Linked Life Data

9546850

Source:http://linkedlifedata.com/resource/pubmed/id/9546850

Statements in which the resource exists as a subject.
PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
1
pubmed:dateCreated
1998-4-10
pubmed:abstractText
Reports in the literature frequently concern miscellaneous types of dissections. This makes correct interpretation of data difficult. In order to assess the determinants of hospital mortality, the results of 148 consecutive patients over a 23-year period, all operated on for a type A dissection, were reviewed. Mean(s.d.) age was 56(13.1) years, 64% were male. An acute dissection (surgery within 14 days after onset of symptoms) was performed in 139 patients. Stigmata of the Marfan syndrome were present in 6.1% (n = 9). Peripheral vascular ischaemic complications were observed in 27.7%. Nowadays, diagnosis is primarily confirmed using transoesophageal echocardiography (75 correct diagnoses among 76 performed). Operation consisted of repair or replacement of the ascending aorta. Resuspension of the aortic valve was performed in 74 patients, and arch replacement in 25. In 74 patients, distal repair was done under deep hypothermic circulatory arrest. Hospital mortality rate was 23.6% (35 patients), though mortality rate calculated over the period 1990-1993 was 17.4% (P = n.s.). Univariate analysis revealed the following variables to be statistically significant predictors of hospital mortality (P < 0.05): preoperative ischaemic complications, preoperative resuscitation, haemopericardium, postoperative neurological complications, rethoracotomy, renal insufficiency and intestinal ischaemia. Multivariate stepwise logistic regression indicated preoperative resuscitation, postoperative haemodialysis and postoperative neurological complications as the only independent predictors of hospital death. Dissections arising from a primary intimal tear in the descending aorta had a more favourable outcome (P = 0.06, odds ratio 0.1). Although hospital mortality has declined over the past few years, no decline was seen in operative mortality since gelatine-resourcine-formol (GRF) glue is used as a routine. Transoesophageal echocardiography is the first choice in confirming diagnosis. Early operation is advocated, with careful haemostasis, before the development of cardiac tamponade or end-organ ischaemia, as the cornerstone of a successful treatment of a type A dissection. Reduction of neurological complications will further improve the results.
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
IM
pubmed:chemical
pubmed:status
MEDLINE
pubmed:month
Feb
pubmed:issn
0967-2109
pubmed:author
pubmed:issnType
Print
pubmed:volume
6
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
76-80
pubmed:dateRevised
2004-11-17
pubmed:meshHeading
pubmed-meshheading:9546850-Aneurysm, Dissecting, pubmed-meshheading:9546850-Aorta, pubmed-meshheading:9546850-Aortic Aneurysm, pubmed-meshheading:9546850-Blood Vessel Prosthesis Implantation, pubmed-meshheading:9546850-Drug Combinations, pubmed-meshheading:9546850-Female, pubmed-meshheading:9546850-Formaldehyde, pubmed-meshheading:9546850-Gelatin, pubmed-meshheading:9546850-Hospital Mortality, pubmed-meshheading:9546850-Humans, pubmed-meshheading:9546850-Logistic Models, pubmed-meshheading:9546850-Male, pubmed-meshheading:9546850-Middle Aged, pubmed-meshheading:9546850-Morbidity, pubmed-meshheading:9546850-Reoperation, pubmed-meshheading:9546850-Resorcinols, pubmed-meshheading:9546850-Retrospective Studies, pubmed-meshheading:9546850-Risk Factors, pubmed-meshheading:9546850-Tissue Adhesives
pubmed:year
1998
pubmed:articleTitle
Predictors of hospital mortality in type A aortic dissections: a retrospective analysis of 148 consecutive surgical patients.
pubmed:affiliation
Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
pubmed:publicationType
Journal Article