Differences in Clinical Presentation, Management, and Outcomes of Acute Type A Aortic Dissection in Patients With and Without Previous Cardiac Surgery
J. Stewart Collins,Arturo Evangelista,Christoph A. Nienaber,Eduardo Bossone,Jianming Fang,Jeanna V. Cooper,Dean E. Smith,Patrick T. O'Gara,Truls Myrmel,Dan Gilon,Eric M. Isselbacher,Marc S. Penn,Linda Pape,Kim A. Eagle,Rajendra H. Mehta +14 more
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The data indicate that a history of PCS (even that of previous AVR) should not preclude physicians from recommending surgical correction of type A aortic dissection in appropriate patients, including those undergoing surgical repair.Abstract:
Background— There are less data on the clinical and diagnostic imaging characteristics, management, and outcomes of patients with previous cardiac surgery (PCS) presenting with acute type A aortic dissection (AAD). Methods and Results— In 617 patients with AAD, we evaluated the differences in the clinical characteristics, management, and in-hospital outcomes of the cohorts with and without PCS. A history of PCS was present in 100 of 617 patients. Patients with PCS were more likely to be males ( P =0.02), older ( P =0.014), and to have a history of previous aortic dissection ( P P P P =0.007). Fewer AAD patients with PCS underwent surgical repair ( P =0.001). Hospital mortality was not adversely influenced by PCS (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.81 to 2.63), but a trend for increased death was seen in patients with previous aortic valve replacement (AVR) (OR, 2.31; 95% CI, 0.98 to 5.43). Age70 years or older, previous AVR, shock, and renal failure identified PCS patients at risk for death. Conclusions— Our study highlights differences in clinical characteristics, management, and outcomes of AAD patients with PCS. Importantly, PCS, with the exception of previous AVR, does not adversely influence early outcomes of AAD patients, including those undergoing surgical repair. However, because of otherwise dismal outcomes with medical management of AAD, our data indicate that a history of PCS (even that of previous AVR) should not preclude physicians from recommending surgical correction of type A aortic dissection in appropriate patients.read more
Citations
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2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: Executive summary: A report of the american college of cardiology foundation/american heart association task force on practice guidelines, american association for thoracic surgery, american college of radiology, american stroke association
Loren F. Hiratzka,George L. Bakris,Joshua A. Beckman,Robert M. Bersin,Vincent F. Carr,Donald E. Casey,Kim A. Eagle,Luke K. Hermann,Eric M. Isselbacher,Ella A. Kazerooni,Nicholas T. Kouchoukos,Bruce W. Lytle,Dianna M. Milewicz,David Reich,Souvik Sen,Julie A. Shinn,Lars G. Svensson,David M. Williams,Alice K. Jacobs,Sidney C. Smith,Jeffery L. Anderson,Cynthia D. Adams,Christopher E. Buller,Mark A. Creager,Steven M. Ettinger,Robert A. Guyton,Jonathan L. Halperin,Sharon A. Hunt,Harlan M. Krumholz,Frederick G. Kushner,Rick A. Nishimura,Richard L. Page,Barbara Riegel,William G. Stevenson,Lynn G. Tarkington,Clyde W. Yancy +35 more
Journal ArticleDOI
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease
Loren F. Hiratzka,George L. Bakris,Joshua A. Beckman,Robert M. Bersin,Vincent F. Carr,Donald E. Casey,Kim A. Eagle,Luke K. Hermann,Eric M. Isselbacher,Ella A. Kazerooni,Nicholas T. Kouchoukos,Bruce W. Lytle,Dianna M. Milewicz,David Reich,Souvik Sen,Julie A. Shinn,Lars G. Svensson,David M. Williams +17 more
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.
Journal ArticleDOI
Editor's Choice - Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)
V. Riambau,Dittmar Böckler,Jan Brunkwall,Piergiorgio Cao,Roberto Chiesa,Giovanni Coppi,Martin Czerny,Gustav Fraedrich,Stéphan Haulon,Michael J. Jacobs,Mario Lachat,F.L. Moll,Carlo Setacci,Peter N Taylor,Matt M. Thompson,Santi Trimarchi,H.J.M. Verhagen,E. L. Verhoeven,Philippe Kolh,G.J. de Borst,Nabil Chakfe,Eike Sebastian Debus,Robert J. Hinchliffe,Stavros K. Kakkos,Igor Koncar,Jes S. Lindholt,M. Vega de Céniga,Frank Vermassen,Fabio Verzini,James H. Black,R. Busund,Martin Björck,Michael D. Dake,Florian Dick,Holger Eggebrecht,Andrea Evangelista,Martin Grabenwöger,Ross Milner,A.R. Naylor,J.-B. Ricco,Hervé Rousseau,Jürg Schmidli +41 more
TL;DR: The management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS) as mentioned in this paper is a guideline for the management of thoracic aorta diseases.
Journal ArticleDOI
Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research.
Arturo Evangelista,Eric M. Isselbacher,Eduardo Bossone,Thomas G. Gleason,Marco Di Eusanio,Udo Sechtem,Marek Ehrlich,Santi Trimarchi,Alan C. Braverman,Truls Myrmel,Kevin M. Harris,Stuart Hutchinson,Patrick T. O'Gara,Toru Suzuki,Christoph A. Nienaber,Kim A. Eagle +15 more
TL;DR: The International Registry of Acute Aortic Dissection (IRAD) was established in 1996 with the mission to raise awareness of this condition and provide insights to guide diagnosis and treatment as mentioned in this paper.
Journal ArticleDOI
Population-Based Study of Incidence and Outcome of Acute Aortic Dissection and Premorbid Risk Factor Control 10-Year Results From the Oxford Vascular Study
Dominic P.J. Howard,Amitava Banerjee,J. F. Fairhead,J.M.T. Perkins,Louise E. Silver,Peter M. Rothwell +5 more
TL;DR: In this article, the authors prospectively determined incidence and outcomes of all acute aortic dissections in a population of 92 728 in Oxfordshire, United Kingdom, from 2002 to 2012.
References
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The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.
Peter Hagan,Christoph A. Nienaber,Eric M. Isselbacher,David Bruckman,Dean Karavite,P. Russman,Arturo Evangelista,Rossella Fattori,Toru Suzuki,Jae K. Oh,Andrew G. Moore,Joseph F. Malouf,Linda Pape,Charlene Gaca,Udo Sechtem,Suzanne Lenferink,Hans J. Deutsch,Holger Diedrichs,Jose Marcos y Robles,Alfredo Llovet,Dan Gilon,Sugata Das,William F. Armstrong,G. Michael Deeb,Kim A. Eagle +24 more
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.
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ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery)
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Journal ArticleDOI
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Journal ArticleDOI
Predicting Death in Patients With Acute Type A Aortic Dissection
Rajendra H. Mehta,Toru Suzuki,Peter Hagan,Eduardo Bossone,Dan Gilon,Alfredo Llovet,Luis C. Maroto,Jeanna V. Cooper,Dean E. Smith,William F. Armstrong,Christoph A. Nienaber,Kim A. Eagle +11 more
TL;DR: The in-hospital mortality rate in acute type A aortic dissection is high and can be predicted with the use of a clinical model incorporated in a simple risk prediction tool.
Journal ArticleDOI
Prediction of operative mortality after valve replacement surgery
Fred H. Edwards,Eric D. Peterson,Laura P. Coombs,Elizabeth R. DeLong,W.R. Eric Jamieson,A. Laurie Shroyer,Frederick L. Grover +6 more
TL;DR: In this paper, the authors developed a risk model for valve replacement surgery based on the Society of Thoracic Surgeons National Cardiac Surgery Database (STHS) from 1994 through 1997, and applied it to a prospective patient population undergoing operation from 1998 to 1999.
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