused by Severe Vomiting

Both empyema and type A aortic dissection are life-threatening conditions.The combination,though rare,can cause serious complications and death.There have been rare cases of empyema caused by a co-infection with a Gram-positive bacterium,Granulicatella adiacens,which is difficult to identify,and a Gram-negative bacterium,Escherichia coli.In this case,a 50-year-old man was referred to the emergency department due to sudden chest pain and a suspected diagnosis of type A aortic dissection.The patient was subsequently found to have co-morbid empyema and a fissure in the esophagus when the cause of the disease was investigated.Considering the possibility that the patient’s infection was of digestive origin,a combination of Gram-positive and Gram-negative antibiotics was given immediately.Etiological examination later confirmed the presence of Granulicatella adiacens and Escherichia coli in chest drainage fluid,and the patient was successfully treated with antimicrobial therapy and conservative treatment.