Table.
Baseline and Clinical Characteristics and Perioperative Outcomes of 3 Cohorts
| Variables | Derivation cohort (N=3124) | Internal cohort (N=571) | External cohort (N=1319) |
|---|---|---|---|
| Demographics | |||
| Age (y), median (IQR) | 50 (41-59) | 49 (39-57) | 49 (40-58) |
| Sex (male), n (%) | 2347 (75.1) | 423 (74.1) | 936 (71.0) |
| Body mass index (kg/m2), median (IQR) | 25.4 (23.0-27.8) | 25.0 (22.7-27.4) | 25.2 (22.5-27.8) |
| Medical history, n (%) | |||
| Hypertension | 2602 (80.9) | 458 (80.2) | 1054 (79.9) |
| Chronic lung diseases | 77 (2.5) | 12 (2.1) | 33 (2.5) |
| Diabetes mellitus | 165 (5.3) | 35 (6.1) | 86 (6.5) |
| Arrhythmia | 85 (2.7) | 8 (1.4) | 98 (7.4) |
| Stroke | 141 (4.5) | 28 (4.9) | 67 (5.1) |
| Coronary heart disease | 298 (9.6) | 29 (5.1) | 106 (8.0) |
| Previous cardiac surgery | 417 (13.4) | 87 (15.2) | 210 (15.9) |
| Specific conditions on admission | |||
| Extent of dissection extension, n (%) | |||
| Limited in the ascending aorta | 1054 (33.7) | 172 (30.1) | 423 (32.1) |
| Extended to the aortic arch | 406 (13.0) | 88 (15.4) | 180 (13.6) |
| Extended to the descending aorta | 1664 (53.3) | 311 (54.5) | 716 (54.3) |
| Aortic regurgitation, n (%) | |||
| Mild | 964 (32.8) | 172 (34.9) | 400 (33.6) |
| Moderate | 399 (13.6) | 82 (16.6) | 170 (14.3) |
| Severe | 614 (20.9) | 101 (20.5) | 227 (19.1) |
| Pericardial tamponade, n (%) | 255 (8.7) | 39 (7.8) | 95 (7.9) |
| Pericardial effusion, n (%) | |||
| Mild | 278 (9.0) | 75 (13.3) | 149 (11.4) |
| Moderate | 59 (1.9) | 9 (1.6) | 18 (1.4) |
| Severe | 30 (1.0) | 4 (0.7) | 15 (1.1) |
| Shock, n (%) | 26 (0.8) | 4 (0.7) | 13 (1.0) |
| Cerebral malperfusion, n (%) | 321 (10.3) | 58 (10.2) | 131 (9.9) |
| Coronary malperfusion, n (%) | 533 (17.1) | 158 (27.7) | 270 (20.5) |
| Renal malperfusion, n (%) | 168 (5.4) | 35 (6.1) | 66 (5.0) |
| Laboratory signatures, median (IQR)a | |||
| Hemoglobin level (g/L) | 138 (126-149) | 137 (125-148) | 128 (115-141) |
| Creatinine level (μmol/L) | 75 (63-90) | 75 (62-91) | 85 (62-110) |
| WBC count (109/L) | 11.4 (8.5-14.5) | 11.1 (7.9-15.3) | 11.4 (8.8-14.3) |
| Platelet count (109/L) | 161 (123-209) | 147 (91-216) | 166 (132-208) |
| Neutrophile count (109/L) | 9.6 (6.6-12.4) | 9.2 (6.1-12.9) | 9.7 (6.9-12.2) |
| Lymphocyte count (109/L) | 1.01 (0.66-1.47) | 1.00 (0.59-1.56) | 1.01 (0.70-1.42) |
| Platelet-lymphocyte ratio | 157 (108-2396) | 148 (94-233) | 163 (116-242) |
| Neutrophile-lymphocyte ratio | 10.1 (5.4-16.4) | 9.6 (5.2-18.0) | 10.2 (5.5-15.8) |
| SII indexb | 1483 (623-3449) | 1351 (519-3499) | 1596 (680-3413) |
| STI indexc | 23.3 (14.5-34.3) | 24.2 (14.5-35.5) | 24.1 (14.9-35.0) |
| Procedural variables | |||
| Root procedures, n (%) | |||
| AVR only | 107 (3.4) | 15 (2.6) | 72 (5.4) |
| Bentall | 1148 (36.7) | 222 (38.8) | 264 (20.1) |
| David | 47 (1.5) | 9 (1.6) | 10 (0.8) |
| Total arch replacement plus FET implantation, n (%) | 1506 (48.2) | 318 (55.7) | 1022 (77.5) |
| Hemi-arch replacement, n (%) | 371 (11.9) | 75 (13.1) | 106 (8.0) |
| Total arch replacement, n (%) | 1530 (49.0) | 326 (57.0) | 1015 (77.0) |
| Inclusion technique, n (%) | 2201 (70.5) | 461 (80.6) | 386 (29.3) |
| Concomitant CABG, n (%) | 225 (7.2) | 38 (6.6) | 75 (5.7) |
| Concomitant valve surgery, n (%) | 145 (4.6) | 25 (4.4) | 32 (2.4) |
| Cardiopulmonary bypass time (min), median (IQR) | 171 (137-206) | 177 (141-220) | 189 (138-236) |
| Aortic cross-clamp time (min), median (IQR) | 99 (77-123) | 100 (79-129) | 110 (82-140) |
| Circulatory arrest of the lower body, n (%) | 2029 (65.1) | 404 (71.0) | 1126 (85.4) |
| Circulatory arrest time (min), median (IQR) | 23(18-30) | 23 (18-30) | 28 (19-34) |
| Perioperative outcomes | |||
| Operative mortality, n (%) | 180 (5.8) | 37 (6.5) | 133 (10.1) |
| Mechanical ventilation time (h), median (IQR) | 18(14-38) | 20 (15-42) | 36 (17-92) |
| ICU stay (h), median (IQR) | 29 (19-64) | 36 (20-83) | 42 (26-95) |
| Hospital stay (d), median (IQR) | 16(11-22) | 15 (11-21) | 18 (13-26) |
AVR, aortic valve regurgitation; CABG, coronary artery bypass grafting; FET = frozen elephant trunk; ICU, intensive care unit; IQR, interquartile range; SII, systemic inflammatory-immune; STI, systemic thrombo-inflammatory; WBC, white blood cell.
a
Variables were collected during the first 24 hours after admission to test for risk factors associated with the end point of mortality.
b
SII index was calculated by platelet count multiplied by neutrophile count divided by lymphocyte count.
c
STI index was calculated by platelet count divided by WBC count.