Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA)

Conzelmann, Lars O.; Weigang, Ernst; Mehlhorn, Uwe; Abugameh, A; Hoffmann, Isabell; Blettner, Maria; Etz, Christian D.; Czerny, Martin; Vahl, Christian F.

doi:10.1093/ejcts/ezv356

Cited by 277 publications

(207 citation statements)

References 22 publications

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“…Our cannulation strategy for initial bypass had no impact on mortality. While some studies show a positive effect with central cannulation (10) other studies could not demonstrate any benefit (1,(11)(12)(13). In a meta-analysis from Patris et al femoral cannulation had a negative outcome, but was used mainly in critically ill patients in hemodynamic collapse when institution of cardiopulmonary bypass was required rapidly (14).…”

Section: Discussionmentioning

confidence: 99%

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Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Klotz¹,

Bucsky²,

Richardt³

et al. 2016

Ann. Cardiothorac. Surg.

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Background: The purpose of this study was to evaluate the single-center experience in initial femoral versus central cannulation of the extracorporeal circulation for acute aortic dissection type A (AADA). Conclusions: AADA can be operated with both femoral and central cannulation with similar results. Risk for early mortality was driven by the preoperative clinical and hemodynamic status before operation rather than the cannulation technique. Methods

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Section: Discussionmentioning

confidence: 99%

“…Acute aortic dissection type A (AADA) is a life threatening medical condition with still high mortality and morbidity requiring emergent surgical therapy (1)(2)(3). While without operation outcome is inacceptable (4,5), the use of extracorporeal circulation with hypothermic circulatory arrest is the gold-standard (6).…”

Section: Introductionmentioning

confidence: 99%

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Klotz¹,

Bucsky²,

Richardt³

et al. 2016

Ann. Cardiothorac. Surg.

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show abstract

“…In recent series, surgical mortality still ranges from 17% to 26% and TAAD continues to represent a great challenge for aortic surgeons (4)(5)(6). In this setting, the international registry of acute aortic dissection (IRAD), the largest worldwide registry for acute aortic dissection, was established to assess clinical characteristics, management and outcomes of TAAD patients, minimizing the inherent biases seen in small surgical registries or single center series.…”

Section: Introductionmentioning

confidence: 99%

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality

Berretta¹,

Patel²,

Gleason³

et al. 2016

Ann. Cardiothorac. Surg.

148

103

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Type A acute aortic dissection (TAAD) is a disease that has a catastrophic impact on a patient's life and emergent surgery represents a key goal of early treatment. Despite continuous improvements in imaging techniques, medical therapy and surgical management, early mortality in patients undergoing TAAD repair still remains high, ranging from 17% to 26%. In this setting, the International Registry of Acute Aortic Dissection (IRAD), the largest worldwide registry for acute aortic dissection, was established to assess clinical characteristics, management and outcomes of TAAD patients. The present review aimed to evaluate and comment on outcomes of TAAD surgery as reported from IRAD series.

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“…Current surgical treatment of acute type A aortic dissection (AAAD) carries an in-hospital mortality between 17-37% (1). Those who undergo successful surgical repair of AAAD have a high mortality of 10% at 1 year, and of 23% to 28% at 5 years (2).…”

Section: Introductionmentioning

confidence: 99%

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

Kodolitsch¹,

Wilson²,

Schuler³

et al. 2017

Cardiovasc. Diagn. Ther.

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Background: Early survivors of acute type A aortic dissection (AAAD) remain at risk for late death and late aortic events. However, the frequency and long-term effects of warfarin anticoagulation on long-term outcome in post-surgical AAAD survivors have not been elucidated. Methods:Two tertiary care centers performed a retrospective observational cohort study of warfarin anticoagulation in AAAD in 243 persons with early survival of surgical repair (WATAS). Serial postoperative tomographic imaging was available in 106 persons.Results: A total of 88 postoperative AAAD survivors (36%) were on long-term warfarin anticoagulation.The indication for anticoagulation was a mechanical aortic prosthesis in 46 (52%), atrial fibrillation in 33 (38%), stroke in 7 (8%), and pulmonary embolism in 1 (1%). The indication for anticoagulation remained unclear in 1 person (1%). Survival and aortic event free survival were 98.3±0.01 and 98.7±0.01 at 1 year, and 76.4±0.03 and 91.8±0.02 at 5 years, respectively, with no differences irrespective of warfarin anticoagulation. Multivariate Cox regression analysis established higher age (P<0.001), and operation extending into the descending aorta (P=0.030) as independent predictors of late death. Follow-up without tomographic imaging independently predicted increased long-term mortality (P<0.001) and lower rates of documented aortic events (P=0.003). Kaplan-Meyer analysis showed a relationship of aortic diameter growth ≥0.5 cm per year with late death (P=0.041) and with late aortic events (P<0.001). However, rapid aortic growth did not relate to warfarin anticoagulation.Conclusions: Warfarin anticoagulation is frequent in postsurgical AAAD and it is administered for vital indications. Warfarin anticoagulation does not relate to late mortality or to late aortic events. Rapid aortic growth predicts late mortality and late aortic events, but warfarin anticoagulation is not associated with aortic growth. Follow-up tomographic imaging is mandatory for long-term survival after surgical repair of AAAD. von Kodolitsch et al. Warfarin in aortic dissection

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Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA)

Cited by 277 publications

References 22 publications

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality

Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS)

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