The Nordic Consortium for Acute type A Aortic Dissection (NORCAAD): objectives and design

Geirsson, Arnar; Ahlsson, Anders; Franco‐Cereceda, Anders; Fuglsang, Simon; Gunn, Jarmo; Hansson, Emma C.; Hjortdal, Vibeke E.; Järvelä, Kati; Jeppsson, Anders; Mennander, Ari; Nozohoor, Shahab; Olsson, Christian; Wickbom, Anders; Zindovic, Igor; Guðbjartsson, Tómas

doi:10.1080/14017431.2016.1235284

Cited by 33 publications

(46 citation statements)

References 15 publications

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“…The most important risk factors for ATAAD are presented in Table 1. Men are over-represented and constitute 62-68% of all patients with surgically treated ATAAD [3,12,33]. However, women tend to present with their dissection at a higher age and constitute the majority of patients over 75 years [27,35].…”

Section: Risk Factorsmentioning

confidence: 99%

“…Iatrogenic aortic dissections account for 1-5% of ATAADs [12,19,27]. ATAAD during pregnancy is uncommon; it usually occurs either during the last trimester or in the puerperium, and is often associated with connective tissue disease [36].…”

Section: Risk Factorsmentioning

confidence: 99%

“…In the NORCAAD registry, 8% of the patients have a family history of aortic dissection [4] and it has been reported that 20% of patients with ATAAD have a first-degree relative with a dilated thoracic aorta [37]. It has been suggested that aneurysms localized in the ascending aorta are more often associated with hereditary conditions, whereas descending aortic aneurysms more often form as a result of atherosclerosis, advanced age, and hypertension [38,39].…”

Section: Risk Factorsmentioning

confidence: 99%

“…This review has been written by nine cardiothoracic surgeons who have participated in the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) collaboration, which assembled a cohort of 1159 ATAAD patients who were operated at eight Nordic university hospitals between 2005 and 2014 [4]. For ATAAD, as with most surgical emergencies, there have been few randomized trials providing evidence for optimal management [5].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, contemporary, sizeable, multicenter observational registries, of which NORCAAD is an example, stand out as important sources of information. This review covers different aspects of ATAAD, including epidemiology, pathophysiology, and surgical treatment, and concentrates especially on the NORCAAD studies that have been published so far [6][7][8][9][10][11][12][13]. We searched the PubMed and MEDLINE databases using the search terms "dissection," "aortic," "ascending," and "type A."…”

Section: Introductionmentioning

confidence: 99%

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Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

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Acute type A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate. ARTICLE HISTORY Definitions and classification systemsDissection of the aorta occurs when the aortic media is separated, usually by pulsatile flow that penetrates the intimal layer of the aortic wall [14] (Figure 1(b)). This allows blood to flow between the layers of the aortic wall, forcing the layers apart, creating a false lumen parallel to the native (i.e. true) aortic lumen (Figure 1(b)). Consequently, the false lumen can propagate in both directions from the tear of intima and affect most of its distal branches, including the coronary, cerebral, and mesenteric arteries [15]. Another-but less common-CONTACT Tomas Gudbjartsson

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Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

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Current review of acute type A aortic dissection in Malaysia

Krishna Moorthy,

Sakijan,

Permal

et al. 2023

Indian J Thorac Cardiovasc Surg

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Acute type A aortic dissection (ATAAD) still poses significant challenges and management dilemmas for cardiovascular surgeons worldwide. Despite the continuous improvement in diagnosis and management strategies for ATAAD, clinical outcomes remain poor and the optimal therapy is still debatable especially those with malperfusion syndrome (MPS). This review is based on the current literature and includes the results from the Aortic Registry of National Heart Institute of Malaysia (NHIM) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. The diagnosis is often delayed leading to variable outcomes. High index of suspicion and urgent treatment is required to tackle this dynamic disease which include the variation in presentation and clinical course. Different surgical techniques and perfusion strategies have been described to save patients. Complex techniques such as total arch replacement (TAR) with frozen elephant trunk and valve sparing root surgery may provide long-term benefit in selected patients, but require significant surgical expertise and experience.

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Is There a Weekend Effect in Surgery for Type A Dissection?: Results From the Nordic Consortium for Acute Type A Aortic Dissection Database

Ahlsson

Wickbom

Geirsson

et al. 2019

The Annals of Thoracic Surgery

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Background. Aortic dissection type A requires immediate surgery. In general surgery populations, patients operated on during weekends have higher mortality rates compared with patients whose operations occur on weekdays. The weekend effect in aortic dissection type A has not been studied in detail.Methods. The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) registry includes data for 1,159 patients who underwent type A dissection surgery at 8 Nordic centers during 2005 to 2014. This study is based on data relating to surgery conducted during weekdays versus weekends and starting between 8:00 AM and 8:00 PM ("daytime") versus from 8:00 PM to 8:00 AM ("nighttime"), as well as time from symptoms, admittance, and diagnosis to surgery. The influence of timing of surgery on the 30-day mortality rate was assessed using logistic regression analysis.Results. The 30-day mortality was 18% (204 of 1,159), with no difference in mortality between surgery performed on weekdays (17% [150 of 889]) and on weekends (20% [54 of 270], p [ 0.45), or during nighttime (19% [87 of 467]) versus daytime (17% [117 of 680], p [ 0.54). Time from symptoms to surgery (median 7.0 hours vs 6.5 hours, p [ 0.31) did not differ between patients who survived and those who died at 30 days. Multivariable regression analysis of risk factors for 30-day mortality showed no weekend effect (odds ratio, 1.04; 95% confidence interval, 60.67 to 1.60; p [ 0.875), but nighttime surgery was a risk factor (odds ratio, 2.43; 95% confidence interval, 1.29 to 4.56; p [ 0.006).Conclusions. The 30-day mortality in surgical repair of aortic dissection type A was not significantly affected by timing of surgery during weekends versus weekdays. Nighttime surgery seems to predict increased 30-day mortality, after correction for other risk factors.

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The Nordic Consortium for Acute type A Aortic Dissection (NORCAAD): objectives and design

Cited by 33 publications

References 15 publications

Acute type A aortic dissection – a review

Acute type A aortic dissection – a review

Current review of acute type A aortic dissection in Malaysia

Is There a Weekend Effect in Surgery for Type A Dissection?: Results From the Nordic Consortium for Acute Type A Aortic Dissection Database

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