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

Publication ,  Journal Article
Trimarchi, S; de Beaufort, HWL; Tolenaar, JL; Bavaria, JE; Desai, ND; Di Eusanio, M; Di Bartolomeo, R; Peterson, MD; Ehrlich, M; Evangelista, A ...
Published in: J Thorac Cardiovasc Surg
January 2019

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.

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Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

January 2019

Volume

157

Issue

1

Start / End Page

66 / 73

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Respiratory System
  • Registries
  • Middle Aged
  • Male
  • Humans
  • Female
  • Computed Tomography Angiography
  • Aortic Dissection
 

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Trimarchi, S., de Beaufort, H. W. L., Tolenaar, J. L., Bavaria, J. E., Desai, N. D., Di Eusanio, M., … Eagle, K. A. (2019). Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg, 157(1), 66–73. https://doi.org/10.1016/j.jtcvs.2018.07.101
Trimarchi, Santi, Hector W. L. de Beaufort, Jip L. Tolenaar, Joseph E. Bavaria, Nimesh D. Desai, Marco Di Eusanio, Roberto Di Bartolomeo, et al. “Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection.J Thorac Cardiovasc Surg 157, no. 1 (January 2019): 66–73. https://doi.org/10.1016/j.jtcvs.2018.07.101.
Trimarchi S, de Beaufort HWL, Tolenaar JL, Bavaria JE, Desai ND, Di Eusanio M, et al. Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg. 2019 Jan;157(1):66–73.
Trimarchi, Santi, et al. “Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection.J Thorac Cardiovasc Surg, vol. 157, no. 1, Jan. 2019, pp. 66–73. Pubmed, doi:10.1016/j.jtcvs.2018.07.101.
Trimarchi S, de Beaufort HWL, Tolenaar JL, Bavaria JE, Desai ND, Di Eusanio M, Di Bartolomeo R, Peterson MD, Ehrlich M, Evangelista A, Montgomery DG, Myrmel T, Hughes GC, Appoo JJ, De Vincentiis C, Yan TD, Nienaber CA, Isselbacher EM, Deeb GM, Gleason TG, Patel HJ, Sundt TM, Eagle KA. Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg. 2019 Jan;157(1):66–73.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

January 2019

Volume

157

Issue

1

Start / End Page

66 / 73

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Respiratory System
  • Registries
  • Middle Aged
  • Male
  • Humans
  • Female
  • Computed Tomography Angiography
  • Aortic Dissection