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

Jehangir J. Appoo¹  Tristan D. Yan²  Joseph E. Bavaria³  Nimesh D. Desai⁴  Mark D. Peterson⁵  G. Chad Hughes⁶  Roberto Di Bartolomeo⁷  Marek Ehrlich⁸  Hector W.L. de Beaufort⁹  Daniel G. Montgomery^1,10  Arturo Evangelista^1,11  Christoph A. Nienaber^1,12  Eric M. Isselbacher^1,13  Truls Myrmel^1,14  Marco Di Eusanio^1,15  Jip L. Tolenaar^1,16  Carlo De Vincentiis^1,17  Santi Trimarchi^1,18 

[1] Cardiology and Aortic Centre, Royal Brompton Hospital, Royal Brompton & Harefield NHS Trust, Imperial College London, London, United Kingdom;Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Mich;Department of Cardiac Surgery, Ospedali Riuniti di Ancona, Ancona, Italy;Department of Cardiac Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy;Department of Cardiology, Hospital General Universitari Vall d'Hebron, Barcelona, Spain;Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia;Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria;Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Mich;Department of Scienze Biomediche per la Salute, University of Milan, Milan, Italy;Department of Surgery, Duke University Medical Center, Durham, NC;Department of Thoracic and Cardiovascular Surgery, University of Tromsø, Tromsø, Norway;Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa;Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass;Division of Cardiac Surgery, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada;Division of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada;Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa;Thoracic Aortic Center and Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Mass;Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy

关键词: aortic dissection;    acute aortic syndrome;    aortic surgery;   

DOI  :  10.1016/j.jtcvs.2018.07.101

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveTo analyze presentation, management, and outcomes of acute aortic dissections with proximal entry tear in the arch.MethodsPatients 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.ResultsThe 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 P P 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.ConclusionsAcute 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.

【 授权许可】

Unknown