Early Mortality in Type A Acute Aortic Dissection

Abstract

ImportanceEarly data revealed a mortality rate of 1% to 2% per hour for type A acute aortic dissection (TAAAD) during the initial 48 hours. Despite advances in diagnostic testing and treatment, this mortality rate continues to be cited because of a lack of contemporary data characterizing early mortality and the effect of timely surgery.ObjectiveTo examine early mortality rates for patients with TAAAD in the contemporary era.Design, Setting, and ParticipantsThis cohort study examined data for patients with TAAAD in the International Registry of Acute Aortic Dissection between 1996 and 2018. Patients were grouped according to the mode of their intended treatment, surgical or medical.ExposureSurgical treatment.Main Outcomes and MeasuresMortality was assessed in the initial 48 hours after hospital arrival using Kaplan-Meier curves. In-hospital complications were also evaluated.ResultsA total of 5611 patients with TAAAD were identified based on intended treatment: 5131 (91.4%) in the surgical group (3442 [67.1%] male; mean [SD] age, 60.4 [14.1] years) and 480 (8.6%) in the medical group (480 [52.5%] male; mean [SD] age, 70.9 [14.7] years). Reasons for medical management included advanced age (n = 141), comorbidities (n = 281), and patient preference (n = 81). Over the first 48 hours, the mortality for all patients in the study was 5.8%. Among patients who were medically managed, mortality was 0.5% per hour (23.7% at 48 hours). For those whose intended treatment was surgical, 48-hour mortality was 4.4%. In the surgical group, 51 patients (1%) died before the operation.Conclusions and RelevanceIn this study, the overall mortality rate for TAAAD was 5.8% at 48 hours. For patients in the medical group, TAAAD had a mortality rate of 0.5% per hour (23.7% at 48 hours). However, among those in the surgical group, 48-hour mortality decreased to 4.4%.

Systematic Review on In Situ Laser Fenestrated Repair for the Endovascular Management of Aortic Arch Pathologies

“…The two-year survival rate was estimated at 77%; very positive outcomes, especially when considering the poor prognosis of type A dissection medical management [ 33 ]. Laser fenestration can provide a therapeutic option in the context of the emergency management of complex aortic pathology in patients considered unfit for any other surgical or interventional repair [ 34 ]. In this review, the specific anatomical characteristics of type A dissection treated with in situ laser fenestration were lacking while type A aortic dissection repair was mainly performed, as a second stage procedure, in the distal part of the ascending aorta, with a proximal sealing in a “non-diseased” area.…”

Management of Thoracic Aortic Dissection

“…4 Another study of 5611 patients showed 48-hour mortality to be 4.4% in patients undergoing emergent repair vs 23.7% in medically managed patients. 5 When cardiac surgery is not immediately available or for patients with complicated ATAAD, transferring patients to a comprehensive aortic 6 For patients with TBAD, the guideline recommends a stepwise approach to confirm organ malperfusion or other indications of complicated disease. Malperfusion is defined as end-organ ischemia and may follow visceral, kidney, spinal, and/or extremity hypoperfusion.…”

“…A study of 2952 patients with ATAAD showed in-hospital mortality associated with emergent surgery to be 19.7% vs 57.1% for patients managed medically ( P < .001) . Another study of 5611 patients showed 48-hour mortality to be 4.4% in patients undergoing emergent repair vs 23.7% in medically managed patients . When cardiac surgery is not immediately available or for patients with complicated ATAAD, transferring patients to a comprehensive aortic center is associated with improved outcomes.…”

Role of Helicopter Transfer and Cloud-Type Imaging for Acute Type A Aortic Dissection

“…Therefore, this study aimed to (1) demonstrate operative outcomes in patients requiring long-distance transfer and (2) analyze the effectiveness of helicopter transfer and cloud-type imaging transfer systems in patients suffering from AADA.…”