Data di Pubblicazione:
2022
Citazione:
Type A Acute Aortic Dissection Presenting With Cerebrovascular Accident at Advanced Age / P. Angleitner, D.R. Brinster, T.G. Gleason, K.M. Harris, A. Evangelista, R. Bekeredjian, D.G. Montgomery, H.K. Sandhu, G.J. Arnaoutakis, M. Di Eusanio, S. Trimarchi, C.A. Nienaber, E.M. Isselbacher, K.A. Eagle, M.P. Ehrlich. - In: SEMINARS IN THORACIC AND CARDIOVASCULAR SURGERY. - ISSN 1043-0679. - 34:3(2022), pp. 805-813. [10.1053/j.semtcvs.2021.06.008]
Abstract:
Our aim was to analyze outcomes of patients aged 70 years or above presenting with type A acute aortic dissection (TAAAD) and cerebrovascular accident (CVA). A retrospective analysis of the International Registry of Acute Aortic Dissection (IRAD) was conducted. Patients aged 70 years or above (n = 1449) were stratified according to presence or absence of CVA before surgery (CVA: n = 110, 7.6%). In-hospital outcomes and mortality up to 5 years were analyzed. Additionally, in-hospital outcomes of patients who received medical management were described. No patient presenting with CVA over the age of 87 years underwent surgery. The rates of in-hospital mortality and post-operative CVA were significantly higher in patients presenting with CVA (in-hospital mortality: 32.7% vs 21.7%, P = 0.008; post-operative CVA: 23.4% vs 8.3%, P < 0.001). Presence of CVA was independently associated with significantly increased in-hospital mortality (odds ratio 2.99, 95% confidence interval 1.35 - 6.60, P = 0.007). In survivors of the hospital stay, presenting CVA had no independent influence on mortality up to 5 years (hazard ratio 1.52, 95% confidence interval 0.99 - 2.31, P = 0.54). In medically managed patients, exceedingly high rates of in-hospital mortality (71.4%) and CVA (90.9%) were noted. Patients presenting with TAAAD and CVA at ≥ 70 years of age are at significantly increased risk of in-hospital mortality, although long-term mortality is not affected in hospital survivors. Medical management is associated with poor outcomes. We believe that surgical management should be offered after critical assessment of comorbidities.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Aortic dissection; Cerebrovascular accident; International registry of acute aortic dissection; Stroke; Type A acute aortic dissection;
Elenco autori:
P. Angleitner, D.R. Brinster, T.G. Gleason, K.M. Harris, A. Evangelista, R. Bekeredjian, D.G. Montgomery, H.K. Sandhu, G.J. Arnaoutakis, M. Di Eusanio, S. Trimarchi, C.A. Nienaber, E.M. Isselbacher, K.A. Eagle, M.P. Ehrlich
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