Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection
Articolo
Data di Pubblicazione:
2019
Citazione:
Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection / S. Trimarchi, H.W.L. de Beaufort, J.L. Tolenaar, J.E. Bavaria, N.D. Desai, M. Di Eusanio, R. Di Bartolomeo, M.D. Peterson, M. Ehrlich, A. Evangelista, D.G. Montgomery, T. Myrmel, G.C. Hughes, J.J. Appoo, C. De Vincentiis, T.D. Yan, C.A. Nienaber, E.M. Isselbacher, G.M. Deeb, T.G. Gleason, H.J. Patel, T.M. Sundt, K.A. Eagle. - In: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. - ISSN 0022-5223. - 157:1(2019 Jan), pp. 66-73. (Intervento presentato al convegno Aortic Symposium of the American-Association-for-Thoracic-Surgery : April, 26 - 27 tenutosi a New York nel 2018) [10.1016/j.jtcvs.2018.07.101].
Abstract:
Objective: To analyze presentation, management, and outcomes of acute aortic dissections with proximal entry tear in the arch.Methods: Patients enrolled in the International Registry of Acute Aortic Dissection and entry tear in the arch were classified into 2 groups: arch A (retrograde extension into the ascending aorta with or without antegrade extension) and arch B (only antegrade extension into the descending aorta or further distally). Presentation, management, and in-hospital outcomes of the 2 groups were compared.Results: The arch A (n = 228) and arch B (n = 140) groups were similar concerning the presence of any preoperative complication (68.4% vs 60.0%; P = .115), but the types of complication were different. Arch A presented more commonly with shock, neurologic complications, cardiac tamponade, and grade 3 or 4 aortic valve insufficiency and less frequently with refractory hypertension, visceral ischemia, extension of dissection, and aortic rupture. Management for both groups were open surgery (77.6% vs 18.6%; P < .001), endovascular treatment (3.5% vs 25.0%; P < .001), and medical management (16.2% vs 51.4%; P < .001). Overall in-hospital mortality was similar (16.7% vs 19.3%; P = .574), but mortality tended to be lower in the arch A group after open surgery (15.3% vs 30.8%; P = .090), and higher after endovascular (25.0% vs 14.3%; P = .597) or medical treatment (24.3% vs 13.9%; P = .191), although the differences were not significant.Conclusions: Acute aortic dissection patients with primary entry tear in the arch are currently managed by a patientspecific approach. In choosing the management type of these patients, it may be advisable to stratify them based on retrograde or only antegrade extension of the dissection.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
acute aortic syndrome; aortic dissection; aortic surgery;
Elenco autori:
S. Trimarchi, H.W.L. de Beaufort, J.L. Tolenaar, J.E. Bavaria, N.D. Desai, M. Di Eusanio, R. Di Bartolomeo, M.D. Peterson, M. Ehrlich, A. Evangelista, D.G. Montgomery, T. Myrmel, G.C. Hughes, J.J. Appoo, C. De Vincentiis, T.D. Yan, C.A. Nienaber, E.M. Isselbacher, G.M. Deeb, T.G. Gleason, H.J. Patel, T.M. Sundt, K.A. Eagle
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