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Background: We have employed a conservative management approach, including intensive control of both blood pressure and heart rate, in patients with aortic intramural hematoma (AIMH) and retrograde thrombosed type A acute aortic dissection (RT-TAAAD), sharing common clinical and imaging characteristics. Methods: To evaluate the outcomes of our conservative management approach, we retrospectively reviewed the clinical records of 98 patients diagnosed with AIMH or RT-TAAAD from January 2008 to March 2023. A conservative management approach was applied, except for those patients with an aortic diameter ≥ 55 mm, false lumen expansion, or cardiac tamponade, who underwent emergency aortic repair. Results: Besides 2 patients, who declined surgery and subsequently died from aortic rupture, 18 patients underwent urgent aortic surgery, while 78 did not. Multivariable logistic regression analysis identified the extrusion type of ulcer-like projections (ULPs) on admission and a maximum aortic diameter ≥ 45 mm on Day 1 as risk factors for acute aortic surgery. Among the 78 patients who were discharged, 9 (12%) underwent aortic surgery, while 69 (88%) did not, with a median follow-up of 44 months. The overall actuarial aortic surgery-free rates were 78% at 1 year and 72% at 5 years, respectively. A Cox proportional hazards analysis identified ULPs and an aortic diameter ≥ 45 mm at discharge as risk factors for late aortic surgery. Conclusions: The early and late outcomes of our conservative strategy for AIMH and RT-TAAAD demonstrate favorable surgery-free rates. The extrusion type of ULPs on admission and an aortic diameter ≥ 45 mm on Day 1 are predictors of acute aortic surgery, while ULPs and an aortic diameter ≥ 45 mm at discharge are predictors of late surgery. [ABSTRACT FROM AUTHOR]

To measure the preoperative uric acid (UA) concentration in patients with type A aortic dissection (TAAD), and to assess its value in predicting in-hospital mortality. A total of 747 patients with TAAD between January 2016 and December 2022 were enrolled. The patients were divided into a survivor group and a non-survivor group. The clinical data of the two groups were compared. Univariate and multiple logistic regression analyses were performed to determine risk factors related to in-hospital mortality. Compared with survivors, non-survivors had significantly higher serum uric acid levels (486.84 ± 127.59 vs 419.49 ± 141.02, P = 0.040). The incidence of in-hospital death increased along with higher UA levels (3.8% vs 0.7%, P = 0.007). Serum UA ≥ 373.5 μmol/L had 89.5% sensitivity and 41.3% specificity for predicting in-hospital death (area under the curve = 0.659, 95% CI: 0.554–0.765, P < 0.05). In the multivariable logistic model, Serum UA ≥ 373.5 μmol/L was independently associated with in-hospital mortality (OR = 1.022, 95% CI: 1.000–1.044, P = 0.048). Serum UA resulted as an independent predictor of adverse prognosis in patients with TAAD, and thus could be used as an effective tool for the risk-stratification of patients with TAAD. [ABSTRACT FROM AUTHOR]

Abstract Objectives This study aimed to analyze the correlation between serum calcium changes and short-term prognosis of patients with acute type A aortic dissection. Methods Patients who underwent acute type A aortic dissection surgery at Fujian Heart Medical Center between June 2019 and June 2021 were retrospectively analyzed. Results A total of 383 patients were enrolled. According to the changing track of serum calcium in patients after acute type A aortic dissection, three potential category tracks were determined: high-level (n = 85), medium-level (n = 259), and continuous low-level groups (n = 39). Using the medium-level group as the control, regression analysis showed that poor prognosis risk was increased in the group with continuous low serum calcium (odds ratio = 2.454, P 48 h (odds ratio = 3.595, P

To ascertain if postoperative thrombocytopenia following open aortic surgery with a median sternotomy can predict early- and intermediate-term morbidity and mortality. From January 2018 to December 2022, a comparison was made between patients who had and didn't have postoperative thrombocytopenia (defined as a nadir < 75 × 103/μL after 72 h of open aortic surgery with median sternotomy). Intermediate-term mortality during follow-up was the main result, with cerebrovascular accident and acute renal injury requiring dialysis as secondary events. Inverse probability treatment weighting (IPTW) was used to account for selection bias between groups. The Kaplan-Meier method with the log-rank test was used to assess intermediate-term survivals following IPTW modification. To identify the nonlinear link between platelet nadir and mortality probability, a generalized additive mix model was applied. To help increase power in testing for the overall effect of platelet nadir on outcomes in the generalized additive mix model, the hazard ratios and 95% CIs for each subgroup and their interactions were examined. The study included 457 patients, 347 male (75.9%), with mean age of 54 ± 12 years. The last follow-up was done on April 14th, 2023 and the median follow-up time was 16 (6-31) months. Following IPTW, patient characteristics were balanced among cohorts. Platelet nadir was found to be significantly inversely related to early-term mortality (IPTW-adjusted hazard ratio = 0.968 (0.960, 0.977), p < 0.001), and AKI requiring dialysis (IPTW-adjusted hazard ratio = 0.979 (0.971, 0.986), p < 0.001). A nonlinear relationship between platelet nadir and mortality risk probability during follow-up visually showed that the likelihood of mortality decreased with platelet nadir increased. In confounder-adjusted survival ('postoperative thrombocytopenia not acquired' vs 'postoperative thrombocytopenia'; HR: 0.086 [95% CI: 0.045-0.163]; p < 0.01) analysis, non-acquired postoperative thrombocytopenia was associated with a lower risk of mortality, and the treatment benefit was validated in IPTW-adjusted analysis, which showed an HR of 0.067. Early postoperative thrombocytopenia following type A aortic dissection surgery is a risk factor for morbidity and mortality. Because postoperative thrombocytopenia can indicate a poor prognosis, monitoring early postoperative platelets helps identify individuals who may develop late postoperative problems, which is performed by this affordable biomarker. What is the context? The most common complications of acute type A aortic dissection included postoperative bleeding, acute kidney injury (AKI), rethoracotomy for hemostasis due to hemorrhage, stroke and even death. It is unknown that platelets are associated with morbidity and mortality in type A aortic dissection. What is new? The present study suggests that early postoperative thrombocytopenia following type A aortic dissection surgery is a risk factor for short- and intermediate-term morbidity and mortality. Furthermore, a nonlinear relationship between platelet nadir and mortality risk probability during follow-up visually showed that the likelihood of mortality decreased with platelet nadir increased. Especially, in confounder-adjusted Kaplan-Meier survival analysis, postoperative thrombo-cytopenia was associated with a higher risk of mortality, and the effect was also validated in IPTW-adjusted analysis. What is the impact? This study provides further evidence that the platelet count represents a reliable early monitoring tool for the predictive value in the prognosis of acute type A aortic dissection. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to analyze the correlation between serum calcium changes and short-term prognosis of patients with acute type A aortic dissection. Methods: Patients who underwent acute type A aortic dissection surgery at Fujian Heart Medical Center between June 2019 and June 2021 were retrospectively analyzed. Results: A total of 383 patients were enrolled. According to the changing track of serum calcium in patients after acute type A aortic dissection, three potential category tracks were determined: high-level (n = 85), medium-level (n = 259), and continuous low-level groups (n = 39). Using the medium-level group as the control, regression analysis showed that poor prognosis risk was increased in the group with continuous low serum calcium (odds ratio = 2.454, P < 0.05) and in the group with continuous low serum calcium > 48 h (odds ratio = 3.595, P < 0.05). Age (odds ratio = 1.063, P < 0.001), body mass index (odds ratio = 1.138, P < 0.05), hypertension (odds ratio = 3.697, P < 0.05), and the highest lactic acid within 72 h after surgery(odds ratio = 1.093, P < 0.05) were independent risk factors for poor prognosis after aortic dissection. Conclusion: Continuous low serum calcium was an independent predictor of poor prognosis in patients with acute type A aortic dissection. Key points: Key Question What is the relationship between serum calcium and poor patient prognosis in acute type A aortic dissection (AAAD). Key finding(s) Of three categories, continuous low calcium for more than 48 h is related to poor prognosis of patients with AAAD. Take-home message Clinicians should determine causes of low calcium and prevent fluctuations postoperatively, thereby decreasing incidence of poor prognosis. [ABSTRACT FROM AUTHOR]

Type A acute aortic dissection (TAAAD) is a serious condition within the acute aortic syndromes that demands immediate treatment. Despite advancements in diagnostic and referral pathways, the survival rate post-surgery currently sits at almost 20%. Our objective was to pinpoint clinical indicators for mortality and morbidity, particularly raised arterial lactate as a key factor for negative outcomes. Methods: All patients referred to the three cardiovascular centres between January 2005 and December 2022 were included in the study. The inclusion criteria required the presence of a lesion involving the ascending aorta, symptoms within 7 days of surgery, and referral for primary surgical repair of TAAAD based on recommendations, with consideration for other concomitant major cardiac surgical procedures needed during TAAAD and retrograde extension of TAAAD. We conducted an analysis of both continuous and categorical variables and utilised predictive mean matching to fill in missing numeric features. For missing binary variables, we used logistic regression to impute values. We specifically targeted early postoperative mortality and employed LASSO regression to minimise potential collinearity of over-fitting variables and variables measured from the same patient. Results: A total of 633 patients were recruited for the study, out of which 449 patients had complete preoperative arterial lactate data. The average age of the patients was 64 years, and 304 patients were male (67.6%). The crude early postoperative mortality rate was 24.5% (110 out of 449 patients). The mortality rate did not show any significant difference when comparing conservative and extensive surgeries. However, malperfusion had a significant impact on mortality [48/131 (36.6%) vs. 62/318 (19.5%), p < 0.001]. Preoperative arterial lactates were significantly elevated in patients with malperfusion. The optimal prognostic threshold of arterial lactate for predicting early postoperative mortality in our cohort was ≥2.6 mmol/L. Conclusion: The arterial lactate concentration in patients referred for TAAAD is an independent factor for both operative mortality and postoperative complications. In addition to mortality, patients with an upper arterial lactate cut-off of ≥2.6 mmol/L face significant risks of VA ECMO and the need for dialysis within the first 48 h after surgery. To improve recognition and facilitate rapid transfer and surgical treatment protocol, more diligent efforts are required in the management of malperfusion in TAAAD. [ABSTRACT FROM AUTHOR]

AbstractObjectives To ascertain if postoperative thrombocytopenia following open aortic surgery with a median sternotomy can predict early- and intermediate-term morbidity and mortality.Methods From January 2018 to December 2022, a comparison was made between patients who had and didn’t have postoperative thrombocytopenia (defined as a nadir < 75 × 103/μL after 72 h of open aortic surgery with median sternotomy). Intermediate-term mortality during follow-up was the main result, with cerebrovascular accident and acute renal injury requiring dialysis as secondary events. Inverse probability treatment weighting (IPTW) was used to account for selection bias between groups. The Kaplan-Meier method with the log-rank test was used to assess intermediate-term survivals following IPTW modification. To identify the nonlinear link between platelet nadir and mortality probability, a generalized additive mix model was applied. To help increase power in testing for the overall effect of platelet nadir on outcomes in the generalized additive mix model, the hazard ratios and 95% CIs for each subgroup and their interactions were examined.Results The study included 457 patients, 347 male (75.9%), with mean age of 54 ± 12 years. The last follow-up was done on April 14th, 2023 and the median follow-up time was 16 (6-31) months. Following IPTW, patient characteristics were balanced among cohorts. Platelet nadir was found to be significantly inversely related to early-term mortality (IPTW-adjusted hazard ratio = 0.968 (0.960, 0.977), p

Abstract Background In recent years, abnormalities in serum lipids and lipoproteins have been shown to be associated with cardiovascular disease risk. However, their prognostic value for acute type A aortic dissection is unclear. This study analyzed the correlation between triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and in-hospital mortality in patients with AAAD, and aimed to investigate the clinical significance of preoperative blood lipids and lipoproteins on the prognosis of acute type A aortic dissection. Methods A total of 361 patients who underwent type A aortic dissection surgery in Fujian Cardiac Medical Center from June 2018 to March 2020 were retrospectively collected. According to the baseline TG/HDL-C ratio, the patients were divided into 3 groups according to the tertile method, the low TG/HDL-C ratio T1 group ( 1.70). Kaplan–Meier was used for survival analysis, and Cox proportional hazards regression model was used to analyze the factors affecting the prognosis of patients. The receiver operating characteristic (ROC) curve was used for the diagnostic efficacy. Results Among the 361 patients in this study, the mean age was 52.4 ± 11.3 years, 73 (20.2%) were female, and 82 (22.7%) died in hospital. Kaplan–Meier curve showed that with the increase of TG/HDL-C ratio, the risk of in-hospital death gradually increased (P

Abstract Objectives Type A acute aortic dissection (TAAAD) complicated with cerebral malperfusion (CM) is a life-threatening condition associated with high mortality, poor outcomes, and the optimal surgical management remains controversial. The aim of this review was to report the current results of surgical interventions of these patients. Methods A systematic review was performed using PubMed and MEDLINE search for cases underwent surgical repair for TAAAD with CM. Demographics, neurological symptom, the time from onset of symptoms to operation, operation data, mortality, neurological outcome, and follow-up were reviewed. Results A total of 363 patients with mean age of 65.7 ± 13 years underwent surgical repair for TAAAD with CM were identified in 12 retrospective studies. In-hospital mortality was 20.1%. Mean duration of follow-up was 40.1 ± 37.6 months. The involved supra-aortic branch vessels were RCCA (n = 99), LCCA (n = 25), B-CCA (n = 52), CCA (n = 131), IA (n = 19), and LSA (n = 8). Time from onset of neurological symptoms to surgery was 13.3 h. Antegrade and/or retrograde cerebral perfusion were applied. Postoperatively, improved, unchanged and worsened neurological status was occurred in 54.3%, 27.1%, and 8.5%, respectively in 199 patients. Conclusion The outcomes of surgical treatment of TAAAD complicated with CM indicate acceptable early mortality and morbidity. It is reasonable to perform lifesaving surgery on these patients. Early central surgical repair and reperfusion of brain may improve the outcomes.

Introduction Type A aortic dissection (TAAD) is a life-threatening condition that often leads to cerebral malperfusion (CM), a severe complication that can result in permanent neurological damage. Traditionally, a cardiopulmonary bypass (CPB) with selective antegrade cerebral perfusion (ACP) is employed during aortic arch reconstruction to protect cerebral circulation. However, the use of CPB carries inherent higher risks, including embolic events, hypothermia, and interrupted cerebral perfusion, especially in patients with CM. This study evaluates an innovative off-pump extra-corporeal ACP technique using an axillo-axillary shunt to provide uninterrupted bihemispheric cerebral perfusion during branch-first stage total aortic arch replacement (BF-TAR) for TAAD with CM; the shunt depends on cardiac contradiction to transfuse blood from the donor axillary artery to the recipient axillary artery, which then flows to through the carotid and vertebral arteries to the brain. Methods Between 2021 and 2023, 18 patients with TAAD complicated by CM underwent BF-TAR; the novel axillo-axillary shunt technique was employed for ACP because of the risks of ischemic neurologic injury. Outcomes measured included operative mortality, neurological complications, cardiopulmonary bypass times (measured after completion of the branch-first stage), and overall morbidity. Results The axillo-axillary shunt provided stable, continuous ACP in all patients. No new permanent neurological deficits were observed. Five (27.8%) patients experienced transient neurological symptoms such as blurred vision, dizziness, and confusion, which resolved within 48 hours. Operative mortality was 5.6% (1 patient), and minor complications included transitory lower limbs ischemia in 3 patients (16.7%) and deep sternal wound infection in 1 patient (5.6%). All transitory complications were managed by "watchful waiting". The mean CPB time was 145.3 ± 48.6 minutes, while the mean cross-clamp time was 100.6 ± 17.4 minutes, which was better than the average of 227 ± 32 minutes and 147 ± 23 minutes reported in other studies. Postoperative imaging confirmed well-reconstructed aortic arches with no residual malperfusion or graft-related complications. Conclusion The off-pump axillo-axillary shunt technique provides a safe and effective method for maintaining continuous bihemispheric cerebral perfusion during total aortic arch replacement in patients with TAAD complicated by CM. This approach minimizes the risks associated with CPB, including embolic events and interrupted cerebral perfusion while achieving favorable neurological and surgical outcomes. Further studies with larger cohorts and longer follow-ups are warranted to validate the long-term benefits of this innovative technique., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. IRB of Bakulev Scientific Center of Cardiovascular Surgery · Moscow, RUS issued approval Protocol №: 4 (15.12.2021). The Institutional Review Board approved this short study after initial tests showed it was a viable and effective approach to cerebral perfusion with improved hemodynamic parameters as compared to conventional measures. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Elias et al.)

Abstract Background The platelet-lymphocyte ratio (PLR), a novel inflammatory marker, is generally associated with increased in-hospital mortality risk. We aimed to investigate the association between PLR and postoperative in-hospital mortality risk in patients with type A acute aortic dissection (AAAD). Methods Patients (n = 270) who underwent emergency surgery for AAAD at Xiangya Hospital of Central South University between January 2014 and May 2019 were divided into three PLR-based tertiles. We used multiple regression analyses to evaluate the independent effect of PLR on in-hospital mortality, and smooth curve fitting and a segmented regression model with adjustment of confounding factors to analyze the threshold effect between PLR and in-hospital mortality risk. Results The overall postoperative in-hospital mortality was 13.33%. After adjusting for confounders, in-hospital mortality risk in the medium PLR tertile was the lowest (Odds ratio [OR] = 0.20, 95% confidence interval [CI] = 0.06–0.66). We observed a U-shaped relationship between PLR and in-hospital mortality risk after smoothing spline fitting was applied. When PLR 188, the in-hospital mortality risk increased by 6% per unit increase in PLR (OR = 1.06, P = 0.045). Conclusions There was a U-shaped relationship between PLR and in-hospital mortality in patients with AAAD, with an optimal PLR range for the lowest in-hospital mortality risk of 108–188. PLR may be a useful preoperative prognostic tool for predicting in-hospital mortality risk in patients with AAAD and can ensure risk stratification and early treatment initiation.

Abstract Objective To investigate the effects of seasonal and climatic changes on postoperative in-hospital mortality and length of stay (LOS) in patients with type A acute aortic dissection (AAD). Methods Patients undergoing implantation of the modified triple-branched stent graft to replace the descending aorta in addition to aortic root reconstruction for type A AAD in our hospital from January 2016 to December 2019 were included. Relevant data were retrospectively collected and analyzed. Results A total of 404 patients were included in our analyses. The multivariate unconditional logistic regression analysis showed that patients admitted in autumn (OR 4.027, 95% CI 1.023–17.301, P = 0.039) or with coronary heart disease (OR 8.938, 95% CI 1.991–29.560, P = 0.049) were independently associated with an increased risk of postoperative in-hospital mortality. Furthermore, patients admitted in autumn (OR 5.956, 95% CI 2.719–7.921, P = 0.041) or with hypertension (OR 3.486, 95% CI 1.192–5.106, P = 0.035) were independently associated with an increased risk of longer LOS. Conclusion Patients admitted in autumn or with coronary heart disease are at higher risk of in-hospital mortality following surgery for type A AAD. Also, patients admitted in autumn or with hypertension have a longer hospital LOS. In the autumn of the temperature transition, we may need to strengthen the management of medical quality after surgery for type A AAD.

ObjectiveA clinical prediction model for postoperative combined Acute kidney injury (AKI) in patients with Type A acute aortic dissection (TAAAD) and Type B acute aortic dissection (TBAAD) was constructed by using Machine Learning (ML).MethodsBaseline data was collected from Acute aortic division (AAD) patients admitted to First Affiliated Hospital of Xinjiang Medical University between January 1, 2019 and December 31, 2021. (1) We identified baseline Serum creatinine (SCR) estimation methods and used them as a basis for diagnosis of AKI. (2) Divide their total datasets randomly into Training set (70%) and Test set (30%), Bootstrap modeling and validation of features using multiple ML methods in the training set, and select models corresponding to the largest Area Under Curve (AUC) for follow-up studies. (3) Screening of the best ML model variables through the model visualization tools Shapley Addictive Explanations (SHAP) and Recursive feature reduction (REF). (4) Finally, the pre-screened prediction models were evaluated using test set data from three aspects: discrimination, Calibration, and clinical benefit.ResultsThe final incidence of AKI was 69.4% (120/173) in 173 patients with TAAAD and 28.6% (81/283) in 283 patients with TBAAD. For TAAAD-AKI, the Random Forest (RF) model showed the best prediction performance in the training set (AUC = 0.760, 95% CI:0.630–0.881); while for TBAAD-AKI, the Light Gradient Boosting Machine (LightGBM) model worked best (AUC = 0.734, 95% CI:0.623–0.847). Screening of the characteristic variables revealed that the common predictors among the two final prediction models for postoperative AKI due to AAD were baseline SCR, Blood urea nitrogen (BUN) and Uric acid (UA) at admission, Mechanical ventilation time (MVT). The specific predictors in the TAAAD-AKI model are: White blood cell (WBC), Platelet (PLT) and D dimer at admission, Plasma The specific predictors in the TBAAD-AKI model were N-terminal pro B-type natriuretic peptide (BNP), Serum kalium, Activated partial thromboplastin time (APTT) and Systolic blood pressure (SBP) at admission, Combined renal arteriography in surgery. Finally, we used in terms of Discrimination, the ROC value of the RF model for TAAAD was 0.81 and the ROC value of the LightGBM model for TBAAD was 0.74, both with good accuracy. In terms of calibration, the calibration curve of TAAAD-AKI's RF fits the ideal curve the best and has the lowest and smallest Brier score (0.16). Similarly, the calibration curve of TBAAD-AKI's LightGBM model fits the ideal curve the best and has the smallest Brier score (0.15). In terms of Clinical benefit, the best ML models for both types of AAD have good Net benefit as shown by Decision Curve Analysis (DCA).ConclusionWe successfully constructed and validated clinical prediction models for the occurrence of AKI after surgery in TAAAD and TBAAD patients using different ML algorithms. The main predictors of the two types of AAD-AKI are somewhat different, and the strategies for early prevention and control of AKI are also different and need more external data for validation.

BackgroundPlatelet distribution width (PDW), as a widely applied and reliable marker of platelet activation, was associated with adverse outcomes in cardiovascular diseases. However, there is little literature on the relationship between PDW and postoperative pneumonia in patients with type A acute aortic dissection (AAAD).MethodsIn this retrospective cohort study, we collected consecutive patients who underwent emergency surgery for AAAD at Xiangya Hospital of Central South University from January 1, 2014 and June 30, 2020. Patients were divided into three tertiles on the basis of the PDW. The independent effect of the PDW on postoperative pneumonia was evaluated using multivariate logistic regression analysis, and smooth curve fitting was performed to visualize the linear relationship between PDW and the risk of postoperative pneumonia in patients with AAAD.ResultsA total of 210 patients with AAAD were enrolled and the overall incidence of postoperative pneumonia was 25.24% (n = 53). Multivariate logistic regression revealed that PDW was positively associated with the risk of postoperative pneumonia (OR: 1.07, 95% CI: 1.02–1.13, P < 0.05) after adjusting the confounders. Compared with the lowest PDW tertile, the risk of postoperative pneumonia increased by 1.21-fold in the medium PDW tertile (OR: 2.21, 95% CI: 0.73–6.72) and by 3.16-fold in the highest PDW tertile (OR: 4.16, 95% CI: 1.40–12.33). A straight-line relationship was observed between PDW and postoperative pneumonia risk in smoothing spline fitting.ConclusionOur findings indicate that high PDW is an independent risk factor of postoperative pneumonia in patients with AAAD. Preoperative PDW may serve as an available indicator of pneumonia, which helps identify AAAD patients with a high risk of postoperative pneumonia.

Type A acute aortic dissection is associated with significant morbidity and mortality, with prompt referral imaging and management to tertiary referral centers needed urgently. Surgery is usually needed emergently, but the choice of surgery often varies depending on the patient and the presentation. Staff and center expertise also play a major role in determining the surgical strategy employed. The aim of this study was to compare the early- and medium-term outcomes of patients undergoing a conservative approach extended only to the ascending aorta and the hemiarch to those of patients subjected to extensive surgery (total arch reconstruction and root replacement) across three European referral centers. A retrospective study was conducted across three sites between January 2008 and December 2021. In total, 601 patients were included within the study, of which 30% were female, and the median age was 64.4 years. The most common operation was ascending aorta replacement (n = 246, 40.9%). The aortic repair was extended proximally (i.e., root n = 105; 17.5%) and distally (i.e., arch n = 250; 41.6%). A more extensive approach, extending from the root to the arch, was employed in 24 patients (4.0%). Operative mortality occurred in 146 patients (24.3%), and the most common morbidity was stroke (75, 12.6%). An increased length of ICU admission was noted in the extensive surgery group, which comprised younger and more frequently male patients. No significant differences were noted in surgical mortality between patients managed with extensive surgery and those managed conservatively. However, age, arterial lactate levels, “intubated/sedated” status on arrival, and “emergency or salvage” status at presentation were independent predictors of mortality both within the index hospitalization and during the follow-up. The overall survival was similar between the groups.

Objectives: Type A acute aortic dissection (TAAAD) complicated with cerebral malperfusion (CM) is a life-threatening condition associated with high mortality, poor outcomes, and the optimal surgical management remains controversial. The aim of this review was to report the current results of surgical interventions of these patients.Methods: A systematic review was performed using PubMed and MEDLINE search for cases underwent surgical repair for TAAAD with CM. Demographics, neurological symptom, the time from onset of symptoms to operation, operation data, mortality, neurological outcome, and follow-up were reviewed.Results: A total of 363 patients with mean age of 65.7 ± 13 years underwent surgical repair for TAAAD with CM were identified in 12 retrospective studies. In-hospital mortality was 20.1%. Mean duration of follow-up was 40.1 ± 37.6 months. The involved supra-aortic branch vessels were RCCA (n = 99), LCCA (n = 25), B-CCA (n = 52), CCA (n = 131), IA (n = 19), and LSA (n = 8). Time from onset of neurological symptoms to surgery was 13.3 h. Antegrade and/or retrograde cerebral perfusion were applied. Postoperatively, improved, unchanged and worsened neurological status was occurred in 54.3%, 27.1%, and 8.5%, respectively in 199 patients.Conclusion: The outcomes of surgical treatment of TAAAD complicated with CM indicate acceptable early mortality and morbidity. It is reasonable to perform lifesaving surgery on these patients. Early central surgical repair and reperfusion of brain may improve the outcomes. [ABSTRACT FROM AUTHOR]

(1) Background: Exercise is recommended to improve physical fitness in patients recovering from acute type A aortic dissection (ATAAD). However, surgery corrects the diseased blood vessels and reduces the risk of ATAAD, but it does not redefine a safe exercise blood pressure (BP) threshold. This review aimed to discuss whether the safe threshold of exercise BP can be upregulated after ATAAD surgery to increase exercise intensity with additional benefits. (2) Data sources: The PubMed databases were searched with the keywords "type A acute aortic dissection surgery", "exercise", "BP", "stress", and variations of these terms. (3) Study selection: Data from clinical trials, guidelines, and recent reviews were selected for review. (4) Results: Regular exercise can be considered a cardioprotective intervention for aortic dissection patients by attenuating hemodynamic responses at rest and during exercise. Previous studies have mainly focused on moderate-intensity aerobic exercise. In practice, the exercise systolic BP of some patients was higher than 160 mm Hg without adverse events, which indicates that the training intensity may be underestimated for patients after ATAAD surgery. Limited studies suggest a light-to-moderate resistance training for selected patients because it may cause a greater increase in BP. (5) Conclusions: Moderate-intensity continuous aerobic exercise supplemented by low-intensity resistance training is appropriate for cardiac rehabilitation after ATAAD surgery. The BP increase based on the normal exercise BP response, corresponding to the moderate-intensity is relatively safe. For high-risk post-ATAAD patients, considering the overall volume of training, personalizing the exercise regimen to remain within "safe" BP limits, and avoiding excessive fluctuations in BP should be the primary considerations for exercise training. [ABSTRACT FROM AUTHOR]

Introduction: Surgically treated acute type A aortic dissection (ATAAD) patients are often restricted from physical exercise due to a lack of knowledge about safe blood pressure (BP) ranges. The aim of this study was to describe the evolution of early postoperative cardiac rehabilitation (CR) for patients with ATAAD. Methods: This is a retrospective study of 73 patients with ATAAD who were referred to the CR department after surgery. An incremental symptom-limited exercise stress test (ExT) on a cyclo-ergometer was performed before and after CR, which included continuous training and segmental muscle strengthening (five sessions/week). Systolic and diastolic blood pressure (SBP and DBP) were monitored before and after all exercise sessions. Results: The patients (78.1% male; 62.2 ± 12.7 years old; 54.8% hypertensive) started CR 26.2 ± 17.3 days after surgery. During 30.4 ±11.6 days, they underwent 14.5 ± 4.7 sessions of endurance cycling training, and 11.8 ± 4.3 sessions of segmental muscle strengthening. At the end of CR, the gain of workload during endurance training and functional capacity during ExT were 19.6 ± 10.2 watts and 1.2 ± 0.6 METs, respectively. The maximal BP reached during endurance training was 143 ± 14/88 ± 14 mmHg. The heart rate (HR) reserve improved from 20.2 ± 13.9 bpm to 33.2 ± 16.8 bpm while the resting HR decreased from 86.1 ± 17.4 bpm to 76.4 ± 13.3 bpm. Conclusion: Early post-operative exercise-based CR is feasible and safe in patients with surgically treated ATAAD. The CR effect is remarkable, but it requires a close BP monitoring and supervision by a cardiologist and physical therapist during training. [ABSTRACT FROM AUTHOR]

Abstract Background Acute aortic dissection (AAD) is a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A AAD (TAAAD) still remains high, and treatment for such patients remains controversial. We report a successful treatment of TAAAD with a communicating false lumen in a 60-year-old man with acute hemi-cerebral malperfusion. Case presentation The ascending aorta was wrapped with stepwise external wrapping (SEW) procedure, and subsequent thoracic endovascular aortic repair (TEVAR) was successfully performed. The patient was discharged in good physical condition without any complications. Conclusions Hybrid therapy with SEW and TEVAR with TAAAD associated with major cerebral malperfusion should be considered, especially in patients for whom open surgery is extremely risky.

Abstract Background Type A acute aortic dissection is a life-threatening disease associated with adverse clinical outcomes. Acute kidney injury (AKI) is common after surgery. However, the relationship between intraoperative blood transfusion and postoperative AKI remains unclear. Methods The records of 130 patients who underwent type A acute aortic dissection surgery from January 2015 to December 2018 were retrospectively analyzed. According to the Kidney Disease Improving Global Outcomes criteria, postoperative AKI was defined based on serum creatinine concentration. Multivariable logistic regression analysis was applied to estimate the independent association between intraoperative blood transfusion volume and the risk of postoperative AKI. Results Postoperative AKI was observed in 82 patients (63.08%). The in-hospital mortality was 16.15% (n = 21). Multivariate logistic regression showed that the amount of intraoperative blood transfusion was independently associated with the risk of postoperative AKI in a dose-dependent manner. Every 200 ml increment of blood transfusion volume was associated with a 31% increase in AKI risk (odds ratio 1.31 and 95% confidence interval 1.01–1.71). Conclusions Intraoperative transfusion volume may increase the incidence of postoperative AKI. The mechanism and influence of transfusion thresholds on AKI need to be explored in the future.

Abstract Background Acute aortic dissection (AAD) is a rare, but a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A Acute aortic dissection (TAAAD) still remains high, and treatment for such patients remains controversial. Case presentation A new surgical approach which entails “stepwise external wrapping (SEW)” using a zero-porosity artificial graft was developed in extremely high-risk patients with TAAAD. Herein, we described its surgical details and showed two representative cases which was successfully done. Conclusions Our SEW procedure is a feasible alternative to conventional graft replacement for TAAAD in extremely high-risk or aged patients, although the gold standard consists of surgical replacement of the dissected aorta. (129 words).

Background: The platelet-lymphocyte ratio (PLR), a novel inflammatory marker, is generally associated with increased in-hospital mortality risk. We aimed to investigate the association between PLR and postoperative in-hospital mortality risk in patients with type A acute aortic dissection (AAAD).Methods: Patients (n = 270) who underwent emergency surgery for AAAD at Xiangya Hospital of Central South University between January 2014 and May 2019 were divided into three PLR-based tertiles. We used multiple regression analyses to evaluate the independent effect of PLR on in-hospital mortality, and smooth curve fitting and a segmented regression model with adjustment of confounding factors to analyze the threshold effect between PLR and in-hospital mortality risk.Results: The overall postoperative in-hospital mortality was 13.33%. After adjusting for confounders, in-hospital mortality risk in the medium PLR tertile was the lowest (Odds ratio [OR] = 0.20, 95% confidence interval [CI] = 0.06-0.66). We observed a U-shaped relationship between PLR and in-hospital mortality risk after smoothing spline fitting was applied. When PLR < 108, the in-hospital mortality risk increased by 10% per unit decrease in PLR (OR = 0.90, P = 0.001). When the PLR was between 108 and 188, the mortality risk was the lowest (OR = 1.02, P = 0.288). When PLR > 188, the in-hospital mortality risk increased by 6% per unit increase in PLR (OR = 1.06, P = 0.045).Conclusions: There was a U-shaped relationship between PLR and in-hospital mortality in patients with AAAD, with an optimal PLR range for the lowest in-hospital mortality risk of 108-188. PLR may be a useful preoperative prognostic tool for predicting in-hospital mortality risk in patients with AAAD and can ensure risk stratification and early treatment initiation. [ABSTRACT FROM AUTHOR]

The outcomes of emergency surgery for type A acute aortic dissection have improved. However, ascending aortic replacement sometimes leads to dilatation of the distal aorta. The present study reviewed our outcomes of ascending aortic replacement and total arch replacement in patients with type A acute aortic dissection. A total of 253 patients with type A acute aortic dissection underwent a central repair operation. Our standard technique was ascending aortic replacement. Total arch replacement was performed only when entry existed in the major curvature of the aortic arch and the proximal descending aorta. A total of 169 patients (67%) underwent ascending aortic replacement, and 84 patients (33%) underwent total arch replacement. Hospital death due to initial surgery, dilatation of the distal aorta greater than 5 cm, new occurrence of aortic dissection, any distal aortic surgery, and aortic-related deaths were defined as distal aortic events. The mortality was 7.1% in the ascending aortic replacement group and 6.0% in the total arch replacement group. Postoperative computed tomography was performed in 162 patients in the ascending aortic replacement group. The false lumen of the residual aortic arch had thrombosed and healed in 94 patients (58%) and remained present in 68 patients (42%). The distal aortic event-free rate in the ascending aortic replacement group decreased from 74% at 5 years to 51% at 9 years, and the rate in the total arch replacement group was 83% at 5 to 9 years (P <. 01). For the ascending aortic replacement group, more patients with a dissected arch had a distal aortic event compared with patients with a healed arch (P <. 01). Total arch replacement was associated with fewer distal aortic events. We may expand the indications for total arch replacement in stable patients. TAR reduced the risk of long-term distal aortic events compared with ascending aortic replacement. AAR, Ascending aortic replacement; TAAAD, type A acute aortic dissection; TAR, total arch replacement. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of seasonal and climatic changes on postoperative in-hospital mortality and length of stay (LOS) in patients with type A acute aortic dissection (AAD).Methods: Patients undergoing implantation of the modified triple-branched stent graft to replace the descending aorta in addition to aortic root reconstruction for type A AAD in our hospital from January 2016 to December 2019 were included. Relevant data were retrospectively collected and analyzed.Results: A total of 404 patients were included in our analyses. The multivariate unconditional logistic regression analysis showed that patients admitted in autumn (OR 4.027, 95% CI 1.023-17.301, P = 0.039) or with coronary heart disease (OR 8.938, 95% CI 1.991-29.560, P = 0.049) were independently associated with an increased risk of postoperative in-hospital mortality. Furthermore, patients admitted in autumn (OR 5.956, 95% CI 2.719-7.921, P = 0.041) or with hypertension (OR 3.486, 95% CI 1.192-5.106, P = 0.035) were independently associated with an increased risk of longer LOS.Conclusion: Patients admitted in autumn or with coronary heart disease are at higher risk of in-hospital mortality following surgery for type A AAD. Also, patients admitted in autumn or with hypertension have a longer hospital LOS. In the autumn of the temperature transition, we may need to strengthen the management of medical quality after surgery for type A AAD. [ABSTRACT FROM AUTHOR]

Background: Acute aortic dissection (AAD) is a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A AAD (TAAAD) still remains high, and treatment for such patients remains controversial. We report a successful treatment of TAAAD with a communicating false lumen in a 60-year-old man with acute hemi-cerebral malperfusion.Case Presentation: The ascending aorta was wrapped with stepwise external wrapping (SEW) procedure, and subsequent thoracic endovascular aortic repair (TEVAR) was successfully performed. The patient was discharged in good physical condition without any complications.Conclusions: Hybrid therapy with SEW and TEVAR with TAAAD associated with major cerebral malperfusion should be considered, especially in patients for whom open surgery is extremely risky. [ABSTRACT FROM AUTHOR]

Background: Type A acute aortic dissection is a life-threatening disease associated with adverse clinical outcomes. Acute kidney injury (AKI) is common after surgery. However, the relationship between intraoperative blood transfusion and postoperative AKI remains unclear.Methods: The records of 130 patients who underwent type A acute aortic dissection surgery from January 2015 to December 2018 were retrospectively analyzed. According to the Kidney Disease Improving Global Outcomes criteria, postoperative AKI was defined based on serum creatinine concentration. Multivariable logistic regression analysis was applied to estimate the independent association between intraoperative blood transfusion volume and the risk of postoperative AKI.Results: Postoperative AKI was observed in 82 patients (63.08%). The in-hospital mortality was 16.15% (n = 21). Multivariate logistic regression showed that the amount of intraoperative blood transfusion was independently associated with the risk of postoperative AKI in a dose-dependent manner. Every 200 ml increment of blood transfusion volume was associated with a 31% increase in AKI risk (odds ratio 1.31 and 95% confidence interval 1.01-1.71).Conclusions: Intraoperative transfusion volume may increase the incidence of postoperative AKI. The mechanism and influence of transfusion thresholds on AKI need to be explored in the future. [ABSTRACT FROM AUTHOR]

Background: Acute aortic dissection (AAD) is a rare, but a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A Acute aortic dissection (TAAAD) still remains high, and treatment for such patients remains controversial.Case Presentation: A new surgical approach which entails "stepwise external wrapping (SEW)" using a zero-porosity artificial graft was developed in extremely high-risk patients with TAAAD. Herein, we described its surgical details and showed two representative cases which was successfully done.Conclusions: Our SEW procedure is a feasible alternative to conventional graft replacement for TAAAD in extremely high-risk or aged patients, although the gold standard consists of surgical replacement of the dissected aorta. (129 words). [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the efficacy of echocardiography-guided ascending aortic central cannulation using the Seldinger technique during surgery for type A acute aortic dissection complicated by stroke due to cerebral malperfusion. Between April 2007 and December 2017, 208 patients with type A acute aortic dissection underwent echocardiography-guided ascending aortic central cannulation using the Seldinger technique. We analyzed 16 of these patients (7.7%; median age, 63 years; 8 men) with stroke due to cerebral malperfusion, including 10 in a comatose state (Glasgow Coma Scale ≤8) and 6 with hemiplegia (manual muscle test ≤1) on hospital arrival. The Modified Rankin Scale was used to evaluate activities of daily living. The median time from onset of symptoms to establishment of cardiopulmonary bypass was 327 (176-561) minutes. The median time from the start of surgery to establishment of cardiopulmonary bypass was 34 (30-44) minutes. The mortality rate was 6.3% (1/16). In patients with preoperative coma, the Glasgow Coma Scale improved significantly after surgery from 4.5 to 15 at 30 days (P <.001). In patients with preoperative hemiplegia, 4 showed improved motor function on the manual muscle test score at 90 days. In all patients, Modified Rankin Scale scores improved significantly from 5.0 preoperatively to 1.0 after follow-up (P <.001). Echocardiography-guided ascending aortic central cannulation using the Seldinger technique has potential as a rapid and reliable perfusion route during surgery for type A acute aortic dissection complicated by stroke due to cerebral malperfusion. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the effect of frozen elephant trunk deployment from the zone 0 aorta to the descending aorta on early and midterm postoperative results in patients with acute type A aortic dissection. Between October 2014 and April 2018, 108 patients underwent a combined strategy of frozen elephant trunk deployment, ascending aortic replacement, and arch vessel reconstruction ("zone 0 arch repair" strategy) for acute type A aortic dissection (excluding DeBakey type II). Of the 108 patients, 32 (29.6%) had primary tears of the aortic arch or descending aorta. The 30-day mortality rate was 2.8% (3 patients), and in-hospital mortality rate was 6.5% (7 patients). New-onset permanent neurologic dysfunction and spinal cord injury occurred in 3.7% and 0% of patients, respectively. Five of the 101 survivors underwent thoracic endovascular aortic repair during hospitalization (2 for rapid false lumen enlargement; 3 for true lumen stenosis). The overall survival was 89.8%, 88.1%, and 88.1% at 1, 2, and 3 years, respectively. The cumulative incidence of distal aortic reintervention was 5.8%, 9.1%, and 9.1% at 1, 2, and 3 years, respectively. Two patients underwent thoracic endovascular aortic repair for distal aortic enlargement after discharge. The use of the "zone 0 arch repair" strategy can eliminate the need for invasive aortic arch resection. It also eliminates the false lumen and produces satisfactory early and midterm postoperative results. Therefore, it can be an alternative to hemiarch and total arch replacements, which are based on a conventional "tear-oriented resection" strategy. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effect of postoperative malperfusion (PM) on operative mortality and on late survival in patients who underwent surgery for acute type A aortic dissection in a referred center for aortic emergency surgery. Patients and Methods: From January 2005 to September 2015, 237 patients were referred for aortic emergency surgery at our center. We examined complete data available on 214 patients (mean age 62.5±12.6 years, 156 males). At presentation, various types of preoperative malperfusion (cerebral, renal, mesenteric) were observed in 119 patients (55.6%). Arterial access for cardiopulmonary bypass was via femoral artery (n = 99), via axillary artery (n = 99), or into the ascending aorta (n = 22). Aortic repair was performed using an open technique in 124 patients (58%). Results: Fifty-five patients (25.7%) presented PM; operative mortality was 29% (62/214): 47.3% in PM patients vs. 22.6% in non-PM patients (P < 0.0001). Independent predictors were age >75 years at the time of operation (OR: 1.1, P = 0.0004) and renal PM (OR: 53.5, P = 0.0027). Five-year survival was 79±7% in PM vs. 94±3% in non-PM patients (P = 0.002). Independent predictors for reduced survival were age >75 years (OR: 375, P = 0.05) and renal PM (OR: 28.6, P = 0.01). All types of PM and the location of intimal tear distal to the ascending aorta were found as risk factors for survival in the univariate analysis only (P < 0.05). Conclusions: Surgery for acute aortic dissection is effective in reducing preoperative malperfusion by about 50%. Renal PM is associated with higher operative mortality, whereas all types of PM, in particular renal PM, negatively affected late survival. Surgical techniques, site of arterial cannulation, and more complex interventions requiring an open technique did not appear to be predictors of increased risk. [Arch Clin Exp Surg 2017; 6(4.000): 175-182]

Objectives: The primary objective of this research was to evaluate the safety and feasibility of an innovative double-branched stent graft system employing four-stage deployment technology for aortic arch repair in porcine models., Methods: The double-branched stent graft system consisted of a proximal polyester artificial blood vessel, the main and double-branched stent grafts and a delivery system. We utilized 12 healthy pigs as experimental animals (6 per group). Postimplantation, samples were collected at 90 and 180 days after the operations. Preoperative and postoperative imaging and intraoperative arterial blood gas analyses were performed. After the pigs were euthanized, the implanted product, surrounding tissue and major organs were collected for pathological analysis., Results: The technical success rate of the stent graft implants was 100% (12/12). All animals survived to the experimental end point. Perioperative assessments showed intact stent grafts, and imaging features at the end of the follow-up period revealed neither endoleak nor device migration. No major adverse cardiovascular events were observed during the postoperative follow-up period. Pathological examinations confirmed the satisfactory biocompatibility of the stent graft., Conclusions: This innovative double-branched stent graft system with four-stage deployment technology was affirmed as a safe and feasible option for aortic arch repair in accordance with our preclinical evaluation with porcine models., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Purpose: Achieving a secure anastomosis and complete hemostasis is essential for surgically treating type A acute aortic dissection (TAAAD). This study assessed the clinical feasibility of "tailored stand-up collar (TSC)" technique for constructing the distal stump., Methods: We enrolled 68 patients who underwent ascending aortic repair for TAAAD. Patients were categorized according to the technique for distal stump construction: conventional (C) group using only a felt strip (32 cases); post-aortotomy (P) group, with a Hydrofit-felt strip attached after aortotomy (18 cases), and TSC group, where a Hydrofit-felt strip attached during cooling (18 cases). Pre-operative characteristics, procedural profiles, and post-operative outcomes were evaluated., Results: The pre-operative characteristics were identical among the groups. The durations of cardiopulmonary bypass, hemostasis, and surgery were significantly shorter in the P and TSC groups. The duration of open distal in the TSC group (21 min) was significantly shorter than the other two groups. Post-operative additional procedures were not required for the TSC group and their post-operative hospital stay was significantly shorter (47.1% of patients were discharged within 2 weeks)., Conclusion: The TSC technique would be practical because of its high reproducibility in terms of ease of use, shorter anastomotic time, and secure hemostasis.

Type A acute aortic dissection is associated with significant morbidity and mortality, with prompt referral imaging and management to tertiary referral centers needed urgently. Surgery is usually needed emergently, but the choice of surgery often varies depending on the patient and the presentation. Staff and center expertise also play a major role in determining the surgical strategy employed. The aim of this study was to compare the early- and medium-term outcomes of patients undergoing a conservative approach extended only to the ascending aorta and the hemiarch to those of patients subjected to extensive surgery (total arch reconstruction and root replacement) across three European referral centers. A retrospective study was conducted across three sites between January 2008 and December 2021. In total, 601 patients were included within the study, of which 30% were female, and the median age was 64.4 years. The most common operation was ascending aorta replacement ( n = 246, 40.9%). The aortic repair was extended proximally (i.e., root n = 105; 17.5%) and distally (i.e., arch n = 250; 41.6%). A more extensive approach, extending from the root to the arch, was employed in 24 patients (4.0%). Operative mortality occurred in 146 patients (24.3%), and the most common morbidity was stroke (75, 12.6%). An increased length of ICU admission was noted in the extensive surgery group, which comprised younger and more frequently male patients. No significant differences were noted in surgical mortality between patients managed with extensive surgery and those managed conservatively. However, age, arterial lactate levels, "intubated/sedated" status on arrival, and "emergency or salvage" status at presentation were independent predictors of mortality both within the index hospitalization and during the follow-up. The overall survival was similar between the groups.

Objective: A clinical prediction model for postoperative combined Acute kidney injury (AKI) in patients with Type A acute aortic dissection (TAAAD) and Type B acute aortic dissection (TBAAD) was constructed by using Machine Learning (ML)., Methods: Baseline data was collected from Acute aortic division (AAD) patients admitted to First Affiliated Hospital of Xinjiang Medical University between January 1, 2019 and December 31, 2021. (1) We identified baseline Serum creatinine (SCR) estimation methods and used them as a basis for diagnosis of AKI. (2) Divide their total datasets randomly into Training set (70%) and Test set (30%), Bootstrap modeling and validation of features using multiple ML methods in the training set, and select models corresponding to the largest Area Under Curve (AUC) for follow-up studies. (3) Screening of the best ML model variables through the model visualization tools Shapley Addictive Explanations (SHAP) and Recursive feature reduction (REF). (4) Finally, the pre-screened prediction models were evaluated using test set data from three aspects: discrimination, Calibration, and clinical benefit., Results: The final incidence of AKI was 69.4% (120/173) in 173 patients with TAAAD and 28.6% (81/283) in 283 patients with TBAAD. For TAAAD-AKI, the Random Forest (RF) model showed the best prediction performance in the training set (AUC = 0.760, 95% CI:0.630-0.881); while for TBAAD-AKI, the Light Gradient Boosting Machine (LightGBM) model worked best (AUC = 0.734, 95% CI:0.623-0.847). Screening of the characteristic variables revealed that the common predictors among the two final prediction models for postoperative AKI due to AAD were baseline SCR, Blood urea nitrogen (BUN) and Uric acid (UA) at admission, Mechanical ventilation time (MVT). The specific predictors in the TAAAD-AKI model are: White blood cell (WBC), Platelet (PLT) and D dimer at admission, Plasma The specific predictors in the TBAAD-AKI model were N-terminal pro B-type natriuretic peptide (BNP), Serum kalium, Activated partial thromboplastin time (APTT) and Systolic blood pressure (SBP) at admission, Combined renal arteriography in surgery. Finally, we used in terms of Discrimination, the ROC value of the RF model for TAAAD was 0.81 and the ROC value of the LightGBM model for TBAAD was 0.74, both with good accuracy. In terms of calibration, the calibration curve of TAAAD-AKI's RF fits the ideal curve the best and has the lowest and smallest Brier score (0.16). Similarly, the calibration curve of TBAAD-AKI's LightGBM model fits the ideal curve the best and has the smallest Brier score (0.15). In terms of Clinical benefit, the best ML models for both types of AAD have good Net benefit as shown by Decision Curve Analysis (DCA)., Conclusion: We successfully constructed and validated clinical prediction models for the occurrence of AKI after surgery in TAAAD and TBAAD patients using different ML algorithms. The main predictors of the two types of AAD-AKI are somewhat different, and the strategies for early prevention and control of AKI are also different and need more external data for validation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Xinsai, Zhengye, Xuan, Xueqian, Kai, Sisi, Xuyan and Suhua.)

Background: Platelet distribution width (PDW), as a widely applied and reliable marker of platelet activation, was associated with adverse outcomes in cardiovascular diseases. However, there is little literature on the relationship between PDW and postoperative pneumonia in patients with type A acute aortic dissection (AAAD)., Methods: In this retrospective cohort study, we collected consecutive patients who underwent emergency surgery for AAAD at Xiangya Hospital of Central South University from January 1, 2014 and June 30, 2020. Patients were divided into three tertiles on the basis of the PDW. The independent effect of the PDW on postoperative pneumonia was evaluated using multivariate logistic regression analysis, and smooth curve fitting was performed to visualize the linear relationship between PDW and the risk of postoperative pneumonia in patients with AAAD., Results: A total of 210 patients with AAAD were enrolled and the overall incidence of postoperative pneumonia was 25.24% ( n = 53). Multivariate logistic regression revealed that PDW was positively associated with the risk of postoperative pneumonia (OR: 1.07, 95% CI: 1.02-1.13, P < 0.05) after adjusting the confounders. Compared with the lowest PDW tertile, the risk of postoperative pneumonia increased by 1.21-fold in the medium PDW tertile (OR: 2.21, 95% CI: 0.73-6.72) and by 3.16-fold in the highest PDW tertile (OR: 4.16, 95% CI: 1.40-12.33). A straight-line relationship was observed between PDW and postoperative pneumonia risk in smoothing spline fitting., Conclusion: Our findings indicate that high PDW is an independent risk factor of postoperative pneumonia in patients with AAAD. Preoperative PDW may serve as an available indicator of pneumonia, which helps identify AAAD patients with a high risk of postoperative pneumonia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Xie, Yan, Liu, Wang, Deng, Yao and Li.)

In this study, a minimum distance classification and forward feature selection technique are joined to determine the relationship between weather conditions and the increase of the risk of type A acute aortic dissection (AAD) events in Berlin. The results demonstrate that changes in the amount of cloudiness and air temperature are the most representative weather predictors among the studied parameters. A discrimination surface was developed for the prediction of AAD events 6 h ahead, and it is found that, under a specific amount of cloudiness and air temperature, the risk of AAD events in Berlin increases about 20 %. [ABSTRACT FROM AUTHOR]