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Preprint ARTICLE | doi:10.20944/preprints202304.0747.v1

Surgical Strategy for Repair of Acute Type A Aortic Dissection: A Multicenter Study

Francesco Nappi, Sanjeet Singh Avtaar Singh, Ivancarmine Gambardella, Alzamil Almothana, Antonio Salsano, Francesco Santini, Fausto Biancari, Thibaut Schoell, Nicolas Bonnet, Thierry Folliguet, Antonio Fiore

Subject: Medicine And Pharmacology, Cardiac And Cardiovascular Systems Keywords: Type A Acute Aortic dissection; ascending aorta replacement; aortic arch repair; total arch replacement procedure; cerebrovascular perfusion

Online: 23 April 2023 (03:37:12 CEST)

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Preprint ARTICLE | doi:10.20944/preprints202309.0449.v1

Lactate-Based Difference as a Determinant of Outcomes Following Surgery for Type A Acute Aortic Dissection: A LASSO Regression Multicenter Study

Francesco Nappi, Almothana Alzamil, Antonio Salsano, Sanjeet Singh Avtaar Singh, Ivancarmine Gambardella, Francesco Santini, Antonio Fiore, Giacomo Perocchio, Pierre Demondion, Patrick Mesnildrey, Thibaut Schoell, Nicolas Bonnet, Pascal Leprince

Subject: Medicine And Pharmacology, Cardiac And Cardiovascular Systems Keywords: Type A acute aortic dissection; arterial lactate; aortic root replacement; aortic arch repair; valve-sparing aorta replacement; ascending aorta replacement; total arch replacement procedure

Online: 7 September 2023 (03:32:28 CEST)

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Abstract: Type A acute aortic dissection 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 utilized 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 minimize potential collinearity of over-fitting variables and variables measured from the same patient. Results: 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 hours 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.

Preprint ARTICLE | doi:10.20944/preprints202311.0661.v1

Survival and Recurrence of Endocarditis Following Mechanical vs. Biological Aortic Valve Replacement in Patients Aged 40 to 65 Years: Data from the INFECT-REGISTRY

Antonio Salsano, Michele Di Mauro, Laura Labate, Alessandro Della Corte, Federica Lo Presti, Michele De Bonis, Cinzia Trumello, Mauro Rinaldi, Erik Cura Stura, Guglielmo Actis Dato, Giuseppe Punta, Francesco Nicolini, Davide Carino, Carlo De Vincentiis, Andrea Garatti, Giangiuseppe Cappabianca, Andrea M Musazzi, Diego Cugola, Maurizio Merlo, Davide Pacini, Gianluca Folesani, Sandro Sponga, Igor Vendramin, Alberto Pilozzi Casado, Francesco Rosato, Elisa Mikus, Carlo Savini, Francesco Onorati, Giovanni Battista Luciani, Roberto Scrofani, Francesco Epifani, Francesco Musumeci, Antonio Lio, Andrea Colli, Giosuè Falcetta, Salvatore Nicolardi, Salvatore Zaccaria, Enrico Vizzardi, Antonio Pantaleo, Giuseppe Minniti, Emmanuel Villa, Margherita Dalla Tomba, Francesco Pollari, Fabio Barili, Alessandro Parolari, Roberto Lorusso, Francesco Santini

Subject: Medicine And Pharmacology, Cardiac And Cardiovascular Systems Keywords: endocarditis; aortic valve replacement; prosthetic heart valve.

Online: 9 November 2023 (15:01:57 CET)

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