| Objectives:After emergency surgery,acute Type A aortic dissection patients had poor in-hospital outcomes.A serious side effect of the procedure is acute renal failure.Incidence,risk factors,and outcomes of acute renal failure were the focus of this investigation.Methods:From January 2013 to December 2018,a sizable,retrospective,single-institution observational research was conducted.Consecutive individuals who had undergone surgery for an acute Type A aortic dissection were enrolled in the trial.Regression using several variables was used to find the risk factors for acute renal failure.To investigate the relationship between acute renal failure and postoperative long-term survival,a Kaplan-Meier survival analysis was performed.Results:Acute renal failure occurred in 89/797(11.2%)patients.Multivariable logistic regression analysis identified that older age(OR=1.03,95%CI:1.01-1.06),coronary artery involvement(OR=1.82,95%CI:1.04-3.19),renal malperfusion(OR=2.99,95%CI:1.67-5.35),higher preoperative creatinine(OR=1.01,95%CI:1.00-1.01)and longer cardiopulmonary bypass time(OR=1.01,95%CI:1.01-1.02)were independent risk factors of acute renal failure.Postoperative acute renal failure in all patients was associated with decreased in-hospital and long-term survival(P<0.01).Acute renal failure was not significantly linked to long-term outcomes in 30-day survivors(P>0.05).Conclusions:In patients undergoing acute Type A aortic dissection surgery,the incidence of acute renal failure is still very high.Acute renal failure has independent risk factors including older age,coronary artery involvement,renal malperfusion,greater preoperative creatinine,and longer cardiopulmonary bypass time.Higher early and long-term mortality is predicted by acute renal failure,although the risk of late mortality fluctuates over time rather than remaining constant.Acute kidney injury(AKI)is a common complication after acute type A aortic dissection(ATAAD)surgery and associated with higher risk of short-term and long-term mortality.We presented the recent advances in international multi-center registries,pathogenesis and mechanisms of ATAAD.Preoperative,intraoperative,postoperative risk factors and prediction models designed for identifying patients at high risk were summarized.Furthermore,we described different diagnosis criterion,early screening biomarkers,preventative and therapeutic strategies.Renal recovery and survival information were also discussed in this review.Objectives:The purpose of this study was to evaluate the perioperative risk factors of spinal cord injury after aortic repair in patients with acute type A aortic dissection using frozen trunk technique.Methods:From January 2013 to December 2018,641 patients in Fuwai Hospital underwent total aortic arch replacement with frozen elephant trunk technique.The baseline characteristics,preoperative and intraoperative factors and postoperative outcomes of patients in spinal cord injury group and non～spinal cord injury group were analyzed and compared.Multivariate logical regression was used to determine the independent risk factors of spinal cord injury.Results:The average age of the patients in this series was 46.8 years old,and 21.1%of the patients were female.18 patients had postoperative spinal cord injury.The age of non～spinal cord injury group and spinal cord injury group was 46.7±10.1 years and 51.7±10.4 years respectively,the difference was statistically significant.Chest pain and back pain were the most common clinical manifestations in patients,with an incidence of 84.9%and 45.7%,respectively.The proportion of preoperative hypotension or shock in the spinal cord injury group was 11.1%,which was significantly higher than 1.8%in the spinal cord non～injury group.The proportion of left renal artery involved in spinal cord injury group was higher(72.2%vs 45.1%),the difference was statistically significant.No statistical difference was found in the involvement of other vascular branches between the two groups.After multivariate logistic regression analysis,shock or hypotension(OR=6.356,CI:1.006～40.169)and left renal artery involvement(OR=3.455,CI:1.132～10.541)were independent risk factors for spinal cord injury.Conclusion:In patients with acute type A aortic dissection,the incidence of spinal cord injury after aortic repair with total arch replacement and elephant trunk stent is higher,and the risk factors include preoperative shock or hypotension and left renal artery involvement.For patients with the above characteristics,appropriate spinal cord protection strategies should be adopted to improve the prognosis.In the middle of last century,people put forward a bio-social-psychological medical model,which pointed out that the disease and health of human beings are influenced by biological factors and social-psychological characteristics.Under this model,the ultimate goal of medical innovation should point to the overall quality of life of patients rather than the improvement of simple biological indicators.However,in the past,due to the limitation of manpower and material resources,there are still some shortcomings in the evaluation methods of medical innovation,such as biological indicators as the endpoint of clinical trials,lack of follow-up of quality of life outside the hospital,and substandard medication.With the application and rise of Internet of Things and telemedicine platform,patients can actively give feedback of all dimensions of health information to doctors through wearable devices and online questionnaires,which is beneficial to their long-term out-of-hospital management and follow-up.In addition,smart medicine box equipment further ensures patients’ medication compliance.The purpose of the new evaluation method is to carry out bio-social-psychological comprehensive evaluation combined with in-hospital and out-of-hospital on the basis of reaching the standard of medication,so as to feedback guidance and optimize clinical intervention,and finally promote the improvement of medical quality and improve the quality of life of patients. |
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