Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection.
Publication/Presentation Date
1-1-2019
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 patient-specific 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.
Volume
157
Issue
1
First Page
66
Last Page
73
ISSN
1097-685X
Published In/Presented At
Trimarchi, S., de Beaufort, H. W. L., Tolenaar, J. L., Bavaria, J. E., Desai, N. D., Di Eusanio, M., Di Bartolomeo, R., Peterson, M. D., Ehrlich, M., Evangelista, A., Montgomery, D. G., Myrmel, T., Hughes, G. C., Appoo, J. J., De Vincentiis, C., Yan, T. D., Nienaber, C. A., Isselbacher, E. M., Deeb, G. M., Gleason, T. G., … Eagle, K. A. (2019). Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection. The Journal of thoracic and cardiovascular surgery, 157(1), 66–73. https://doi.org/10.1016/j.jtcvs.2018.07.101
Disciplines
Medicine and Health Sciences
PubMedID
30396735
Department(s)
Department of Surgery
Document Type
Article