Objective: To analyze presentation, management, and outcomes of acute aortic dissections with proximal entry tear in the arch.Methods: Patients enrolled in the International Registry of Acute Aortic Dissection and entry tear in the arch were classified into 2 groups: arch A (retrograde extension into the ascending aorta with or without antegrade extension) and arch B (only antegrade extension into the descending aorta or further distally). Presentation, management, and in-hospital outcomes of the 2 groups were compared.Results: The arch A (n = 228) and arch B (n = 140) groups were similar concerning the presence of any preoperative complication (68.4% vs 60.0%; P = .115), but the types of complication were different. Arch A presented more commonly with shock, neurologic complications, cardiac tamponade, and grade 3 or 4 aortic valve insufficiency and less frequently with refractory hypertension, visceral ischemia, extension of dissection, and aortic rupture. Management for both groups were open surgery (77.6% vs 18.6%; P < .001), endovascular treatment (3.5% vs 25.0%; P < .001), and medical management (16.2% vs 51.4%; P < .001). Overall in-hospital mortality was similar (16.7% vs 19.3%; P = .574), but mortality tended to be lower in the arch A group after open surgery (15.3% vs 30.8%; P = .090), and higher after endovascular (25.0% vs 14.3%; P = .597) or medical treatment (24.3% vs 13.9%; P = .191), although the differences were not significant.Conclusions: Acute aortic dissection patients with primary entry tear in the arch are currently managed by a patientspecific approach. In choosing the management type of these patients, it may be advisable to stratify them based on retrograde or only antegrade extension of the dissection.

Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection / S. Trimarchi, H.W.L. de Beaufort, J.L. Tolenaar, J.E. Bavaria, N.D. Desai, M. Di Eusanio, R. Di Bartolomeo, M.D. Peterson, M. Ehrlich, A. Evangelista, D.G. Montgomery, T. Myrmel, G.C. Hughes, J.J. Appoo, C. De Vincentiis, T.D. Yan, C.A. Nienaber, E.M. Isselbacher, G.M. Deeb, T.G. Gleason, H.J. Patel, T.M. Sundt, K.A. Eagle. - In: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. - ISSN 0022-5223. - 157:1(2019 Jan), pp. 66-73. (Intervento presentato al convegno Aortic Symposium of the American-Association-for-Thoracic-Surgery : April, 26 - 27 tenutosi a New York nel 2018) [10.1016/j.jtcvs.2018.07.101].

Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection

S. Trimarchi
Primo
;
2019

Abstract

Objective: To analyze presentation, management, and outcomes of acute aortic dissections with proximal entry tear in the arch.Methods: Patients enrolled in the International Registry of Acute Aortic Dissection and entry tear in the arch were classified into 2 groups: arch A (retrograde extension into the ascending aorta with or without antegrade extension) and arch B (only antegrade extension into the descending aorta or further distally). Presentation, management, and in-hospital outcomes of the 2 groups were compared.Results: The arch A (n = 228) and arch B (n = 140) groups were similar concerning the presence of any preoperative complication (68.4% vs 60.0%; P = .115), but the types of complication were different. Arch A presented more commonly with shock, neurologic complications, cardiac tamponade, and grade 3 or 4 aortic valve insufficiency and less frequently with refractory hypertension, visceral ischemia, extension of dissection, and aortic rupture. Management for both groups were open surgery (77.6% vs 18.6%; P < .001), endovascular treatment (3.5% vs 25.0%; P < .001), and medical management (16.2% vs 51.4%; P < .001). Overall in-hospital mortality was similar (16.7% vs 19.3%; P = .574), but mortality tended to be lower in the arch A group after open surgery (15.3% vs 30.8%; P = .090), and higher after endovascular (25.0% vs 14.3%; P = .597) or medical treatment (24.3% vs 13.9%; P = .191), although the differences were not significant.Conclusions: Acute aortic dissection patients with primary entry tear in the arch are currently managed by a patientspecific approach. In choosing the management type of these patients, it may be advisable to stratify them based on retrograde or only antegrade extension of the dissection.
acute aortic syndrome; aortic dissection; aortic surgery;
Settore MED/22 - Chirurgia Vascolare
gen-2019
American Associon Thoracic Surgerons
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/994512
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