Acute Aortic Dissection—Refining Contemporary Outcomes With the Penn Classification for This Aortic Emergency

Al-Ghofaily, Lourdes; Feinman, Jared W.; Augoustides, John

doi:10.1053/j.jvca.2019.12.037

Cited by 6 publications

(3 citation statements)

References 22 publications

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“…This was related to the level of preoperative ischemia. Laboratory results depend heavily on the effect of AD on the blood supply to the organs [ 18 ]. All patients in this study were Penn's type Aa patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of tolvaptan in postoperative volume therapy for acute Stanford type A aortic dissection

Wang

Gao

et al. 2023

BMC Cardiovasc Disord

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Background Despite the increasing application of tolvaptan in cardiac surgery, there is no information on the use of tolvaptan in Stanford patients with type A aortic dissection. This study aimed to evaluate the postoperative clinical effects of tolvaptan in patients with type A aortic dissection after tafter surgery. Methods A retrospective analysis was performed on 45 patients treated for type A aortic dissection in our hospital from 2018 to 2020. These included 21 patients who were treated with tolvaptan (Group T) and 24 patients who received traditional diuretics (Group L). The hospital's electronic health records were used to obtain perioperative data. Results Group T did not differ significantly from Group L in terms of the duration of mechanical ventilation, postoperative blood required, length of catecholamine use, or the amount of intravenous diuretic drugs administered (all P > 0.05). The development of postoperative atrial fibrillation was significantly less in the tolvaptan group (P = 0.023). The urine volumes and change in body weight loss were slightly higher in group T than in group L but the differences were non-significant (P > 0.05). Serum potassium, creatinine, and urea nitrogen levels did not differ between the groups in the week after surgery, At the same time, sodium was significantly higher in the Group T group on day 7 after transfer from the ICU (P = 0.001). In Group L, sodium levels were also elevated by day 7 (P = 0.001). On days 3 and 7, serum creatinine and urea nitrogen levels increased in both groups (both P < 0.05). Conclusions Both tolvaptan and traditional diuretics were found to be effective and safe for patients with acute Stanford type A aortic dissection. Moreover, tolvaptan may be associated with reducing the incidence of postoperative atrial fibrillation.

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Section: Discussionmentioning

confidence: 99%

Efficacy of tolvaptan in postoperative volume therapy for acute Stanford type A aortic dissection

Wang

Gao

et al. 2023

BMC Cardiovasc Disord

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“…1,2 The role of TEVAR in this setting remains controversial when classic complications are absent. [1][2][3][4] The adverse natural history of uncomplicated acute type B dissection has recently prompted selective consideration of TEVAR to supplement best medical therapy. 3,4 The report by Hong and colleagues 5 in this issue of the Journal evaluates the rationale for TEVAR in uncomplicated type B aortic dissection.…”

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confidence: 99%

Commentary: Acute type B aortic dissection: Navigating new horizons

Augoustides

2022

The Journal of Thoracic and Cardiovascular Surgery

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Acute type B aortic dissection is a challenging acute aortic syndrome in which thoracic endovascular aortic repair (TEVAR) is indicated for such complications as rupture and malperfusion. 1,2 The role of TEVAR in this setting remains controversial when classic complications are absent. [1][2][3][4] The adverse natural history of uncomplicated acute type B dissection has recently prompted selective consideration of TEVAR to supplement best medical therapy. 3,4 The report by Hong and colleagues 5 in this issue of the Journal evaluates the rationale for TEVAR in uncomplicated type B aortic dissection. The authors highlight the advances in classification, emergence of high-risk features, and current management options and also suggest extended indications for TEVAR based on the presence of high-risk features. 5,6 How might their report stratify our management approach to type B aortic dissection? First, uncomplicated presentations are now defined by an absence of high-risk features, malperfusion, or rupture. [5][6][7] These patients require intense medical therapy, including titrated analgesia, strict blood pressure control, and close monitoring for disease progression. 5,6 This medical management can often be successful through the hyperacute (the first 24 hours of symptoms), acute (1-14 days from symptom onset), and subacute (15-90 days from symptom onset) phases of care. If a systolic blood pressure

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