scholarly journals Insights from the International Registry of Acute Aortic Dissection

2016 ◽  
Vol 2016 (1) ◽  
Author(s):  
Arturo Evangelista ◽  
Giuliana Maldonado ◽  
Doménico Gruosso ◽  
Gisela Teixido ◽  
Jose Rodríguez-Palomares ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
University Of Michigan ◽  
Type B ◽  
Clinical Observations ◽  
International Registry ◽  
Diagnostic Management ◽  
The University

The International Registry of Acute Aortic Dissection (IRAD) was established in 1996 for the purpose of enrolling patients at large referral centres to assess the presentation, management and outcomes of acute aortic dissection (AAD). Data on presentation, diagnostic, management and outcomes were initially collected by 12 centres and then extended to 28 referral centres. All data of more than 5,000 cases were reviewed and analysed by the IRAD Coordinating Center at the University of Michigan. Since the first publication in 2000, IRAD investigators have reported a number of clinical observations, in more than 70 publications. This article will cover most of these points highlighting the findings of IRAD in patients with type A (with ascending aorta involvement) and type B (without ascending aorta involvement) AAD. 

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 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.

Cannulating a Dissecting Aorta Using Ultrasound-Epiaortic and Transesophageal Guidance

2011 ◽  
Vol 14 (6) ◽  
pp. 373 ◽  
Author(s):  
Saina Attaran ◽  
Maria Safar ◽  
Hesham Zayed Saleh ◽  
Mark Field ◽  
Manoj Kuduvalli ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Type A Aortic Dissection ◽  
Complete Rupture

<p>Management of acute Stanford type A aortic dissection remains a major surgical challenge. Directly cannulating the ascending aorta provides a rapid establishment of cardiopulmonary bypass but consists of risks such as complete rupture of the aorta, false lumen cannulation, subsequent malperfusion and propagation of the dissection.</p><p>We describe a technique of cannulating the ascending aorta in patients with acute aortic dissection that can be performed rapidly in hemodynamically unstable patients under ultrasound-epiaortic and transesophageal (TEE) guidance.</p>

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.

Epiaortic Ultrasound-Guided True Lumen Cannulation of Ascending Aorta in Acute Aortic Dissection Type A

2021 ◽  
Vol 104 (4) ◽  
pp. 604-609
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Axillary Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Ultrasound Guided ◽  
True Lumen ◽  
Artery Cannulation ◽  
Aortic Cannulation ◽  
Aortic Dissection Type A

Background: The choice of arterial inflow for acute Stanford type A aortic dissection repair remains controversial. The axillary artery should be considered as first choice for cannulation, but this technique is time-consuming. The ascending aortic cannulation provides antegrade perfusion and can be performed rapidly but there are several concerns such as aortic rupture, extension of dissection, and false lumen cannulation. Objective: To compare the establishment time of cardiopulmonary bypass (CPB) and postoperative outcomes of the two cannulation techniques that provide antegrade perfusion, which was direct true lumen cannulation on the dissected ascending aorta using epiaortic ultrasound-guided and axillary artery cannulation in Siriraj Hospital. Materials and Methods: The authors retrospectively reviewed all the 30 cases of acute aortic dissection type A using two different cannulation methods performed between February 2011 and May 2017. Direct true lumen ascending aortic cannulation was performed using the epiaortic ultrasound-guide with Seldinger technique in 12 patients, and axillary artery cannulation was performed in 18 patients. Results: The direct true lumen ascending aortic cannulation was safely performed in all patients. None of them had aortic rupture. Skin incision to CPB time was significantly faster in the epiaortic ultrasound-guided ascending aortic cannulation group at 29±8 versus 49±14 minutes (p<0.001). The 30-day mortality and postoperative adverse events, such as ischemic stroke, acute kidney injury, visceral organ and limb malperfusion showed no statistically significant difference from the axillary artery cannulation method. Conclusion: Epiaortic ultrasound-guided true lumen cannulation of ascending aorta in the treatment of acute aortic dissection type A is safe and feasible. Skin incision to CPB time can be performed faster and provided good outcome compared to the axillary artery cannulation technique. Keywords: Acute aortic dissection, Ascending cannulation, Epiaortic ultrasound

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

Stroke ◽  
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.

scholarly journals Aorto-Cutaneous Fistula and False Aneurysm of the Ascending Aorta Five Years after its Prosthetic Replacement for Stanford Type A Acute Aortic Dissection

Aorta ◽  
2017 ◽  
Vol 05 (02) ◽  
pp. 57-60
Author(s):  
Pierre Demondion ◽  
Dorian Verscheure ◽  
Pascal Leprince
Keyword(s):  
Aortic Dissection ◽  
Carotid Arteries ◽  
Acute Aortic Dissection ◽  
False Aneurysm ◽  
Type A ◽  
Aneurysm Rupture ◽  
Ascending Aorta ◽  
Cutaneous Fistula ◽  
The Right ◽  
Selective Cannulation

AbstractAorto-cutaneous fistula and false aneurysm of the ascending aorta in patients who previously underwent Stanford Type A acute aortic dissection are rare and severe complications. Surgical correction remains a demanding challenge. In a case of false aneurysm rupture during redo sternotomy, selective cannulation of the right axillary and left carotid arteries allowed an efficient method of cerebral perfusion.

scholarly journals Early misdiagnosis of acute aortic dissection: A case report and analysis of the causes

2016 ◽  
Vol 4 (1) ◽  
pp. 15
Author(s):  
Xiao-yan Chen ◽  
Fan-liang Kong ◽  
Tong-guo Wu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Case Report ◽  
Aortic Dissection ◽  
Emergency Room ◽  
Male Patient ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Type A Aortic Dissection

Type A aortic dissection is a catastrophic clinical entity involving the ascending aorta. In this case report, a patient was admitted to the emergency room with a presentation resembling acute myocardial infarction (AMI) that led to the inappropriate administration of anticoagulant agents or platelet. This is a case report of a 69-year-old male patient with early misdiagnosis and analysis of type A aortic dissection with discussion on the causes of misdiagnosis in light of the literature.

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