TY - JOUR
T1 - Contemporary results of surgery in acute type a aortic dissection
T2 - The International Registry of Acute Aortic Dissection experience
AU - Trimarchi, Santi
AU - Nienaber, Christoph A.
AU - Rampoldi, Vincenzo
AU - Myrmel, Truls
AU - Suzuki, Toru
AU - Mehta, Rajendra H.
AU - Bossone, Eduardo
AU - Cooper, Jeanna V.
AU - Smith, Dean E.
AU - Menicanti, Lorenzo
AU - Frigiola, Alessandro
AU - Oh, Jae K.
AU - Deeb, Michael G.
AU - Isselbacher, Eric M.
AU - Eagle, Kim A.
N1 - Funding Information:
Co-Principal Investigators: Kim A. Eagle, MD, University of Michigan, Ann Arbor, Mich; Eric M. Isselbacher, MD, Massachusetts General Hospital, Boston, Mass; Christoph A. Nienaber, MD, University of Rostock, Rostock, Germany. Co-Investigators: Eduardo Bossone, MD, National Research Council, Lecce, Italy; Arturo Evangelista, MD, Hospital General Universitari Vall d'Hebron, Barcelona, Spain; Rosella Fattori, MD, University Hospital S. Orsola, Bologna, Italy; Dan Gilon, MD, Hadassah University Hospital, Jerusalem, Israel; Stuart Hutchison, MD, St Michael's Hospital, Toronto, Ontario, Canada; Alfredo Llovet, MD, Hospital Universitario “12 de Octubre,” Madrid, Spain; Rajendra H. Mehta, MD, MS, University of Michigan, Ann Arbor, Mich; Truls Myrmel, MD, Tromsø University Hospital, Tromsø, Norway; Patrick O'Gara, MD, Brigham and Women's Hospital, Boston, Mass; Jae K. Oh, MD, Mayo Clinic, Rochester, Minn; Linda A. Pape, MD, University of Massachusetts Hospital, Worcester, Mass; Udo Sechtem, MD, Robert-Bosch Krankenhaus, Stuttgart, Germany; Toru Suzuki, MD, University of Tokyo, Tokyo, Japan; Santi Trimarchi, MD, Istituto Policlinico San Donato, San Donato Milanese, Italy.
PY - 2005/1
Y1 - 2005/1
N2 - Surgical mortality for acute type A aortic dissection reported in different experiences from single centers or surgeons varies from 7% to 30%. The International Registry of Acute Aortic Dissection, collecting patients from 18 referral centers worldwide, identifies a preoperative risk stratification scheme and a real average surgical mortality for acute type A aortic dissection in the current era. A comprehensive analysis was completed of 290 clinical variables and their relationship to surgical outcomes in 526 of 1032 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 through 2001. Extracted cases, categorized according to risk profile, were defined as unstable (group I) in the presence of cardiac tamponade; shock; congestive heart failure; cerebrovascular accident; stroke; coma; myocardial ischemia, infarction, or both; electrocardiograms with new Q waves or ST elevation; acute renal failure; or mesenteric ischemia-infarction at the time of the operation. Outside of an unstable condition, patients were categorized as stable (group II). The overall in-hospital mortality was 25.1%. Mortality in group I was 31.4% compared with 16.7% in group II (P <. 001). Independent preoperative predictors of operative mortality were history of aortic valve replacement (odds ratio = 3.12), migrating chest pain (odds ratio = 2.77), hypotension as sign of acute type A aortic dissection (odds ratio = 1.95), shock or tamponade (odds ratio = 2.69), preoperative cardiac tamponade (odds ratio = 2.22), and preoperative limb ischemia (odds ratio = 2.10). The International Registry of Acute Aortic Dissection experience confirms that patient selection plays an important role in determining surgical outcomes in patients with acute type A aortic dissection. Knowledge of significant risk factors for operative mortality can contribute to better management and a more defined risk assessment in patients affected by acute type A aortic dissection.
AB - Surgical mortality for acute type A aortic dissection reported in different experiences from single centers or surgeons varies from 7% to 30%. The International Registry of Acute Aortic Dissection, collecting patients from 18 referral centers worldwide, identifies a preoperative risk stratification scheme and a real average surgical mortality for acute type A aortic dissection in the current era. A comprehensive analysis was completed of 290 clinical variables and their relationship to surgical outcomes in 526 of 1032 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 through 2001. Extracted cases, categorized according to risk profile, were defined as unstable (group I) in the presence of cardiac tamponade; shock; congestive heart failure; cerebrovascular accident; stroke; coma; myocardial ischemia, infarction, or both; electrocardiograms with new Q waves or ST elevation; acute renal failure; or mesenteric ischemia-infarction at the time of the operation. Outside of an unstable condition, patients were categorized as stable (group II). The overall in-hospital mortality was 25.1%. Mortality in group I was 31.4% compared with 16.7% in group II (P <. 001). Independent preoperative predictors of operative mortality were history of aortic valve replacement (odds ratio = 3.12), migrating chest pain (odds ratio = 2.77), hypotension as sign of acute type A aortic dissection (odds ratio = 1.95), shock or tamponade (odds ratio = 2.69), preoperative cardiac tamponade (odds ratio = 2.22), and preoperative limb ischemia (odds ratio = 2.10). The International Registry of Acute Aortic Dissection experience confirms that patient selection plays an important role in determining surgical outcomes in patients with acute type A aortic dissection. Knowledge of significant risk factors for operative mortality can contribute to better management and a more defined risk assessment in patients affected by acute type A aortic dissection.
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U2 - 10.1016/j.jtcvs.2004.09.005
DO - 10.1016/j.jtcvs.2004.09.005
M3 - Article
C2 - 15632832
AN - SCOPUS:19944414614
SN - 0022-5223
VL - 129
SP - 112
EP - 122
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 1
ER -