Author
P. Russman
Bio: P. Russman is an academic researcher from University of Michigan. The author has contributed to research in topics: Irad & Aortic dissection. The author has an hindex of 7, co-authored 10 publications receiving 3051 citations.
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TL;DR: The data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection and suggest a high clinical index of suspicion is necessary.
Abstract: ContextAcute aortic dissection is a life-threatening medical emergency associated
with high rates of morbidity and mortality. Data are limited regarding the
effect of recent imaging and therapeutic advances on patient care and outcomes
in this setting.ObjectiveTo assess the presentation, management, and outcomes of acute aortic
dissection.DesignCase series with patients enrolled between January 1996 and December
1998. Data were collected at presentation and by physician review of hospital
records.SettingThe International Registry of Acute Aortic Dissection, consisting of
12 international referral centers.ParticipantsA total of 464 patients (mean age, 63 years; 65.3% male), 62.3% of whom
had type A dissection.Main Outcome MeasuresPresenting history, physical findings, management, and mortality, as
assessed by history and physician review of hospital records.ResultsWhile sudden onset of severe sharp pain was the single most common presenting
complaint, the clinical presentation was diverse. Classic physical findings
such as aortic regurgitation and pulse deficit were noted in only 31.6% and
15.1% of patients, respectively, and initial chest radiograph and electrocardiogram
were frequently not helpful (no abnormalities were noted in 12.4% and 31.3%
of patients, respectively). Computed tomography was the initial imaging modality
used in 61.1%. Overall in-hospital mortality was 27.4%. Mortality of patients
with type A dissection managed surgically was 26%; among those not receiving
surgery (typically because of advanced age and comorbidity), mortality was
58%. Mortality of patients with type B dissection treated medically was 10.7%.
Surgery was performed in 20% of patients with type B dissection; mortality
in this group was 31.4%.ConclusionsAcute aortic dissection presents with a wide range of manifestations,
and classic findings are often absent. A high clinical index of suspicion
is necessary. Despite recent advances, in-hospital mortality rates remain
high. Our data support the need for continued improvement in prevention, diagnosis,
and management of acute aortic dissection.
3,110 citations
TL;DR: Increased left ventricular mass index is associated with increased adverse in-hospital clinical outcomes in patients undergoing aortic valve replacement, and this finding warrants special modification in perioperative management.
101 citations
TL;DR: Implementation of the American College of Cardiology/American Heart Association cardiac risk assessment guidelines appropriately reduced resource use and costs in patients who underwent elective aortic surgery without affecting outcomes.
65 citations
TL;DR: This prediction model identifies a number of potentially reversible factors responsible for prolonging postprocedure LOS and may enable the development of more accurate risk-adjusted methods with which to improve or compare care.
54 citations
TL;DR: Although admission during the last 3 days of the month is an independent predictor of length of stay, it does not have a large effect on quality of care among patients with myocardial infarction.
23 citations
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3,024 citations
1,797 citations
TL;DR: It is essential that the medical profession play a central role in critically evaluating the evidence related to drugs, devices, and procedures for the detection, management, or prevention of disease.
1,492 citations
TL;DR: The 2007 Guidelines on Perioperative Cardiovascular Evaluation for Non-Cardiac Surgery (e159-e242) as discussed by the authors were developed by the American College of ACC/AHA Task Force on Practice Guidelines Care for Noncardiac Surgery.
1,397 citations
TL;DR: WRITING COMMITTEE MEMBERS Lee A. Fleisher, MD, FACC, FAHA, Chair; Joshua A. Beckman,MD, F ACC¶; Kenneth A. Kasper, MD; Judy R. Kersten,MD; Barbara Riegel, DNSc, RN,FAHA.
1,393 citations