scholarly journals DEBAKEY TYPES I AND II ARE DISTINCT SUBSETS WITHIN TYPE A DISSECTION: A REPORT FROM THE INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION

2013 ◽  
Vol 61 (10) ◽  
pp. E1520
Author(s):  
Nilla Majahalme ◽  
Louis Kohl ◽  
Artur Evangelista Masip ◽  
Mark Russo ◽  
Stuart Hutchison ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
International Registry ◽  
Type A Dissection

Abstract 280: Cocaine-Related Aortic Dissection: Lessons from the International Registry of Acute Aortic Dissection

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Joshua H Dean ◽  
Patrick O’Gara ◽  
Daniel G Montgomery ◽  
Santi Trimarchi ◽  
Truls Myrmel ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Tobacco Use ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Type B ◽  
Cocaine Use ◽  
International Registry ◽  
Type B Dissection ◽  
History Of ◽  
Type A Dissection

Background: Acute Aortic Dissection (AAD) associated with cocaine use is a rare event for which only limited case reports and small cohort studies are available. This study compares demographics, history, presenting symptoms and in-hospital outcomes among AAD patients with a history of cocaine use (C+) to those of patients without a history of cocaine use (C-) in a large international registry. Methods: Our study analyzed 3584 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2012. We divided the population based on documented cocaine use and further stratified patients into Type A (33 C+/2332, 1.4%) and Type B (30 C+/1252, 2.4%) dissection cohorts. Results: C+ patients presented at a younger age and were more likely to be male and black for both Type A and B dissections. Type B dissection was more common among C+ patients than in C- patients. Cocaine-related AAD was reported more often at US sites compared to European sites (86.4% 51/63 v. 13.6% 8/63, p<0.001). Tobacco use was more prevalent in the C+ cohort. No differences were seen in history of hypertension, known atherosclerosis or time from symptom onset to presentation between cohorts. Type B C+ patients were more likely to be hypertensive at presentation. Both Type A and Type B C+ cohorts had significantly smaller ascending aortic diameters than C- patients. Acute renal failure was more common in Type A C+ patients but mortality was significantly lower in Type A C+ patients vs type C- patients for reasons than could not be identified from the data base. Conclusions: Cocaine abuse is implicated in approximately 2% of patients with acute aortic dissection. The typical patient is a relatively young male cigarette smoker, who like the majority of patients with AAD, has a history of hypertension. In hospital mortality for cocaine-related Type A dissection is lower than that seen with non-cocaine related type A dissection. The combination of tobacco use, cocaine use, and hypertension may predispose patients to AAD who may otherwise have little risk for the condition.

The role of preoperative coronary angiography in the setting of type A acute aortic dissection: Insights from the International Registry of Acute Aortic Dissection

2011 ◽  
Vol 161 (4) ◽  
pp. 790-796.e1 ◽  
Author(s):  
Vijay S. Ramanath ◽  
Kim A. Eagle ◽  
Christoph A. Nienaber ◽  
Eric M. Isselbacher ◽  
James B. Froehlich ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
International Registry

scholarly journals Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience

2005 ◽  
Vol 129 (1) ◽  
pp. 112-122 ◽  
Author(s):  
Santi Trimarchi ◽  
Christoph A. Nienaber ◽  
Vincenzo Rampoldi ◽  
Truls Myrmel ◽  
Toru Suzuki ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
International Registry ◽  
Results Of Surgery

Abstract 19334: Management and Outcomes of Acute Retrograde Type A Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Foeke J Nauta ◽  
Joon Bum Kim ◽  
Himanshu J Patel ◽  
Mark D Peterson ◽  
Hans-Henning Eckstein ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Innominate Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Early Mortality ◽  
Long Term Results ◽  
Descending Aorta ◽  
International Registry

Background: Presentations and outcomes of acute aortic dissection (AD) with an entry tear in the ascending aorta may differ from retrograde dissection with an entry tear in the descending aorta. However, guidelines recommend urgent surgical repair for both entities. Methods and Results: All patients with AD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2014 were analyzed. We identified 99 patients (67 men; 63.2±14.0 years) with an entry tear in the descending aorta and retrograde extension into the arch or ascending aorta. Overall, independent predictors of retrograde type A AD were increasing age(OR 1.0; 95% CI, 1.0 to 1.0; P=0.004), history of cocaine abuse (OR 4.9; 95% CI, 1.7 to 13.6; P=0.003), back pain at presentation (OR 2.1; 95% CI, 1.3 to 3.3; P=0.002), and non-white race (OR 0.4; 95% CI, 0.2 to 0.6; P<0.001). During initial hospitalization, 44 of these patients were managed medically (MED), 33 with open surgery(SURG) and 22with endovascular therapy (ENDO). Patients in the SURG group presented with larger ascending aortic diameters than MED and ENDO patients (P=0.04). The majority of the MED (72.7%) and ENDO (86.4%) patients had AD extension confined to zone 1 (proximal arch, P<0.001), whereas most of the SURG patients (71.8%) presented with AD extension into zone 0 (proximal to the innominate artery, P<0.001). Early (30-day or in-hospital) mortality rates of the MED, SURG and ENDO groups were 9.1%, 18.2%, and 13.6%, respectively (P=0.51), with 5-year survival of 86.7%, 80.0%, and 90.9%, respectively (mean follow-up, 3.3 years, log rank P=0.67). A trend of favorable early mortality was observed in patients with retrograde extension till zone 1 (8.6%) versus into zone 0 (18.6%, P=0.14).Early mortality of patients with retrograde type A AD (12.9%) was lower than those with type A AD (20.0%, P=0.001), while 5-year survival was similar (86.8% and 89.5%, respectively, mean follow-up, 3.0 years, log rank P=0.96). Conclusion: There is a subset of patients with acute retrograde type A AD who can be managed non-operatively with acceptable short and long-term results. This implies that a selective approach may be reasonable, particularly among those with proximal extension limited to the arch distal to the innominate artery.

Abstract 751: Retrograde Acute Type A Aortic Dissection: Are Outcomes Worse Than Classic Acute Aortic Dissection?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Anthony L Estrera ◽  
Charles C Miller ◽  
Ali Azizzadeh ◽  
Taek-Yeon Lee ◽  
Saad Abdullah ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Acute Type A Dissection ◽  
Initial Symptoms ◽  
Type A Dissection ◽  
Poor Outcomes

Introduction: Recent reports of retrograde acute type A aortic dissection (RTAAD) following thoracic aortic endovascular repair have been associated with poor outcomes. This raises concerns about outcomes with RTAAD in general. We report and compare outcomes of retrograde acute Type A aortic dissection repair with classic acute aortic dissection (CAAD). Methods: Between 8/1991 and 5/2008, we repaired 322 patients with acute type A dissection. This cohort was divided into two groups: RTAAD Group (52 cases), and CAAD Group (270 cases). RTAAD was defined as the presence of a dissection tear originating distal to the arch as identified intra-operatively. Tears in the ascending aorta denoted dissection as classic. Repairs using circulatory arrest were similar between groups, p>0.33. Preoperative, operative, and post-operative variables were analyzed retrospectively. Results: Retrograde type A aortic dissection occurred in 16.1% (52/322) of patients. RTAAD differed from CAAD in the median time from initial symptoms to operation (75+−87 hours vs. 47+−61 hours) and specific presenting conditions. (See Table 1 ) Outcomes (stroke: RTAAD, 2.1% vs. CAAD, 3.6%, bleeding: 4% vs. 9%, myocardial infarction: 6% vs. 6%, and mortality: 11% vs. 18%) did not differ significantly between the groups, p>0.05. Conclusions: RTAAD presented later for repair and less frequently with redo-sternotomy and aortic valvular insufficiency. Despite these differences, outcomes from surgical repair did not differ significantly. Acceptable outcomes may be achieved with timely intervention. Table 1: Preoperative Variables

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