ABSTRACT
Objective:To evaluate the association between preoperative thyroid hormones and the postoperative acute kidney injury (AKI) in acute Standford type A aortic dissection (ASTAAD) patients.Methods:The patients with ASTAAD, who underwent surgeries in Beijing Anzhen Hospital from July 2016 to December 2016, were included in this retrospective cohort study. Multivariable regression and stratification analyses were used to examine the association of preoperative thyroid hormone with postoperative AKI.Results:The overall occurrence of postoperative AKI was 42.0%. Multivariate regression revealed that low level of TT3 ( OR=0.08, 95% CI: 0.01-0.94, P=0.04) and TT4 ( OR=0.97, 95% CI: 0.94-1.00, P=0.04) was independently associated with postoperative AKI. Subgroup analyses showed that the relation between TT3 and AKI was significantly noticed in patients with normal TSH levels ( OR=0.004, 95% CI: 0.001-0.16, P<0.01) other than in patients with lower TSH levels ( P=0.26). Conclusion:The present study showed that a low level of TT3 or TT4 was a predictor of postoperative AKI in ASTAAD patients, especially in patients with normal TSH. The thyroid function should be checked before surgical intervention of patients with ASTAAD, and patients with low T3 might be at higher risk of postoperative AKI.
ABSTRACT
@#Objective To observe the efficacy of restrictive bare stent released on the distal end of the trunk of Standford type A aortic dissection. Methods The clinical data of 22 patients with Standford type A aortic dissection requiring aortic arch replacement and trunk surgery and selected for restrictive bare stent placement from November 2016 to February 2018 in our hospital were retrospectively analyzed. Among them, there were 19 males and 3 females, aged 34-68 (49.72±8.05) years. The bare stent was released in the descending thoracic aorta, and the stented elephant trunk was placed in the bare stent. The aortic computerized tomography angiography was reviewed before discharge and the stent position and complications were observed. Results One patient failed to be implanted with bare stents due to a greater resistance and prolapse during implantation. Bare stents were successfully implanted in the remaining 21 patients. One patient died of large-area cerebral infarction after surgery and one patient suffered paraplegia. Twenty patients who survived and successfully implanted bare stents were followed up at regular intervals for 4-21 (13.00±6.14) months. No stroke or death occurred during the follow-up. The computerized tomography angiography showed good stent morphology and position, and no displacement or type Ⅲ endoleak. No stent graft-induced new entry was found. Conclusion As an adjunct to stented elephant trunk, the use of restrictive bare stents can reduce the possibility of recurrence of a distal stent fracture, significantly expand the narrowest segment and true lumen caliber near the endoluminal graft. Aortic remodeling works well.