Type A Acute Aortic Dissection Presenting With Cerebrovascular Accident at Advanced Age

Angleitner, Philipp; Brinster, Derek R.; Gleason, Thomas G.; Harris, Kevin M.; Evangelista, Arturo; Bekeredjian, Raffi; Montgomery, Daniel; Sandhu, Harleen K.; Arnaoutakis, George J.; Eusanio, Marco Di; Trimarchi, Santi; Nienaber, Christoph; Isselbacher, Eric M.; Eagle, Kim A.; Ehrlich, Marek

doi:10.1053/j.semtcvs.2021.06.008

Cited by 6 publications

(3 citation statements)

References 32 publications

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“…In addition, we observed that operative mortality and major morbidities such as stroke, reexploration, new onset acute kidney injury, and prolonged ventilation were comparable between the two time periods. The operative mortality and morbidity rates are comparable to other large registry series, particularly those stemming from recent international registry of acute aortic dissection (IRAD) studies 13–15 …”

Section: Discussionmentioning

confidence: 53%

“…| 4547 to other large registry series, particularly those stemming from recent international registry of acute aortic dissection (IRAD) studies. [13][14][15] For the purposes of this study, we determined the median number of annual ATAAD repairs during the preceding 3 years from 2017 to 2020, and used the median value of 10 annual ATAAD repairs to serve as the cut-off between low and highvolume centers. Admittedly, this demarcation renders this volume metric as a binary variable, which may hamper the analysis in part due to loss of granularity, however, facilitates statistical interpretation.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of acute type A aortic dissection during the COVID‐19 pandemic: An analysis of the Society of Thoracic Surgeons Database

Arnaoutakis

Wallen

Desai

et al. 2022

Journal of Cardiac Surgery

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Purpose There have been reported reductions of hospital presentation for acute cardiovascular conditions such as myocardial infarction and acute type A aortic dissection (ATAAD) in the United States during the COVID‐19 pandemic. This study examined presentation patterns and outcomes of ATAAD in North America immediately before, and during, the COVID‐19 pandemic. Methods The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) was queried to identify patients presenting with ATAAD in the 12 months pre‐pandemic (March 2019–February 2020), and during the early pandemic (March through June 2020). Demographics and operative characteristics were compared using χ² test and Wilcoxon Rank‐sum test. The median annual case volume designated low‐volume centers versus high‐volume centers (>10 cases per month). Step‐wise variable selection was used to create a risk set used for adjustment of all multivariable models. Results There were 5480 patients identified: 4346 pre‐pandemic and 1134 during pandemic. There was significantly lower volume of median cases per month during the COVID‐19 pandemic period (286 interquartile range [IQR]: 256–306 vs. 372 IQR: 291–433,p = .0152). In historically low‐volume centers (<10 cases per year), there was no difference in volume between the two periods (142 IQR: 133–166 vs. 177 IQR: 139–209, p = NS). In high‐volume centers, there was a decline during the pandemic (140 IQR: 123–148 vs. 212 IQR: 148–224, p = .0052). There was no difference in overall hospital‐to‐hospital transfers during the two time periods (54% of cases pre‐pandemic, 55% during). Patient demographics, operative characteristics, malperfusion rates, and cardiac risk factors were similar between the two time periods. There was no difference in unadjusted operative mortality (19.01% pre‐pandemic vs. 18.83% during, p = .9) nor major morbidity (52.42% pre‐pandemic vs. 51.24% during, p = .5). Risk‐adjusted multivariable models showed no difference in either operative mortality nor major morbidity between time periods. Conclusions For patients presenting to the hospital with ATAAD during the first surge of the pandemic, operative outcomes were similar to pre‐pandemic despite a 30% reduction in volume. Out‐of‐hospital mortality from ATAAD during the pandemic remains unknown. Further understanding these findings will inform management of ATAAD during future pandemics.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Outcomes of acute type A aortic dissection during the COVID‐19 pandemic: An analysis of the Society of Thoracic Surgeons Database

Arnaoutakis

Wallen

Desai

et al. 2022

Journal of Cardiac Surgery

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“…The branches of the subclavian artery include the vertebral artery, which enters the cranial fossa through the foramen magnum and then branches to the brain and spinal cord. AD lesions can therefore lead to tearing or occlusion of the brachiocephalic trunk, common carotid artery [ 7 ] and subclavian artery [ 8 ], resulting in cerebral malperfusion [ 9 ] and even cerebral ischemia [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Cerebral Infarction as the Primary Presentation of Acute Aortic Dissection

Zhou¹,

Li²,

Huang³

et al. 2023

Rev. Cardiovasc. Med.

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Background:The aim of this study was to determine the clinical characteristics and outcome of patients with aortic dissection (AD) who present with an initial manifestation of cerebral infarction. Methods: We retrospectively analyzed patients who were diagnosed with AD and admitted to the emergency department from May 1, 2017 to May 1, 2022. Data was collected for variables including age, sex, clinical manifestation, past medical history, and laboratory test results. Results: Twenty-five patients (2.61%, 22 type A and 3 type B) showed cerebral infarction as the primary presentation for acute AD, while another 933 AD patients (471 type A and 462 type B) who presented with other symptoms served as the control group. Eighteen of the 25 patients (72%) were initially diagnosed with stroke, and the diagnosis of AD was missed. However, patients with a missed diagnosis of AD did not have significantly different mortality to those in whom AD was diagnosed (chi-square test, p > 0.9999). Patients with cerebral infarction as the first presentation had a higher incidence of type A AD than the control patients (p = 0.0002), while their mortality rate was also higher than the control group of AD patients (p < 0.0001). Furthermore, patients with cerebral infarction as the first presentation were more likely to have multiple organ dysfunction. Conclusions: AD with an initial presentation of cerebral infarction is a rare condition with high mortality. However, the initial failure to diagnose AD does not further increase patient mortality.

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Prognostic significance of serum secreted frizzled-related protein 5 in patients with acute aortic dissection

Zhang,

Li,

et al. 2024

Heliyon

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Type A Acute Aortic Dissection Presenting With Cerebrovascular Accident at Advanced Age

Cited by 6 publications

References 32 publications

Outcomes of acute type A aortic dissection during the COVID‐19 pandemic: An analysis of the Society of Thoracic Surgeons Database

Outcomes of acute type A aortic dissection during the COVID‐19 pandemic: An analysis of the Society of Thoracic Surgeons Database

Cerebral Infarction as the Primary Presentation of Acute Aortic Dissection

Prognostic significance of serum secreted frizzled-related protein 5 in patients with acute aortic dissection

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