Predicting Death in Patients With Acute Type A Aortic Dissection

Mehta, Rajendra H.; Suzuki, Toru; Hagan, Peter; Bossone, Eduardo; Gilon, Dan; Llovet, Alfredo; Maroto, Luis; Cooper, Jeanna V.; Smith, Dean E.; Armstrong, William F.; Nienaber, Christoph; Eagle, Kim A.

doi:10.1161/hc0202.102246

Cited by 494 publications

(300 citation statements)

References 30 publications

(26 reference statements)

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“…3,[7][8][9][10][11][12][13] In our study preoperative malperfusion was the only independent predictor of hospital death. Patients with preoperative malperfusion usually presented with a compromised limb circulation.…”

Section: Discussionsupporting

confidence: 56%

In-hospital mortality and three-year survival after repaired acute type A aortic dissection

Aalberts¹,

Boonstra²,

Berg³

et al. 2009

NHJL

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Background. The results of acute type A dissection (AAD) surgery in the Netherlands are largely unknown, as was recently stated in a report by the Health Council of the Netherlands. In order to gain more insight into the Dutch situation we investigated predictors of in-hospital mortality of surgically treated AAD patients and assessed threeyear survival.Methods. 104 consecutive patients undergoing surgery for AAD in a 16-year period (1990-2006) were evaluated. Preoperative and intraoperative variables were analysed to identify predictors of early mortality.Results. Preoperative malperfusion (limb ischaemia or mesenteric ischaemia) was present in 15.4%, shock in 18.3%, and 6.7% were operated under cardiac massage. Marfan syndrome was present in four patients and four patients had a bicuspid aortic valve. In-hospital mortality was 22.1%. Seven patients died intraoperatively; other causes of inhospital mortality were major brain damage in ten patients, multiple organ failure in three patients, low cardiac output in two patients and sudden cardiac death in one patient. Multivariate logistic regression revealed preoperative malperfusion (p=0.004) to be the only independent predictor of in-hospital mortality. Three-year survival was 68.8+/-4.7% (including hospital mortality). Hospital survivors had a three-year survival of 88.3+/-3.9%.Conclusion. In-hospital mortality of our patients (22.1%) is comparable with the results of larger case series published in the literature. Prognosis after successful surgical treatment is relatively good with a three-year survival of 88.3% in our series. (Neth Heart J 2009;17:226-31.).

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Section: Discussionsupporting

confidence: 56%

In-hospital mortality and three-year survival after repaired acute type A aortic dissection

Aalberts¹,

Boonstra²,

Berg³

et al. 2009

NHJL

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“…[1][2][3] The former leads to an unpredictable abrupt onset of circulatory derangement with systemic malperfusion. The latter starts at the onset of dissection or later in the subsequent course and is progressive unless perfusion is adequately restored.…”

Section: Introductionmentioning

confidence: 99%

Treatment Strategy for Acute Type A Aortic Dissection Complicated with Organ Ischemia

Orihashi

Ozawa

Takahashi

et al. 2011

Annals of Vascular Diseases

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Objective: We report our current treatment strategy for acute type A aortic dissection with organ ischemia as well as notable findings in our experience. Materials and Methods: Among 101 cases of acute type A aortic dissection, 25 had organ ischemia. Malperfusion was assessed at the aorta, proximal portion of the branch, organ parenchyma, and organ function by means of multiple modalities, including transesophageal echocardiography (TEE), near-infrared spectroscopy, and physical examinations. It was assessed every time the perfusion status was altered. Results: There were three operative deaths and one late hospital death. Uncertainty of symptoms and inadequate preoperative assessment in an emergent situation indicated the necessity of an overall checkup of organ ischemia in the operating room on a routine basis. Multi-modality assessment including TEE was helpful for this purpose. Two cases indicated that recovery of a true lumen could be inadequate despite true lumen perfusion including central cannulation. Thrombus in the false lumen appeared to be responsible. Conclusions:To solve practical problems in treating acute type A dissection with organ ischemia, realtime information on organ perfusion is important for detecting the presence of malperfusion, making an appropriate strategy, and immediately assuring the efficacy of the means taken.

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“…Medical management alone is associated with a mortality of nearly 25% by 24 h and over 30% by 48 h ( [4,21], . Fig.…”

Section: Acute Type a Aortic Dissectionmentioning

confidence: 99%

“…It is estimated that 27% of patients presenting with TAAoD will have involvement of the aortic arch [21,28]. In this setting, partial or total arch replacement with reimplantation of the great vessels may be required to eliminate the false lumen and restore adequate perfusion to the descending aorta [29].…”

Section: Arch Involvementmentioning

confidence: 99%

Acute aortic syndromes

Booher

Eagle

Bossone³

2011

Herz

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Acute aortic syndromes (AAS) comprise a group of potentially lethal conditions that require prompt recognition, diagnosis as well as acute medical stabilization and surgical intervention. The purpose of this article is to review the relevant variants of AAS presentation, as well as diagnostic and management issues, including adequate long-term medical therapy and follow-up imaging. In this context, the American College of Cardiology and the American Heart Association recently published guidelines on the management of thoracic aortic disease, drawing greater attention to these processes.

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Predicting Death in Patients With Acute Type A Aortic Dissection

Cited by 494 publications

References 30 publications

In-hospital mortality and three-year survival after repaired acute type A aortic dissection

In-hospital mortality and three-year survival after repaired acute type A aortic dissection

Treatment Strategy for Acute Type A Aortic Dissection Complicated with Organ Ischemia

Acute aortic syndromes

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