Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: Observations from the International Registry of Acute Aortic Dissection

Eusanio, Marco Di; Trimarchi, Santi; Patel, Himanshu J.; Hutchison, Stuart J.; Suzuki, Toru; Peterson, Mark D.; Bartolomeo, Roberto Di; Folesani, Gianluca; Pyeritz, Reed E.; Braverman, Alan C.; Montgomery, Daniel; Isselbacher, Eric M.; Nienaber, Christoph; Eagle, Kim A.; Fattori, Rossella

doi:10.1016/j.jtcvs.2012.01.042

Cited by 255 publications

(230 citation statements)

References 16 publications

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“…Patients with malperfusion had longer hospital lengths of stay {20 vs. 12 [8][9][10][11][12][13][14][15][16][17][18] days, P=0.006}, as well as more reoperations for postoperative hemorrhage (24.0% vs. 5.6%, P=0.01) and a greater number of postoperative CNS events (44.0% vs. 18.3%, P=0.01).…”

Section: Resultsmentioning

confidence: 99%

“…In one of the largest series, Di Eusanio et al reviewed the International Registry of Acute Aortic Dissection, a database compiled from 18 contributing centers and comprised of 1,809 consecutive patients presenting with an acute, type A dissection, to better understand the influence of mesenteric malperfusion on outcomes. While only present in 3.8% of the patients, intestinal ischemia was associated with considerably higher in-hospital mortality (63.2% vs. 23.8%, P<0.001) (10). These patients were commonly afflicted by multiple sites of malperfusion and were routinely managed nonoperatively (10).…”

Section: Discussionmentioning

confidence: 99%

“…The presence of mesenteric malperfusion has been identified as a predictor of a poor prognosis in several studies (9)(10)(11)(12). In one of the largest series, Di Eusanio et al reviewed the International Registry of Acute Aortic Dissection, a database compiled from 18 contributing centers and comprised of 1,809 consecutive patients presenting with an acute, type A dissection, to better understand the influence of mesenteric malperfusion on outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Differential outcomes of type A dissection with malperfusion according to affected organ system

Grimm¹,

Magruder²,

Crawford³

et al. 2016

Ann. Cardiothorac. Surg.

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Background: The management of malperfusion in patients with acute Stanford type A aortic dissection is controversial. We sought to determine the rate of resolution of malperfusion following primary repair of the dissection and to identify anatomic sites of malperfusion that may require additional management. Methods:We reviewed the hospital records of patients who presented to our institution with acute type A aortic dissection. Patient demographics, operative details and post-operative course were retrospectively extracted from our institutional electronic database. Depending upon the anatomic site, malperfusion was identified by a combination of radiographic and clinical definitions. Data were analyzed using standard univariable and multivariable methods. Conclusions: Malperfusion complicating acute type A dissection can be managed in many patients by aortic replacement alone with low overall mortality. Most cases of renal and cerebral malperfusion resolved following aortic surgery. Revascularization was frequently necessary in patients with extremity malperfusion.Patients presenting with intestinal ischemia had very poor outcomes. A patient-specific approach is recommended in such complex patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Differential outcomes of type A dissection with malperfusion according to affected organ system

Grimm¹,

Magruder²,

Crawford³

et al. 2016

Ann. Cardiothorac. Surg.

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“…The most common risk factor but not the most important, associated with AAD is the acute hypertension, observed in 65 -75% of individuals [6][7][8][9].…”

Section: Epidemiologymentioning

confidence: 99%

“…Registry IRAD data show that this complication occurs within 10% of cases of AAD and is commonly related to aortic regurgitation [9]. Although more common in Type A, heart failure may also be encountered in patients with Type B, suggesting additional aetiologies of heart failure, such as myocardial ischemia, pre-existing diastolic dysfunction or uncontrolled chronic hypertension.…”

Section: Heart Failurementioning

confidence: 99%

Warning at emergency room: The role of diagnostic test in acute aortic dissection

Lagi¹

2017

Vascul Dis Ther

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Early Mortality in Type A Acute Aortic Dissection

et al. 2022

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ImportanceEarly data revealed a mortality rate of 1% to 2% per hour for type A acute aortic dissection (TAAAD) during the initial 48 hours. Despite advances in diagnostic testing and treatment, this mortality rate continues to be cited because of a lack of contemporary data characterizing early mortality and the effect of timely surgery.ObjectiveTo examine early mortality rates for patients with TAAAD in the contemporary era.Design, Setting, and ParticipantsThis cohort study examined data for patients with TAAAD in the International Registry of Acute Aortic Dissection between 1996 and 2018. Patients were grouped according to the mode of their intended treatment, surgical or medical.ExposureSurgical treatment.Main Outcomes and MeasuresMortality was assessed in the initial 48 hours after hospital arrival using Kaplan-Meier curves. In-hospital complications were also evaluated.ResultsA total of 5611 patients with TAAAD were identified based on intended treatment: 5131 (91.4%) in the surgical group (3442 [67.1%] male; mean [SD] age, 60.4 [14.1] years) and 480 (8.6%) in the medical group (480 [52.5%] male; mean [SD] age, 70.9 [14.7] years). Reasons for medical management included advanced age (n = 141), comorbidities (n = 281), and patient preference (n = 81). Over the first 48 hours, the mortality for all patients in the study was 5.8%. Among patients who were medically managed, mortality was 0.5% per hour (23.7% at 48 hours). For those whose intended treatment was surgical, 48-hour mortality was 4.4%. In the surgical group, 51 patients (1%) died before the operation.Conclusions and RelevanceIn this study, the overall mortality rate for TAAAD was 5.8% at 48 hours. For patients in the medical group, TAAAD had a mortality rate of 0.5% per hour (23.7% at 48 hours). However, among those in the surgical group, 48-hour mortality decreased to 4.4%.

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Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: Observations from the International Registry of Acute Aortic Dissection

Cited by 255 publications

References 16 publications

Differential outcomes of type A dissection with malperfusion according to affected organ system

Differential outcomes of type A dissection with malperfusion according to affected organ system

Warning at emergency room: The role of diagnostic test in acute aortic dissection

Early Mortality in Type A Acute Aortic Dissection

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