Acute aortic dissection: Epidemiology and outcomes

Pacini, Davide; Marco, Luca Di; Fortuna, Daniela; Belotti, Laura Maria Beatrice; Gabbieri, Davide; Zussa, Claudio; Pigini, F; Contini, Andrea; Barattoni, Maria Cristina; Palma, Rossana De; Bartolomeo, Roberto Di

doi:10.1016/j.ijcard.2012.07.008

Cited by 120 publications

(74 citation statements)

References 19 publications

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“…These numbers increase dramatically when there is hemodynamic compromise at presentation (1,2,(5)(6)11,13,14). Hence, early recognition and surgical correction is recommended to prevent aortic rupture, repair the aortic regurgitation, and restore flow to end-organs (2,14).…”

Section: Discussionmentioning

confidence: 99%

“…Ascending aortic dissection remains one of the most catastrophic emergencies amongst cardiovascular diseases (1)(2)(3)(4)(5). Delay in diagnosis and surgical treatment is associated with increased mortality (2,6).…”

Section: Introductionmentioning

confidence: 99%

“…Delay in diagnosis and surgical treatment is associated with increased mortality (2,6). Collective efforts from different groups in the last 20 years have aimed to improve outcomes, but there are still many aspects in its management that have yet to be agreed upon (7,8).…”

Section: Introductionmentioning

confidence: 99%

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Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Cabasa¹,

Pochettino²

2016

Ann. Cardiothorac. Surg.

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Background: Type A aortic dissection (TAAD) is a complex cardiovascular disease that is associated with high perioperative morbidity and mortality. The most effective approach is still being debated-such as the best cannulation technique, and conservative versus extensive initial surgery. We reviewed our experience over the last 20 years and examined for variables that correlated with observed outcomes.Methods: All patients who underwent TAAD repair were reviewed. Chi-Square tests, Fisher Exact tests and Wilcoxon tests were performed where appropriate. Survival and freedom from reoperations were analyzed with the Kaplan-Meier actuarial method.Results: Acute TAAD was associated with a higher incidence of permanent stroke (P=0.010), renal failure (P=0.025), prolonged mechanical ventilator support (P=0.004), higher operative mortality (P=0.039) and higher 30-day mortality (P=0.003) compared to chronic TAAD. There was a trend towards higher risk for transient neurologic events among patients who were reoperated on (P=0.057). Extensive proximal repair led to longer perfusion and cross clamp times (P<0.001) and the need for temporary mechanical support postoperatively (P=0.011). More patients that had extensive distal repair underwent circulatory arrest (P=0.009) with no significant differences in the incidence of peri-operative complications, early, middle and long-term survival compared to the conservative management group. Overall survival in our series was 66.73% and 46.30% at 5 and 10 years respectively (median survival time: 9.38 years). There was a significant improvement in operative mortality (P=0.002) and 30-day mortality (P=0.033) in the second decade of our study.Conclusion: TAAD is a complex disease with several options for its surgical management. Each technique has its own advantages and complications and surgical management should be individualized depending on the clinical presentation. We propose our present approach to maximize benefits in both the short and long term.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Cabasa¹,

Pochettino²

2016

Ann. Cardiothorac. Surg.

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“…In a previous study, including 416 patients with BAV, aortic dissection occurred in 2 patients over a mean follow-up of 16 years, indicating the low incidence of this complication but still significantly higher than in the general population. 29,30 All aortic dissections occurred in men and male sex is a recognized risk factor for this complication. 31 However, Beller et al 32 did not manage to show any difference in percentage of patients with BAV presenting with dissection according to sex (25.8% versus 20.0%, P=0.4).…”

Section: Bav Complications In Men and Womenmentioning

confidence: 99%

Sex Differences in Phenotypes of Bicuspid Aortic Valve and Aortopathy

Kong

Regeer

et al. 2017

Circ: Cardiovascular Imaging

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Background-This large multicenter, international bicuspid aortic valve (BAV) registry aimed to define the sex differences in prevalence, valve morphology, dysfunction (aortic stenosis/regurgitation), aortopathy, and complications (endocarditis and aortic dissection). Methods and Results-Demographic, clinical, and echocardiographic data at first presentation of 1992 patients with BAV (71.5% men) were retrospectively analyzed. BAV morphology and valve function were assessed; aortopathy configuration was defined as isolated dilatation of the sinus of Valsalva or sinotubular junction, isolated dilatation of the ascending aorta distal to the sinotubular junction, or diffuse dilatation of the aortic root and ascending aorta. New cases of endocarditis and aortic dissection were recorded. There were no significant sex differences regarding BAV morphology and frequency of normal valve function. When presenting with moderate/severe aortic valve dysfunction, men had more frequent aortic regurgitation than women (33.8% versus 22.2%, P<0.001), whereas women were more likely to have aortic stenosis (34.5% versus 44.1%, P<0.001). Men had more frequently isolated dilatation of the sinus of Valsalva or sinotubular junction (14.2% versus 6.7%, P<0.001) and diffuse dilatation of the aortic root and ascending aorta (16.2% versus 7.3%, P<0.001) than women. Endocarditis (4.5% versus 2.5%, P=0.037) and aortic dissections (0.5% versus 0%, P<0.001) occurred more frequently in men. Conclusions-Although there is a male predominance among patients with BAV, men with BAV had more frequently moderate/severe aortic regurgitation at first presentation compared with women, whereas women presented more often with moderate/severe aortic stenosis compared with men. Furthermore, men had more frequent aortopathy than women. (Circ Cardiovasc Imaging. 2017;10:e005155.

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“…12 Previous studies of AD have been limited to homogenous cohorts and are not applicable to demographically diverse populations. [13][14][15][16] The purpose of our study was to evaluate racial differences in AD by using a comprehensive, statewide inpatient database to analyze hospitalizations in the state of Maryland.…”

Section: Introductionmentioning

confidence: 99%

Non-White Race Is an Independent Risk Factor for Hospitalization for Aortic Dissection

et al. 2016

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Objective: To evaluate racial differences in the burden of aortic dissection. Design: Retrospective analysis of a comprehensive state-wide inpatient database. Setting: Acute care hospitals in the state of Maryland, 2009 – 2014. Participants: All hospitalized adults with aortic dissection (AD), stratified by race. Main Outcome Measures: Statewide and county-level population adjusted hospitalization rates, access to specialty aortic care, and mortality. Results: Of 3,719,412 admissions to Maryland hospitals during the study period, 3,190 had AD (.09%; 1665 White, 1525 non- White). Non-White race was more common in patients with AD than without (48% vs. 41%, P<.0001). Adjusted for statewide demographics, admission for AD was 1.4 times more common among non-Whites (11 vs. 8 per 100,000, P<.0001). Non-White race was an independent risk factor for AD admission (OR 1.5, 95% CI 1.4 – 1.7). Among patients with AD, non-Whites were younger and more often female, but had similar or lower rates of cardiovascular comorbidities. Non-White race was not associated with decreased access to care or increased mortality. Conclusion: Hospitalization for AD is more common among non-Whites, who develop AD at younger ages despite fewer comorbidities. While clinical correlates are limited from this dataset, this may reflect more severe pathophysiology related to clinical or socioeconomic factors among non-Whites. Further study is warranted to better define this disparity and identify high-risk subgroups who may benefit from aggressive primary prevention. Ethn Dis. 2016;26(3):363-368; doi:10.18865/ed.26.3.363

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Acute aortic dissection: Epidemiology and outcomes

Cited by 120 publications

References 19 publications

Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Sex Differences in Phenotypes of Bicuspid Aortic Valve and Aortopathy

Non-White Race Is an Independent Risk Factor for Hospitalization for Aortic Dissection

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