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J Thorac Cardiovasc Surg 2005;129:112-122
© 2005 The American Association for Thoracic Surgery


Surgery for Acquired Cardiovascular Disease

Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience

Santi Trimarchi, MD*, Christoph A. Nienaber, MD, Vincenzo Rampoldi, MD, Truls Myrmel, MD, Toru Suzuki, MD, Rajendra H. Mehta, MD, Eduardo Bossone, MD, Jeanna V. Cooper, MS, Dean E. Smith, PhD, Lorenzo Menicanti, MD, Alessandro Frigiola, MD, Jae K. Oh, MD, Michael G. Deeb, MD, Eric M. Isselbacher, MD, Kim A. Eagle, MD on behalf of the International Registry of Acute Aortic Dissection Investigators*

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25-28, 2004.

Received for publication January 16, 2004; revisions received August 4, 2004; accepted for publication September 3, 2004.

* Address for reprints: Santi Trimarchi, MD, Istituto Policlinico S Donato, via Morandi 30, 20097 S Donato Milanese, Italy (E-mail: satrimarchi{at}yahoo.it).

BACKGROUND: Surgical mortality for acute type A aortic dissection reported in different experiences from single centers or surgeons varies from 7% to 30%. The International Registry of Acute Aortic Dissection, collecting patients from 18 referral centers worldwide, identifies a preoperative risk stratification scheme and a real average surgical mortality for acute type A aortic dissection in the current era.

METHODS: A comprehensive analysis was completed of 290 clinical variables and their relationship to surgical outcomes in 526 of 1032 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 through 2001. Extracted cases, categorized according to risk profile, were defined as unstable (group I) in the presence of cardiac tamponade; shock; congestive heart failure; cerebrovascular accident; stroke; coma; myocardial ischemia, infarction, or both; electrocardiograms with new Q waves or ST elevation; acute renal failure; or mesenteric ischemia-infarction at the time of the operation. Outside of an unstable condition, patients were categorized as stable (group II).

RESULTS: The overall in-hospital mortality was 25.1%. Mortality in group I was 31.4% compared with 16.7% in group II (P < .001). Independent preoperative predictors of operative mortality were history of aortic valve replacement (odds ratio = 3.12), migrating chest pain (odds ratio = 2.77), hypotension as sign of acute type A aortic dissection (odds ratio = 1.95), shock or tamponade (odds ratio = 2.69), preoperative cardiac tamponade (odds ratio = 2.22), and preoperative limb ischemia (odds ratio = 2.10).

CONCLUSIONS: The International Registry of Acute Aortic Dissection experience confirms that patient selection plays an important role in determining surgical outcomes in patients with acute type A aortic dissection. Knowledge of significant risk factors for operative mortality can contribute to better management and a more defined risk assessment in patients affected by acute type A aortic dissection.





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S. M. Nouraei, S. R. Nouraei, A. K. Sadashiva, and T. Pillay
Subclavian Cannulation Improves Outcome of Surgery for Type a Aortic Dissection
Asian Cardiovascular and Thoracic Annals, April 1, 2007; 15(2): 118 - 122.
[Abstract] [Full Text] [PDF]


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Interact CardioVasc Thorac SurgHome page
O. Chavanon, V. Costache, V. Bach, A. Ketata, M. Durand, R. Hacini, F. Thony, and D. Blin
Preoperative predictive factors for mortality in acute type A aortic dissection: an institutional report on 217 consecutives cases
Interact CardioVasc Thorac Surg, February 1, 2007; 6(1): 43 - 46.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
V. Rampoldi, S. Trimarchi, K. A. Eagle, C. A. Nienaber, J. K. Oh, E. Bossone, T. Myrmel, G. M. Sangiorgi, C. De Vincentiis, J. V. Cooper, et al.
Simple Risk Models to Predict Surgical Mortality in Acute Type A Aortic Dissection: The International Registry of Acute Aortic Dissection Score
Ann. Thorac. Surg., January 1, 2007; 83(1): 55 - 61.
[Abstract] [Full Text] [PDF]


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CirculationHome page
C. Olsson, S. Thelin, E. Stahle, A. Ekbom, and F. Granath
Thoracic Aortic Aneurysm and Dissection: Increasing Prevalence and Improved Outcomes Reported in a Nationwide Population-Based Study of More Than 14 000 Cases From 1987 to 2002
Circulation, December 12, 2006; 114(24): 2611 - 2618.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
H. Yamabi, H. Lu, X. Dai, Y. Lu, G. Hannigan, and J. G. Coles
Overexpression of integrin-linked kinase induces cardiac stem cell expansion
J. Thorac. Cardiovasc. Surg., December 1, 2006; 132(6): 1272 - 1279.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
P. Centofanti, R. Flocco, F. Ceresa, M. Attisani, M. L. Torre, L. Weltert, and A. M. Calafiore
Is Surgery Always Mandatory for Type A Aortic Dissection?
Ann. Thorac. Surg., November 1, 2006; 82(5): 1658 - 1664.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. Trimarchi, C. A. Nienaber, V. Rampoldi, T. Myrmel, T. Suzuki, E. Bossone, V. Tolva, M. G. Deeb, G. R. Upchurch Jr, J. V. Cooper, et al.
Role and Results of Surgery in Acute Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection (IRAD)
Circulation, July 4, 2006; 114(1_suppl): I-357 - I-364.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
M. Pocar, D. Passolunghi, A. Moneta, R. Mattioli, and F. Donatelli
Coma Might Not Preclude Emergency Operation in Acute Aortic Dissection
Ann. Thorac. Surg., April 1, 2006; 81(4): 1348 - 1351.
[Abstract] [Full Text] [PDF]




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