Clinical benefits of fast-track rehabilitation program for patients with uncomplicated type B acute aortic dissection

Abstract Background Despite recent advances in diagnosis and management, the mortality of acute aortic dissection (AAD) remains high. Purpose This study aims to develop quality indicators (QIs) for the management of AAD, and to evaluate the associations between QIs and outcomes of AAD in a Japanese nationwide administrative database. Methods A total of 18,348 patients suffered from AAD (Type A: 10,131, Type B: 8,217) in the Japanese Registry of All Cardiac and Vascular Diseases database between 2012 and 2015 were studied. A systematic review was performed to establish initial index items for QIs. Evaluation was performed through the expert consensus meeting using a Delphi method. Associations between developed QIs and the mortality were determined by multivariate mixed logistic regression analyses. Results A total of nine QIs (five structural and four processatic) were developed. Achievements of developed QIs (High: 7–9, Middle: 4–6, Low: 0–3) were significantly associated with lower in-hospital mortality even after adjustment for covariates in both type A (Middle: odds ratio [OR], 0.257; 95% confidence interval [CI], 0.211–0.312; P<0.001; High: OR, 0.064; 95% CI, 0.047–0.086; P<0.001 vs. Low) and type B (Middle: OR, 0.447; 95% CI, 0.338–0.590; P<0.001; High: OR, 0.128; 95% CI, 0.077–0.215; P<0.001 vs. Low). Additionally, achievements of structural and processatic QIs were consistently associated with reduced in-hospital mortality. QIs and in-hospital mortality Conclusions Developed QIs for AAD management were significantly associated with lower in-hospital mortality. Evaluation of each hospital's management with QIs could be helpful to equalize quality of treatment and to fill the evidence-to-practice gaps in the real-world treatment.

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Letter by Benedetto et al Regarding Article, “Importance of Refractory Pain and Hypertension in Acute Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection (IRAD)”

Circulation ◽

10.1161/circulationaha.110.991182 ◽

2011 ◽

Vol 123 (24) ◽

Author(s):

Umberto Benedetto ◽

Giovanni Melina ◽

Riccardo Sinatra

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

Refractory Pain ◽

International Registry

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Two-stage Operation for Stanford Type B Acute Aortic Dissection with Renal Blood Flow Reduction

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.79.708 ◽

2018 ◽

Vol 79 (4) ◽

pp. 708-712

Author(s):

Yusuke SHIMIZU ◽

Susumu ISHIKAWA ◽

Hideki MISHIMA ◽

Yuki MATSUNAGA ◽

Yuki NISHIHARA ◽

...

Keyword(s):

Blood Flow ◽

Aortic Dissection ◽

Renal Blood Flow ◽

Acute Aortic Dissection ◽

Type B ◽

Two Stage ◽

Flow Reduction ◽

Blood Flow Reduction ◽

Stanford Type B

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Conservatively treated Type B intramural hematoma: Progression into acute aortic dissection followed by spontaneous resolution, assessed by CT

Radiology Case Reports ◽

10.2484/rcr.v9i2.929 ◽

2014 ◽

Vol 9 (2) ◽

pp. 929

Author(s):

Guadalupe Buitrago ◽

Sabina Vasaturo ◽

Lucia J.M. Kroft

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Intramural Hematoma ◽

Spontaneous Resolution ◽

Type B

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Abstract TP144: Mechanisms And Prognosis Of Acute Ischemic Stroke Related To Acute Aortic Dissection

Stroke ◽

10.1161/str.44.suppl_1.atp144 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Seung-Jae Lee ◽

Dong-Suk Shim ◽

Si-Ryung Han

Keyword(s):

Ischemic Stroke ◽

Aortic Dissection ◽

Early Onset ◽

Acute Aortic Dissection ◽

Type A ◽

Posterior Circulation ◽

Type B ◽

Delayed Onset ◽

Bilateral Carotid ◽

Type B Dissection

Background: Acute aortic dissection (AD) is one of the lethal cardiac diseases involving the aorta. Although pain is a typical symptom, stroke may not rarely occur with the occlusive dissection of aortic branches or hypotension under the condition of AD. We attempted to explores the clinical features, possible mechanisms and prognosis of acute ischemic stroke (AIS) related to AD Method: Medical records of 278 consecutive patients with AD (165 with type A and 113 with type B dissection) over 11.5 years were retrospectively analyzed for clinical history, CT or MRI findings and outcome. AIS were categorized into early- or delayed-onset stroke. Early-onset stroke was defined as an AIS presented at admission, and delayed-onset stroke was an AIS which were developed during the two months after the first admission. Results: 26 (9.4%) patients experienced an ischemic stroke, which included 22 with type A and 4 with type B dissection. 8 patients (2.9%) including a case of TIA had an early-onset stroke, whereas delayed-onset stroke occurred in 18 patients (6.5%) postoperatively or under medical treatment. Early-onset stroke was all referable to the anterior circulation, predominantly right-sided (87.5%). One or more main branches of the aortic arch were involved in 6 out of 8 patients (75%) with early-onset stroke. Innominate artery was most frequently involved (75.0%). In contrast, delayed-onset stroke affected similarly bilateral carotid territories, and also included lesions in bilateral carotid, posterior-circulation and anterior/posterior-circulation territories. Among the 26 patients, 8 patients (30.8%) expired within 6 months of the disease onset (3 cases from hemispheric stroke with brain herniation, 2 cases from aortic rupture, 2 cases from sepsis with multiple organ failure and a case from mesentery ischemia and renal failure). Additionally, 9 patients (34.6%) remained functionally dependent six months later. Conclusion: AD not infrequently causes AIS with grave prognosis, especially in patients with type A dissection. The presumed mechanisms were aortic branch dissection causing luminal occlusion and emboli from thrombosed vascular lumen and hypotension under the condition of AD.

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