Insights from the International Registry of Acute Aortic Dissection

Evangelista, Arturo; Maldonado, Giuliana; Gruosso, Doménico; Teixidó, Gisela; Rodríguez-Palomares, José F.; Eagle, Kim A.

doi:10.21542/gcsp.2016.8

Cited by 236 publications

(413 citation statements)

References 52 publications

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“…Over the past 17 years, the International Registry of Acute Aortic Dissection (IRAD) has unraveled vestibules to answer most unknown avenues on incidence, predisposition, aetiological factors, modes of presentation and clinical features, treatment, and outcome of patients with TAAD . However, the diverse population enrolled, changes in demographics, protuberance of sex and age differences, and aging population across the globe raised a debate on level of IRAD consistency in current era.…”

Section: Introductionmentioning

confidence: 99%

“…Aging, which represents a standalone configure on associated mortality and morbidities, has been reported and widely varied among affected populations worldwide . For instance, the IRAD reported a mean age of 61 years for patients presenting with type A dissection . This, coupled with poorer outcomes on different patient population related to aging aspects, raised a red herring whether or not septuagenarians and octogenarians should be operated on.…”

Section: Introductionmentioning

confidence: 99%

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Type A aortic dissection in patients over the age of seventy in the UK

Bashir

Harky

Shaw³

et al. 2019

J Card Surg

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Objectives: Recent guidelines have stated that age alone should not be a limiting factor for offering life-saving surgery to patients with acute type A dissection (ATAD).The objective of this study was to review the outcomes of patients above the age of 70 undergoing surgery for type A aortic dissection (TAAD) in the UK. Methods: Prospectively collected data of procedures undertaken on patients with an age of 70 years or more were extracted from the National Institute for Cardiovascular Outcomes Research (NICOR) National Adult Cardiac Surgery Audit registry. All operations were performed in England and Wales between 1 April 2007 and 31 March 2013. The primary outcome for this study was in-hospital mortality.The secondary outcome was mid-term mortality followed up to 5 years.Results: A total of 507 patients were included in the study. The highest number of procedures performed by a single surgeon during the study period was 12. The overall in-hospital mortality rate for all ATAD patients aged 70 or over was 22.5% (114 patients); the stroke rate was 11% (57) and postop dialysis rate 15% (76).Conclusions: ATAD is a life-threatening condition with a high mortality rate if left untreated. Our results show that surgery for ATAD in patients over 70 is feasible with acceptable mortality rates. However, similar to previous studies, rates of stroke in older patients may be higher. The present study supports the notion that age should not be a discriminating factor in operating on patients with TAAD.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Type A aortic dissection in patients over the age of seventy in the UK

Bashir

Harky

Shaw³

et al. 2019

J Card Surg

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“…Em 2019, os resultados já alcançam 11%, sendo que a mortalidade média dos melhores centros é >20%. 21 Vale ressaltar que vários protocolos foram estruturados em função do melhor momento para a abordagem cirúrgica e a padronização da técnica cirúrgica. Nas CRM + valva, o volume anual médio teve uma queda não significativa de 22,4% (p = 0,1481); no entanto, houve uma queda significativa da mortalidade (12,1%).…”

Section: Discussionunclassified

Análise de >100.000 Cirurgias Cardiovasculares Realizadas no Instituto do Coração e a Nova Era com Foco nos Resultados

et al. 2020

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ResumoFundamento: O desafio atual da cirurgia cardiovascular (CCV) é melhorar resultados em pacientes cada vez mais graves. Nesse sentido, Programas de Melhoria Contínua da Qualidade (PMCQ) tem impactado os resultados. Objetivo: Avaliar a evolução da incidência e mortalidade das CCV, assim como os resultados atuais do Instituto do A análise incluiu o total de cirurgias e a evolução dos procedimentos mais frequentes.Resultados: Foram realizadas 105.599 CCV, com uma média anual de 2.964 procedimentos e mortalidade de 5,63%. Comparando o 4° com o 5° período, o volume global médio de cirurgias foi de 2.943 para 3.139 (p = 0,368), cirurgias de revascularização miocárdica (CRM) de 638 para 597 (p = 0,214), valvas cardíacas de 372 para 465 (p = 0,201) e cardiopatias congênitas de 530 para 615 (p = 0,125). A mortalidade média global passou de 7,8% para 5% (p < 0,0001), nas cirurgias de revascularização miocárdica de 5,8% para 3,1% (p < 0,0001), nas cirurgias valvares de 14% para 7,5% (p < 0,0001) e nas cirurgias de cardiopatias congênitas de 12,1% para 9,6% (p < 0,0001). Conclusão: Embora haja uma tendência recente ao aumento dos volumes cirúrgicos, houve uma diminuição significativa da mortalidade cirúrgica nos grupos analisados. Após o estabelecimento do PMCQ, as taxas de mortalidade se aproximaram a dos padrões internacionais. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0) Palavras-chave: Procedimentos Cirúrgicos Cardiovasculares/tendências; Melhoria de Qualidade; Segurança do Paciente; Mortalidade Hospitalar; Banco de Dados. AbstractBackground: The current challenge of cardiovascular surgery (CVS) is to improve the outcomes in increasingly severe patients. In this respect, continuous quality improvement (CQI) programs have had an impact on outcomes.Objective: To assess the evolution of the incidence and mortality due to CVS, as well as the current outcomes of the Hospital das Clínicas Heart ). The CQI program was implemented between 2015 and 2016. The analysis included the total number of surgeries and the evolution of the most frequent procedures.Results: A total of 105,599 CCVs were performed, with an annual mean of 2,964 procedures and mortality of 5,63%. When comparing the 4th and the 5th periods, the average global volume of surgeries was increased from 2,943 to 3,139 (p = 0.368), bypass graft (CABG), from 638 to 597 (p = 0.214), heart valve surgery, from 372 to 465 (p = 0.201), and congenital heart disease surgery, from 530 to 615 (p = 0.125). The average global mortality went from 7.8% to 5% (p < 0.0001); in CABG surgery, from 5.8% to 3.1% (p < 0.0001); in heart valve surgery, from 14% to 7.5% (p < 0.0001) and in congenital heart disease surgery, from 12.1% to 9.6% (p < 0.0001). Conclusion:In spite of a recent trend towards increased surgical volume, there was a significant decrease in operative mortality in the groups studied. After the implementation of the CQI program, the mortality rates were closer to international standards. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

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“…Based on the review of International Registry of Acute Aortic Dissection (IRAD), in Type A aortic dissection, common presentation includes acute onset chest pain (85%), radiation to back (43%) or abdomen (22%), syncope (19%), and focal neurologic deficits (3%). Pulse deficit define as a difference in systolic blood pressure by >20 mmHg on both arms is an infrequent finding in up to 30% of cases 5,7 . Risk factors for aortic dissection include hypertension, hyperlipidemia, tobacco dependence, advanced age, and CABG 8 .…”

Section: Discussionmentioning

confidence: 99%

Type A aortic dissection mimicking saddle pulmonary embolism on CT imaging

et al. 2020

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Type A aortic dissection is an uncommon cause of chest pain that carries a high morbidity and mortality rate. A previous history of hypertension and coronary artery bypass grating (CABG) are recognized risk factors for Type A aortic dissection. We present a case of an elderly man who presents with acute onset chest pain and was found to have an acute ruptured Type A aortic dissection that has a "saddle pulmonary embolism"-like appearance on computed tomography (CT) imaging. We also describe the clinical, laboratory, and radiological workup done leading up to the diagnosis of Type A aortic dissection in the emergency setting.

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Insights from the International Registry of Acute Aortic Dissection

Cited by 236 publications

References 52 publications

Type A aortic dissection in patients over the age of seventy in the UK

Type A aortic dissection in patients over the age of seventy in the UK

Análise de >100.000 Cirurgias Cardiovasculares Realizadas no Instituto do Coração e a Nova Era com Foco nos Resultados

Type A aortic dissection mimicking saddle pulmonary embolism on CT imaging

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