Clinical research| Volume 27, ISSUE 6, P685-691, November 2011

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Direct Admission to the Operating Room: An Efficient Strategy for Patients With Diagnosed or Highly Suspected Acute Type A Aortic Dissection



      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.


      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.


      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.


      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.



      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.


      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.


      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).


      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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