Five-year mortality in uncomplicated type B aortic dissections with high-risk anatomic features: A 15-year retrospective review
Notice bibliographique
Résumé
Objective To evaluate the importance of high-risk anatomic features in the long-term outcomes of patients with acute uncomplicated type B aortic dissections (TBAD) who receive medical management or early thoracic endovascular aortic repair (TEVAR). Methods A retrospective review of all adult patients who were diagnosed with acute uncomplicated TBAD (by Society for Vascular Surgery and Society of Thoracic Surgeons reporting standards) at a Calgary hospital between January 1, 2007, and June 30, 2022, was performed. Anatomic features were analyzed using TeraRecon at diagnosis and at follow-up up to 5 years, and high-risk anatomic features such as an aortic diameter of >40 mm, a false lumen diameter of >22 mm, and a tear on the inner curve are used to risk-stratify patients. The primary outcome was 5-year all-cause mortality and aortic-related mortality. Subgroup analysis was performed for patients with the initial diagnosis of uncomplicated TBAD medically managed with no high-risk features (uTBAD), uncomplicated TBAD medically managed with high-risk anatomic features (uTBAD-HR), and uncomplicated TBAD who received early TEVAR (uTBAD-T), which encompasses patients with both high-risk features and no high-risk features, before the chronic dissection phase. We used the Cox proportional hazards model to analyze the impact of multiple covariates on survival times. Results A total of 41 patients were identified with the diagnosis of acute uncomplicated TBAD during the study period: 19 patients with acute uTBAD, 12 patients with acute uTBAD-HR, and 10 patients with uTBAD-T. The 5-year all-cause mortality and aortic-related mortality in patients with uTBAD-T was 50% and 40%, respectively. Of this subset, patients with high-risk features who received early TEVAR had the worst outcomes, with the all-cause mortality of 80% and aortic-related mortality of 60% at 5 years. All-cause mortality was similar among uTBAD (with thoracic aorta involvement), uTBAD-HR, and uTBAD-T without high-risk features (23.1% vs 25% vs 20%). Maximal descending thoracic aorta diameter and maximal false lumen diameter demonstrated a nonsignificant all-cause mortality trend on survival analysis. Conclusions Real-world data suggest that the role of early TEVAR in patients with acute uncomplicated TBAD remains uncertain. In this small dataset, patients with high-risk anatomic features who received TEVAR before the chronic phase of dissection experienced a higher rate of all-cause and aortic-related mortality.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».