Abstract
Background
Acute type A aortic dissection (ATAAD) is a life-threatening condition with a poor
acute prognosis, which requires rapid and effective surgical management. The aim of
this study is to assess our strategy with regard to this condition.
Methods
According to a regional emergency protocol, patients with diagnosed or highly suspected
ATAAD are directly transferred to the cardiac operating room. Transesophageal echocardiography
is performed under anaesthesia, and the patient then undergoes surgery if the diagnosis
is confirmed. The present retrospective study examines the implementation of this
management strategy between January 1, 1990 and December 31, 2009.
Results
Out of 380 patients, 245 were directly admitted to the operating room. Three hundred
twelve cases of ATAAD, 15 cases of aneurysm of the ascending aorta, 9 cases of acute
type B dissection, 4 cases of chronic dissection, 4 cases of hemopericardium, and
7 other diagnoses were observed. In 10 cases, no etiology was found. Nineteen patients
died before surgery could be performed. Out of the 307 cases of ATAAD undergoing surgery,
15 patients were operated with cardiac massage (14 cases of aortic rupture). This
management strategy was justified in 93.1% of patients (228/245) directly admitted
to the operating room, because of the need for surgery or aortic rupture.
Conclusions
Our management strategy enabled patients with ATAAD to receive effective and unselective
treatment. Despite appropriate management, the large number of patients still dying
before surgery, or undergoing surgery with cardiac massage, justifies and consolidates
the need for immediate treatment of this condition.
Résumé
Introduction
La dissection aortique aiguë de type A (DAAA) est une affection grave de pronostic
spontané redoutable qui nécessite une prise en charge chirurgicale rapide et efficace.
Le but de cette étude est d'évaluer notre stratégie dans cette pathologie.
Méthodes
Selon une organisation régionale des urgences, un patient présentant une forte probabilité
ou un diagnostic de DAAA est transféré directement au bloc opératoire de chirurgie
cardiaque. Une échographie transoesophagienne est réalisée sous anesthésie et le patient
opéré si le diagnostic est confirmé. Cette étude rétrospective analyse cette prise
en charge du 1er janvier 1990 au 31 décembre 2009.
Résultats
Sur 380 patients, 245 ont été admis directement au bloc opératoire. Il a été diagnostiqué
312 DAAA, 15 anévrismes de l'aorte ascendante, 9 dissections aiguës de type B, 4 dissections
chroniques, 4 hémopéricardes, 7 autres diagnostics et 10 fois aucune étiologie n'a
été retrouvée. Dix neuf patients sont décédés avant toute prise en charge chirurgicale.
Sur les 307 DAAA opérées, 15 l'ont été sous massage cardiaque (14 ruptures aortiques).
Pour 93,1 % des patients admis directement au bloc, cette stratégie était justifiée
en raison d'une chirurgie ou d'une rupture aortique (228/245).
Conclusions
Notre stratégie a permis de traiter efficacement et sans sélection les patients atteints
de DAAA. Malgré une prise en charge adéquate, les patients décédés avant toute intervention
ainsi que ceux opérés sous massage cardiaque, justifient et renforcent la nécessité
d'un traitement sans délai de cette pathologie.
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References
- Acute aortic dissection.Lancet. 2008; 372: 55-66
- Guidelines for the diagnosis and management of patients with thoracic aortic disease.Circulation. 2010; 121: e266-e369
- Acute aortic dissection: Perspectives from the International Registry of Acute Aortic Dissection (IRAD).Eur J Vasc Endovasc Surg. 2009; 37: 149-159
- The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.J Am Med Assoc. 2000; 283: 897-903
- Epidemiology and clinicopathology of aortic dissection.Chest. 2000; 117: 1271-1278
- Simple risk models to predict surgical mortality in acute type a aortic dissection: The International Registry of Acute Aortic Dissection Score.Ann Thorac Surg. 2007; 83: 55-61
- Aortic dissections and dissecting aneurysms.Am J Cardiol. 1972; 30: 263-273
- Diagnosis and management of aortic dissection.Eur Heart J. 2001; 22: 1642-1681
- Medical management of acute type A aortic dissection.Ann Thorac Cardiovasc Surg. 2009; 15: 286-293
- Thoracic aortic aneurysm and dissection.Circulation. 2006; 114: 2611-2618
- Operative delay for peripheral malperfusion syndrome in acute type A aortic dissection: A long-term analysis.J Thorac Cardiovasc Surg. 2008; 135: 1288-1296
- Acute type A aortic dissection: the prognostic impact of preoperative cardiac tamponade.Eur J Cardiothorac Surg. 2001; 20: 1194-1198
- Predicting death in patients with acute type A aortic dissection.Circulation. 2002; 105: 200-206
- Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis.Arch Intern Med. 2006; 166: 1350-1356
Article info
Publication history
Published online: June 27, 2011
Accepted:
January 14,
2011
Received:
December 21,
2010
Footnotes
See page 691 for disclosure information.
Identification
Copyright
© 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
