scholarly journals Application of the Type, Entry Site, and Malperfusion Classification in Treatment of Aortic Dissection

2021 ◽  
Vol 24 (5) ◽  
pp. E909-E915
Author(s):  
Xuening Wang ◽  
Chunyan Wang ◽  
Xinmeng Cheng ◽  
Yuyuan Hu ◽  
Lingbo Yang ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Classification System ◽  
Disease Process ◽  
Type A ◽  
Neurological Complications ◽  
Operative Indication ◽  
New Classification ◽  
Entry Site

Background: Our goal is to investigate a new practical dissection classification system, including type of dissection, location of the tear of the primary entry, and malperfusion. Methods: The outcome of 151 patients with aortic dissection between January 2019 and May 2020 retrospectively were analyzed. All cases were classified with the Stanford dissection classification (A and B) by adding type non-A non-B. They were then further classified by the new classification system, including location of the primary Entry (E) and Malperfusion (M). All cases were followed up for six months. Results: The distribution of 151 patients was 53.0%, 27.8%, and 19.2%, respectively, in type A, B, and non-A non-B. The in-hospital mortality rate was 8.8%, 2.4%, and 3.4% in type A, B, and non-A non-B (P < 0.05) and postoperative neurological complications occurred in 33.8%, 7.1%, and 13.8% in type A, B, and non-A non-B (P < 0.05). Total arch replacement was performed in 53.8%, 4.8%, and 13.8% in type A, B, and non-A non-B. The in-hospital mortality rate was 12.0%, 10.4%, and 8.5% in type E1, E2 and E3, while it was 20.0%, 10.4%, and 8.5% in type M1, M2 and M3 (P < 0.05). Conclusions: The new practical dissection classification system is useful as a supplement to the Stanford dissection classification by regarding the extent of the disease process, aiding in decision-making about the operative indication and plan, and helping in anticipating prognosis.

scholarly journals Aortic dissection reconsidered: type, entry site, malperfusion classification adding clarity and enabling outcome prediction

2019 ◽  
Vol 30 (3) ◽  
pp. 451-457 ◽  
Author(s):  
Hans-Hinrich Sievers ◽  
Bartosz Rylski ◽  
Martin Czerny ◽  
Anna L M Baier ◽  
Maximilian Kreibich ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Classification System ◽  
Radiological Finding ◽  
Disease Process ◽  
Treatment Modalities ◽  
Disease Mechanism ◽  
Entry Site ◽  
Descending Aorta

Abstract OBJECTIVES Aortic dissection is complex. Imaging and treatment modalities are evolving, demanding a more differentiated but pragmatic dissection classification. Our goal was to provide a new practical classification system including Type of dissection, location of the tear of the primary Entry and Malperfusion (TEM). METHODS We extended the Stanford dissection classification (A and B) by adding non-A non-B aortic dissection, the location of the primary entry tear (E) and malperfusion (M). A 0 was added if the primary entry tear was not visible; 1, if it was in the ascending aorta; 2, if it was in the arch; and 3, if it was in the descending aorta (E0, E1, E2, E3). We added 0 if malperfusion was absent; 1, if coronary arteries; 2, if supra-aortic vessels; and 3, if visceral/renal and/or a lower extremity was affected (M0, M1, M2, M3). Plus (+) was added if malperfusion was clinically present and minus (−) if it was a radiological finding. RESULTS The new classification system was analysed in 357 patients retrospectively; distribution was 59%, 31% and 10% for A, B and non-A non-B dissections. The in-hospital mortality rate was 16%, 5% and 8% (P = 0.01). Postoperative stroke occurred in 14%, 1% and 3% (P &lt; 0.001). The in-hospital mortality rate was 22%, 14%, 40% and 0% in A E0, E1, E2 and E3 (P = 0.023), respectively. Two years after the onset of dissection, the lowest survival rate was observed in A, followed by non-A non-B and B (83 ± 3% vs 88 ± 6% vs 93 ± 3%; P = 0.019). CONCLUSIONS The new practical TEM aortic dissection classification system adds clarity regarding the extent of the disease process, enhances awareness of the disease mechanism, aids in decision-making regarding the extent of repair and helps in anticipating outcome.

scholarly journals Aortic Dissection Rethought: A New Classification System Adding Clarity and Allowing Prediction of In-Hospital Mortality

2019 ◽  
Author(s):  
H.-H. Sievers ◽  
A. Baier ◽  
F. Beyersdorf ◽  
M. Czerny ◽  
M. Kreibich ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Classification System ◽  
New Classification

The treatment of patients with Type A aortic dissection - predictors for in hospital mortality in 534 patients as two center experience

2014 ◽  
Vol 62 (S 01) ◽  
Author(s):  
S. Leontyev ◽  
J.-F. Légaré ◽  
M.A. Borger ◽  
K.J. Buth ◽  
A.K. Funkat ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Type A ◽  
Type A Aortic Dissection

The short-term prognostic value of serum platelet to hemoglobin in patients with type A acute aortic dissection

Perfusion ◽  
2020 ◽  
pp. 026765912098222
Author(s):  
Yu Wang ◽  
Tengfei Qiao ◽  
Jun Zhou
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Acute Aortic Dissection ◽  
Independent Predictor ◽  
Type A ◽  
Short Term ◽  
Survivor Group ◽  
Mortality Hazard ◽  
Mortality Hazard Ratio ◽  
The Ideal

Purpose: Type A acute aortic dissection (AAD) is an uncommon catastrophic cardiovascular disease with high pre-hospital mortality rate without timely and effectively treated. The aim of this study was to assess the value of serum platelet to hemoglobin (PHR) in predicting in-hospital mortality in type A AAD patients. Methods: A total of 183 type A AAD patients were included in this retrospective investigation from January 2017 to December 2019. Admission blood routine parameters were gathered and PHR was computed. The outcome was all-cause in-hospital mortality within 30 days. Results The average levels of serum PHR were significant higher in survivor group than those in non-survivor group (1.14 ± 0.57 vs 0.87 ± 0.47, p = 0.006) and serum PHR was an independent factor associated with in-hospital mortality (hazard ratio (HR): 2.831; 95% confidence interval (CI): 1.108–7.231; p = 0.030). ROC noted that 0.8723 was chosen as the ideal cutoff value with a sensitivity of 64.3% and specificity of 72.5%. In addition, the area under the ROC curve (AUC) was 0.693 (95% CI 0.599–0.787, p < 0.001). Conclusion: Admission serum PHR can be used as an independent predictor of in-hospital mortality in patients with type A AAD.

P5599Prognostic impact of quality indicators on outcomes of acute aortic dissection in Japan

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Yamaguchi ◽  
M Nakai ◽  
Y Sumita ◽  
Y Miyamoto ◽  
H Matsuda ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Quality Indicators ◽  
Acute Aortic Dissection ◽  
Vascular Diseases ◽  
Type A ◽  
Administrative Database ◽  
Type B ◽  
Practice Gaps

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.

scholarly journals Chronic Type A Aortic Dissection

Aorta ◽  
2016 ◽  
Vol 04 (01) ◽  
pp. 16-21 ◽  
Author(s):  
Conor Hynes ◽  
Michael Greenberg ◽  
Shawn Sarin ◽  
Gregory Trachiotis
Keyword(s):  
Aortic Dissection ◽  
Surgical Repair ◽  
False Lumen ◽  
Disease Process ◽  
Type A ◽  
Delayed Presentation ◽  
Chronic Type ◽  
Type A Aortic Dissection ◽  
First Line Therapy ◽  
Acute Dissection

AbstractStanford Type A aortic dissection is a rapidly progressing disease process that is often fatal without emergent surgical repair. A small proportion of Type A dissections go undiagnosed in the acute phase and are found upon delayed presentation of symptoms or incidentally. These chronic lesions may have a distinct natural history that may have a better prognosis and could potentially be managed differently then those presenting acutely. The method of repair depends on location and extent of the false lumen, as well as involvement of critical structures and branch arteries. Surgical repair techniques similar to those employed for acute dissection management are currently first-line therapy for chronic cases that involve the aortic valve, sinuses of Valsalva, coronary arteries, and supra-aortic branch arteries. In patients with high-risk for surgery, endovascular repairs have been successful, and active development of delivery systems and grafts will continue to enhance outcomes. We present two cases of chronic Type A aortic dissection and review the current literature.

Impact of GERAADA Score in Patients With Acute Type A Aortic Dissection

2021 ◽  
Author(s):  
Kayo Sugiyama ◽  
Hirotaka Watanuki ◽  
Masato Tochii ◽  
Yasuhiro Futamura ◽  
Yuka Kitagawa ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Postoperative Results ◽  
Entire Study ◽  
Type A Aortic Dissection ◽  
Actual Mortality ◽  
Aortic Dissection Type A

Abstract Background Despite continuous developments and advances in the perioperative management of patients suffering from acute aortic dissection type A (AADA), the associated postoperative morbidity and mortality remain high and strongly depend on the preoperative clinical status. The associated postoperative mortality is still hard to predict prior to the surgical procedure. The so-called German Registry of Acute Aortic Dissection Type A (GERAADA) score uses very basic and easily retrievable parameters and was specifically designed for predicting the 30-day mortality rate in patients undergoing surgery for AADA. This study evaluated impact of the GERAADA score in the authors’ institutional results. MethodsAmong 101 acute type A aortic dissection patients treated at our hospital during August 2015–March 2021, the GERAADA was calculated individually and retrospectively. Predicted and actual mortalities were assessed, and independent predicted factors were searched. The primary endpoint was defined as comparison of GERAADA scores and early mortality, and the secondary endpoints were defined as comparison of GERAADA scores and other postoperative results, and comparison of preoperative factors and postoperative results regardless to GERAADA scores.ResultsWhile the overall 30-day mortality for the entire study cohort calculated by the GERAADA score was 14.3 (8.1-77.6) %, the actual mortality rate was 6%. However, the GERAADA score was significantly high in some postoperative complications and showed significant correlation with some peri- and post-operative factors. In addition, factors not belonging to GERAADA score such as time from onset to arrival at the hospital, time from onset to arrival at the operation room, spouse presence, and hemodialysis were significantly associated with 30-day mortality.ConclusionsAlthough the actual mortality was lower than predicted, GERAADA score may impact on the postoperative course. In addition, it would be desirable to add parameters such as the time from onset to arrival, family background, and hemodialysis for further accuracy.

ASSA13-18-4 In-Hospital Mortality and Two-Year Survival After Therapy With Type A Aortic Dissection

Heart ◽  
2013 ◽  
Vol 99 (Suppl 1) ◽  
pp. A82-A82
Author(s):  
Yuan Yuan Qinghua ◽  
Ma Ma Xiang ◽  
Ma Ma Yitong
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Type A ◽  
Type A Aortic Dissection

Perioperative Risk Factors for Hospital Mortality in Patients with Acute Type A Aortic Dissection

2009 ◽  
pp. 195-195
Author(s):  
Masashi Tanaka ◽  
Naoyuki Kimura ◽  
Hideo Adachi ◽  
Atsushi Yamaguchi ◽  
Takashi Ino
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Type A ◽  
Perioperative Risk ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Perioperative Risk Factors

scholarly journals Prediction of mortality rate in acute type A dissection: the German Registry for Acute Type A Aortic Dissection score

2020 ◽  
Vol 58 (4) ◽  
pp. 700-706 ◽  
Author(s):  
Martin Czerny ◽  
Matthias Siepe ◽  
Friedhelm Beyersdorf ◽  
Manuel Feisst ◽  
Michael Gabel ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Data Set ◽  
Web Based ◽  
Final Model ◽  
Type A Aortic Dissection ◽  
Prediction Of Mortality ◽  
German Registry

Abstract OBJECTIVES The goal was to develop a scoring system to predict the 30-day mortality rate for patients undergoing surgery for acute type A aortic dissection on the basis of the German Registry for Acute Type A Aortic Dissection (GERAADA) data set and to provide a Web-based application for standard use. METHODS A total of 2537 patients enrolled in GERAADA who underwent surgery between 2006 and 2015 were analysed. Variable selection was performed using the R-package FAMoS. The robustness of the results was confirmed via the bootstrap procedure. The coefficients of the final model were used to calculate the risk score in a Web-based application. RESULTS Age [odds ratio (OR) 1.018, 95% confidence interval (CI) 1.009–1.026; P &lt; 0.001; 5-year OR: 1.093], need for catecholamines at referral (OR 1.732, 95% CI 1.340–2.232; P &lt; 0.001), preoperative resuscitation (OR 3.051, 95% CI 2.099–4.441; P &lt; 0.001), need for intubation before surgery (OR 1.949, 95% CI 1.465–2.585; P &lt; 0.001), preoperative hemiparesis (OR 1.442, 95% CI 0.996–2.065; P = 0.049), coronary malperfusion (OR 1.870, 95% CI 1.386–2.509; P &lt; 0.001), visceral malperfusion (OR 1.748, 95% CI 1.198–2.530; P = 0.003), dissection extension to the descending aorta (OR 1.443, 95% CI 1.120–1.864; P = 0.005) and previous cardiac surgery (OR 1.772, 95% CI 1.048–2.903; P = 0.027) were independent predictors of the 30-day mortality rate. The Web application based on the final model can be found at https://www.dgthg.de/de/GERAADA_Score. CONCLUSIONS The GERAADA score is a simple, effective tool to predict the 30-day mortality rate for patients undergoing surgery for acute type A aortic dissection. We recommend the widespread use of this Web-based application for standard use.

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