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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Blood Pressure and Heart Rate Management in Patients After Repair of Type A Aortic Dissection
Chun-Hung Ho1, Chia-Pin Lin2, Feng-Cheng Chang3
1Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan District, Taoyuan City, Taiwan.
Insights
Optimal blood pressure and heart rate control after acute type A aortic dissection (TAAD) surgery are key for long-term survival. Elevated systolic blood pressure and heart rate increase mortality risks post-TAAD repair.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease Management
Background:
- Optimal blood pressure (BP) and heart rate (HR) targets post-acute type A aortic dissection (TAAD) surgical repair are not well-defined.
- This study investigates the long-term impact of BP and HR control on outcomes following TAAD repair.
Purpose of the Study:
- To evaluate the association between blood pressure and heart rate control and long-term outcomes in patients after TAAD surgical repair.
- To identify specific BP and HR thresholds associated with adverse events.
Main Methods:
- Retrospective analysis of 839 patients who underwent TAAD surgical repair (2003-2018).
- Primary outcomes: all-cause mortality, aortic progression, and aortic surgery events.
- Assessment of systolic blood pressure (SBP), diastolic blood pressure, and heart rate (HR) at discharge and 3-month follow-up.
Main Results:
- Higher SBP (>150 mm Hg) at discharge correlated with increased all-cause mortality (aHR, 3.21).
- Elevated HR (81-100 bpm) at discharge linked to higher mortality (aHR, 2.59).
- HR >100 bpm at discharge and at 3-month follow-up associated with increased mortality and aortic surgery events.
Conclusions:
- Careful management of blood pressure and heart rate is crucial for favorable long-term outcomes in TAAD patients.
- Maintaining optimal BP and HR levels post-surgery may reduce mortality and prevent aortic complications.
Background:
The long-term optimal targets for blood pressure and heart rate in patients after surgical repair of acute type A aortic dissection (TAAD) remain unclear. This study evaluated the long-term association of blood pressure and heart rate control on patients after TAAD surgical repair.
Methods:
We identified 839 patients who underwent TAAD surgical repair and survived to discharge between 2003 and 2018 from the Chang Gung Research Database. Primary outcomes included all-cause mortality, aortic progression, and aortic surgery events. Vital signs examined were systolic blood pressure (SBP), diastolic blood pressure, and heart rate (HR) at discharge and at 3 months of follow-up.
Results:
The patients were a mean age of 57.2 ± 13.6 years, and approximately two-thirds were men. The results showed that SBP >150 mm Hg at discharge was correlated with increased all-cause mortality (adjusted hazard ratio [aHR], 3.21; 95% CI, 1.61-6.37). Moreover, an HR between 81 and 100 beats/min was associated with a higher hazard of all-cause mortality (aHR, 2.59; 95% CI, 1.28-5.24) and an HR >100 beats/min was also associated with a higher hazard of aortic surgery events (aHR, 2.19; 95% CI 1.24-3.86) compared with an HR of ≤80 beats/min at discharge. During the 3-month follow-up, an HR >100 beats/min was associated with a higher hazard of all-cause mortality (aHR, 3.59; 95% CI, 1.19-10.78) relative to an HR ≤80.
Conclusions:
The careful management of blood pressure and HR contributes to favorable long-term outcomes in patients after surgical repair of TAAD.
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