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Jeanna V Cooper - One of the best experts on this subject based on the ideXlab platform.
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correlates of delayed recognition and treatment of acute type a Aortic Dissection the international registry of acute Aortic Dissection irad
Circulation, 2011Co-Authors: Kevin M Harris, Thomas T Tsai, Eric M. Isselbacher, Rossella Fattori, Kim A. Eagle, Craig Strauss, Alan T Hirsch, Hadas Shiran, A Evangelista, Jeanna V CooperAbstract:Background—In acute Aortic Dissection, delays exist between presentation and diagnosis and, once diagnosed, definitive treatment. This study aimed to define the variables associated with these delays. Methods and Results—Acute Aortic Dissection patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and January 2007 were evaluated for factors contributing to delays in presentation to diagnosis and in diagnosis to surgery. Multiple linear regression was performed to determine relative delay time ratios (DTRs) for individual correlates. The median time from arrival at the emergency department to diagnosis was 4.3 hours (quartile 1–3, 1.5–24 hours; n=894 patients) and from diagnosis to surgery was 4.3 hours (quartile 1–3, 2.4–24 hours; n=751). Delays in acute Aortic Dissection diagnosis occurred in female patients; those with atypical symptoms that were not abrupt or did not include chest, back, or any pain; patients with an absence of pulse deficit or hypotension; or t...
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sensitivity of the Aortic Dissection detection risk score a novel guideline based tool for identification of acute Aortic Dissection at initial presentation results from the international registry of acute Aortic Dissection
Circulation, 2011Co-Authors: Adam Rogers, Patrick T Ogara, Christoph A. Nienaber, Luke K Hermann, Anna M Booher, David M Williams, Ella A Kazerooni, James B Froehlich, Daniel G Montgomery, Jeanna V CooperAbstract:Background—In 2010, the American Heart Association and American College of Cardiology released guidelines for the diagnosis and management of patients with thoracic Aortic disease, which identified high-risk clinical features to assist in the early detection of acute Aortic Dissection. The sensitivity of these risk markers has not been validated. Methods and Results—We examined patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2009. The number of patients with confirmed acute Aortic Dissection who presented with 1 or more of 12 proposed clinical risk markers was determined. An Aortic Dissection detection (ADD) risk score of 0 to 3 was calculated on the basis of the number of risk categories (high-risk predisposing conditions, high-risk pain features, high-risk examination features) in which patients met criteria. The ADD risk score was tested for sensitivity. Of 2538 patients with acute Aortic Dissection, 2430 (95.7%) were identified by 1 or more of 12 proposed clinic...
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sensitivity of the Aortic Dissection detection risk score a novel guideline based tool for identification of acute Aortic Dissection at initial presentation results from the international registry of acute Aortic Dissection
Circulation, 2011Co-Authors: Adam M Rogers, Patrick T Ogara, Christoph A. Nienaber, Luke K Hermann, Anna M Booher, David M Williams, Ella A Kazerooni, James B Froehlich, Daniel Montgomery, Jeanna V CooperAbstract:Background— In 2010, the American Heart Association and American College of Cardiology released guidelines for the diagnosis and management of patients with thoracic Aortic disease, which identified high-risk clinical features to assist in the early detection of acute Aortic Dissection. The sensitivity of these risk markers has not been validated. Methods and Results— We examined patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2009. The number of patients with confirmed acute Aortic Dissection who presented with 1 or more of 12 proposed clinical risk markers was determined. An Aortic Dissection detection (ADD) risk score of 0 to 3 was calculated on the basis of the number of risk categories (high-risk predisposing conditions, high-risk pain features, high-risk examination features) in which patients met criteria. The ADD risk score was tested for sensitivity. Of 2538 patients with acute Aortic Dissection, 2430 (95.7%) were identified by 1 or more of 12 proposed clinical risk markers. With the use of the ADD risk score, 108 patients (4.3%) were identified as low risk (ADD score 0), 927 patients (36.5%) were intermediate risk (ADD score 1), and 1503 patients (59.2%) were high risk (ADD score 2 or 3). Among 108 patients with no clinical risk markers present (ADD score 0), 72 had chest x-rays recorded, of which 35 (48.6%) demonstrated a widened mediastinum. Conclusions— The clinical risk markers proposed in the 2010 thoracic Aortic disease guidelines and their application as part of the ADD risk score comprise a highly sensitive clinical tool for the detection of acute Aortic Dissection.
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Simple Risk Models to Predict Surgical Mortality in Acute Type A Aortic Dissection: The International Registry of Acute Aortic Dissection Score
The Annals of thoracic surgery, 2007Co-Authors: Vincenzo Rampoldi, Santi Trimarchi, Christoph A. Nienaber, Eduardo Bossone, Truls Myrmel, Kim A. Eagle, Giuseppe Sangiorgi, Carlo De Vincentiis, Jeanna V CooperAbstract:Background Surgical mortality for acute type A Aortic Dissection is frequently related to preoperative clinical conditions. We report a predictive score to identify risk of death that may be helpful to assist surgeons who are considering whether to proceed with surgical correction in the case of patients in extreme clinical risk. Methods Surgical outcome of 682 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2003 was analyzed. Two different models were used. The initial model included only preoperative variables such as demographics, history, symptoms, signs, and diagnostic methods (model 1). The second model also tested intraoperative hemodynamic and surgical variables (model 2). A bedside risk prediction tool to predict operative mortality in individual patients was developed. Results The overall in-hospital surgical mortality was 23.9%. Independent preoperative predictors of mortality in model 1 were age greater than 70 years, prior cardiac surgery, hypotension (systolic blood pressure less than 100 mm Hg) or shock at presentation, migrating pain, cardiac tamponade, any pulse deficit, and electrocardiogram with findings of myocardial ischemia or infarction. In model 2, other predictors of surgical death were intraoperative hypotension, a right ventricle dysfunction at surgery, and a necessity to perform coronary revascularization. An independent predictor for favorable surgical outcome was right hemiarch replacement. Conclusions Surgery in unstable patients with acute type A Aortic Dissection can be highly unsuccessful. The International Registry of Acute Aortic Dissection risk models predict in-hospital mortality using a multivariable risk prediction tool, useful for surgeons and patients as they consider their surgical risk and the pros and cons of embarking on high-risk surgery.
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long term survival in patients presenting with type b acute Aortic Dissection insights from the international registry of acute Aortic Dissection
Circulation, 2006Co-Authors: Thomas T Tsai, Arturo Evangelista, Santi Trimarchi, Eric M. Isselbacher, Rossella Fattori, Jeanna V Cooper, Udo Sechtem, Truls Myrmel, Stuart Hutchison, Dean E SmithAbstract:Background— Follow-up survival studies in patients with acute type B Aortic Dissection have been restricted to a small number of patients in single centers. We used data from a contemporary registry of acute type B Aortic Dissection to better understand factors associated with adverse long-term survival. Methods and Results— We examined 242 consecutive patients discharged alive with acute type B Aortic Dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. Kaplan-Meier survival curves were constructed, and Cox proportional hazards analysis was performed to identify independent predictors of follow-up mortality. Three-year survival for patients treated medically, surgically, or with endovascular therapy was 77.6±6.6%, 82.8±18.9%, and 76.2±25.2%, respectively (median follow-up 2.3 years, log-rank P=0.61). Independent predictors of follow-up mortality included female gender (hazard ratio [HR],1.99; 95% confidence interval [CI], 1.07 to 3.71; P=0.03), a hist...
Christoph A. Nienaber - One of the best experts on this subject based on the ideXlab platform.
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management of acute Aortic Dissection
The Lancet, 2015Co-Authors: Christoph A. Nienaber, Rachel E CloughAbstract:Summary A new appraisal of the management of acute Aortic Dissection is timely because of recent developments in diagnostic strategies (including biomarkers and imaging), endograft design, and surgical treatment, which have led to a better understanding of the epidemiology, risk factors, and molecular nature of Aortic Dissection. Although open surgery is the main treatment for proximal Aortic repair, use of endovascular management is now established for complicated distal Dissection and distal arch repair, and has recently been discussed as a pre-emptive measure to avoid late complications by inducing Aortic remodelling.
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survival after endovascular therapy in patients with type b Aortic Dissection a report from the international registry of acute Aortic Dissection irad
Jacc-cardiovascular Interventions, 2013Co-Authors: Rossella Fattori, Eric M. Isselbacher, Kim A. Eagle, Daniel Montgomery, Luigi Lovato, Stephan Kische, Marco Di Eusanio, Huseyin Ince, Christoph A. NienaberAbstract:Objectives This study sought to evaluate long-term survival in type B Aortic Dissection patients treated with thoracic endovascular Aortic repair (TEVAR) therapy. Background Historical data have supported medical therapy in type B acute Aortic Dissection (TBAAD) patients. Recent advances in TEVAR appear to improve in-hospital mortality. Methods We examined 1,129 consecutive patients with TBAAD enrolled in IRAD (International Registry of Acute Aortic Dissection) between 1995 and 2012 who received medical (n = 853, 75.6%) or TEVAR (n = 276, 24.4%) therapy. Results Clinical history was similar between groups. TEVAR patients were more likely to present with a pulse deficit (28.3% vs. 13.4%, p Conclusions Results from IRAD show that TEVAR is associated with lower mortality over a 5-year period than medical therapy for TBAAD. Further randomized trials with long-term follow-up are needed.
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the irad classification system for characterizing survival after Aortic Dissection
The American Journal of Medicine, 2013Co-Authors: Anna M Booher, Arturo Evangelista, Santi Trimarchi, Eric M. Isselbacher, Christoph A. Nienaber, James L Januzzi, James B Froehlich, Daniel G Montgomery, Marek Ehrlich, Patrick T OgaraAbstract:BACKGROUND: The classification of Aortic Dissection into acute ( 30 days). Overall survival was progressively lower through the 4 time periods. CONCLUSIONS: This IRAD classification system can provide clinicians with a more robust method of characterizing survival after Aortic Dissection over time than previous methods. This system will be useful for treating patients, counseling patients and families, and studying new diagnostic and treatment methods.
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interdisciplinary expert consensus document on management of type b Aortic Dissection
Journal of the American College of Cardiology, 2013Co-Authors: Rossella Fattori, Paola De Rango, Arturo Evangelista, H. Rousseau, Christoph A. Nienaber, Martin Czerny, Marc A.a.m. SchepensAbstract:An expert multidisciplinary panel in the treatment of type B Aortic Dissection reviewed available literature to develop treatment algorithms using a consensus method. Data from 63 studies published from 2006 to 2012 were retrieved for a total of 1,548 patients treated medically, 1,706 patients who underwent open surgery, and 3,457 patients who underwent thoracic endovascular repair (TEVAR). For acute (first 2 weeks) type B Aortic Dissection, the pooled early mortality rate was 6.4% with medical treatment and increased to 10.2% with TEVAR and 17.5% with open surgery, mostly for complicated cases. Limited data for treatment of subacute (2 to 6 weeks after onset) type B Aortic Dissection showed an early mortality rate of 2.8% with TEVAR. In chronic (after 6 weeks) type B Aortic Dissection, 5-year survival of 60% to 80% was expected with medical therapy because complications were likely. If interventional treatment was applied, the pooled early mortality rate was 6.6% with TEVAR and 8.0% with open surgery. Medical treatment of uncomplicated acute, subacute, and chronic type B Aortic Dissection is managed with close image monitoring. Hemodynamic instability, organ malperfusion, increasing periAortic hematoma, and hemorrhagic pleural effusion on imaging identify patients with complicated acute type B Aortic Dissection requiring urgent Aortic repair. Recurrence of symptoms, Aortic aneurysmal dilation (>55 mm), or a yearly increase of >4 mm after the acute phase are predictors of adverse outcome and need for delayed Aortic repair (“complicated chronic Aortic Dissections”). The expert panel is aware that this consensus document provides proposal for strategies based on nonrobust evidence for management of type B Aortic Dissection, and that literature results were largely heterogeneous and should be interpreted cautiously.
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sensitivity of the Aortic Dissection detection risk score a novel guideline based tool for identification of acute Aortic Dissection at initial presentation results from the international registry of acute Aortic Dissection
Circulation, 2011Co-Authors: Adam Rogers, Patrick T Ogara, Christoph A. Nienaber, Luke K Hermann, Anna M Booher, David M Williams, Ella A Kazerooni, James B Froehlich, Daniel G Montgomery, Jeanna V CooperAbstract:Background—In 2010, the American Heart Association and American College of Cardiology released guidelines for the diagnosis and management of patients with thoracic Aortic disease, which identified high-risk clinical features to assist in the early detection of acute Aortic Dissection. The sensitivity of these risk markers has not been validated. Methods and Results—We examined patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2009. The number of patients with confirmed acute Aortic Dissection who presented with 1 or more of 12 proposed clinical risk markers was determined. An Aortic Dissection detection (ADD) risk score of 0 to 3 was calculated on the basis of the number of risk categories (high-risk predisposing conditions, high-risk pain features, high-risk examination features) in which patients met criteria. The ADD risk score was tested for sensitivity. Of 2538 patients with acute Aortic Dissection, 2430 (95.7%) were identified by 1 or more of 12 proposed clinic...
Santi Trimarchi - One of the best experts on this subject based on the ideXlab platform.
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body mass index and acute Aortic Dissection
Journal of the American College of Cardiology, 2017Co-Authors: Jordan Jabara, Santi Trimarchi, Truls Myrmel, Marco Di Eusanio, Marek Ehrlich, Alan Braverman, Hanshenning Eckstein, Maral Ouzounian, Gilbert R Upchurch, Ali KhoynezhadAbstract:Background: Obesity has been linked to many cardiovascular diseases, yet little is known about its impact on acute Aortic Dissection (AAD). We sought to assess the clinical manifestations, management and outcomes of AAD in relation to body mass index (BMI). Methods: We evaluated 2037 AAD patients
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original investigationpresentation diagnosis and outcomes of acute Aortic Dissection 17 year trends from the international registry of acute Aortic Dissection
Journal of the American College of Cardiology, 2015Co-Authors: Linda Pape, Arturo Evangelista, Santi Trimarchi, Toru Suzuki, Truls Myrmel, Kevin M Harris, Mazen Awais, Elise M Woznicki, Magnus Larsen, Kevin L GreasonAbstract:Background Diagnosis, treatment, and outcomes of acute Aortic Dissection (AAS) are changing.
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the irad classification system for characterizing survival after Aortic Dissection
The American Journal of Medicine, 2013Co-Authors: Anna M Booher, Arturo Evangelista, Santi Trimarchi, Eric M. Isselbacher, Christoph A. Nienaber, James L Januzzi, James B Froehlich, Daniel G Montgomery, Marek Ehrlich, Patrick T OgaraAbstract:BACKGROUND: The classification of Aortic Dissection into acute ( 30 days). Overall survival was progressively lower through the 4 time periods. CONCLUSIONS: This IRAD classification system can provide clinicians with a more robust method of characterizing survival after Aortic Dissection over time than previous methods. This system will be useful for treating patients, counseling patients and families, and studying new diagnostic and treatment methods.
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role of age in acute type a Aortic Dissection outcome report from the international registry of acute Aortic Dissection irad
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Santi Trimarchi, Thomas T Tsai, Christoph A. Nienaber, Vincenzo Rampoldi, Kim A. Eagle, Carlo De Vincentiis, Lorenzo Menicanti, Frederik H W Jonker, Alessandro Frigiola, Jim FroehlichAbstract:Objective The increasing life expectancy of the population will likely be accompanied by a rise in the incidence of acute type A Aortic Dissection. However, because of an increased risk of cardiac surgery in an elderly population, it is important to define when, if at all, the risks of Aortic repair outweigh the risk of death from unoperated type A Aortic Dissection. Methods We analyzed 936 patients with type A Aortic Dissection enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2004. Patients with type A Aortic Dissection were categorized according to patient age by decade and by surgical versus medical management, and outcomes of both management types were investigated in the different age groups. Results The rate of surgical Aortic repair decreased progressively with age, whereas surgical mortality significantly increased with age. Age 70 years or more was an independent predictor for mortality (38.2% vs 26.0%; P Conclusions Although the surgical mortality significantly increased with increased age, surgical management was still associated with significantly lower in-hospital mortality rates compared with medical management until the age of 80 years. Surgery may decrease the in-hospital mortality rate for octogenarians with type A Aortic Dissection and might be considered in all patients with type A Aortic Dissection regardless of age.
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importance of refractory pain and hypertension in acute type b Aortic Dissection insights from the international registry of acute Aortic Dissection irad
Circulation, 2010Co-Authors: Santi Trimarchi, Patrick T Ogara, Christoph A. Nienaber, Toru Suzuki, Vincenzo Rampoldi, Kim A. Eagle, Frederik H W Jonker, Reed E Pyeritz, Stuart Hutchinson, Viviana GrassiAbstract:Background—In patients with acute type B Aortic Dissection, presence of recurrent or refractory pain and/or refractory hypertension on medical therapy is sometimes used as an indication for invasive treatment. The International Registry of Acute Aortic Dissection (IRAD) was used to investigate the impact of refractory pain and/or refractory hypertension on the outcomes of acute type B Aortic Dissection. Methods and Results—Three hundred sixty-five patients affected by uncomplicated acute type B Aortic Dissection, enrolled in IRAD from 1996 to 2004, were categorized according to risk profile into 2 groups. Patients with recurrent and/or refractory pain or refractory hypertension (group I; n=69) and patients without clinical complications at presentation (group II; n=296) were compared. “High-risk” patients with classic complications were excluded from this analysis. The overall in-hospital mortality was 6.5% and was increased in group I compared with group II (17.4% versus 4.0%; P=0.0003). The in-hospital ...
Kim A. Eagle - One of the best experts on this subject based on the ideXlab platform.
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survival after endovascular therapy in patients with type b Aortic Dissection a report from the international registry of acute Aortic Dissection irad
Jacc-cardiovascular Interventions, 2013Co-Authors: Rossella Fattori, Eric M. Isselbacher, Kim A. Eagle, Daniel Montgomery, Luigi Lovato, Stephan Kische, Marco Di Eusanio, Huseyin Ince, Christoph A. NienaberAbstract:Objectives This study sought to evaluate long-term survival in type B Aortic Dissection patients treated with thoracic endovascular Aortic repair (TEVAR) therapy. Background Historical data have supported medical therapy in type B acute Aortic Dissection (TBAAD) patients. Recent advances in TEVAR appear to improve in-hospital mortality. Methods We examined 1,129 consecutive patients with TBAAD enrolled in IRAD (International Registry of Acute Aortic Dissection) between 1995 and 2012 who received medical (n = 853, 75.6%) or TEVAR (n = 276, 24.4%) therapy. Results Clinical history was similar between groups. TEVAR patients were more likely to present with a pulse deficit (28.3% vs. 13.4%, p Conclusions Results from IRAD show that TEVAR is associated with lower mortality over a 5-year period than medical therapy for TBAAD. Further randomized trials with long-term follow-up are needed.
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correlates of delayed recognition and treatment of acute type a Aortic Dissection the international registry of acute Aortic Dissection irad
Circulation, 2011Co-Authors: Kevin M Harris, Thomas T Tsai, Eric M. Isselbacher, Rossella Fattori, Kim A. Eagle, Craig Strauss, Alan T Hirsch, Hadas Shiran, A Evangelista, Jeanna V CooperAbstract:Background—In acute Aortic Dissection, delays exist between presentation and diagnosis and, once diagnosed, definitive treatment. This study aimed to define the variables associated with these delays. Methods and Results—Acute Aortic Dissection patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and January 2007 were evaluated for factors contributing to delays in presentation to diagnosis and in diagnosis to surgery. Multiple linear regression was performed to determine relative delay time ratios (DTRs) for individual correlates. The median time from arrival at the emergency department to diagnosis was 4.3 hours (quartile 1–3, 1.5–24 hours; n=894 patients) and from diagnosis to surgery was 4.3 hours (quartile 1–3, 2.4–24 hours; n=751). Delays in acute Aortic Dissection diagnosis occurred in female patients; those with atypical symptoms that were not abrupt or did not include chest, back, or any pain; patients with an absence of pulse deficit or hypotension; or t...
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role of age in acute type a Aortic Dissection outcome report from the international registry of acute Aortic Dissection irad
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Santi Trimarchi, Thomas T Tsai, Christoph A. Nienaber, Vincenzo Rampoldi, Kim A. Eagle, Carlo De Vincentiis, Lorenzo Menicanti, Frederik H W Jonker, Alessandro Frigiola, Jim FroehlichAbstract:Objective The increasing life expectancy of the population will likely be accompanied by a rise in the incidence of acute type A Aortic Dissection. However, because of an increased risk of cardiac surgery in an elderly population, it is important to define when, if at all, the risks of Aortic repair outweigh the risk of death from unoperated type A Aortic Dissection. Methods We analyzed 936 patients with type A Aortic Dissection enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2004. Patients with type A Aortic Dissection were categorized according to patient age by decade and by surgical versus medical management, and outcomes of both management types were investigated in the different age groups. Results The rate of surgical Aortic repair decreased progressively with age, whereas surgical mortality significantly increased with age. Age 70 years or more was an independent predictor for mortality (38.2% vs 26.0%; P Conclusions Although the surgical mortality significantly increased with increased age, surgical management was still associated with significantly lower in-hospital mortality rates compared with medical management until the age of 80 years. Surgery may decrease the in-hospital mortality rate for octogenarians with type A Aortic Dissection and might be considered in all patients with type A Aortic Dissection regardless of age.
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importance of refractory pain and hypertension in acute type b Aortic Dissection insights from the international registry of acute Aortic Dissection irad
Circulation, 2010Co-Authors: Santi Trimarchi, Patrick T Ogara, Christoph A. Nienaber, Toru Suzuki, Vincenzo Rampoldi, Kim A. Eagle, Frederik H W Jonker, Reed E Pyeritz, Stuart Hutchinson, Viviana GrassiAbstract:Background—In patients with acute type B Aortic Dissection, presence of recurrent or refractory pain and/or refractory hypertension on medical therapy is sometimes used as an indication for invasive treatment. The International Registry of Acute Aortic Dissection (IRAD) was used to investigate the impact of refractory pain and/or refractory hypertension on the outcomes of acute type B Aortic Dissection. Methods and Results—Three hundred sixty-five patients affected by uncomplicated acute type B Aortic Dissection, enrolled in IRAD from 1996 to 2004, were categorized according to risk profile into 2 groups. Patients with recurrent and/or refractory pain or refractory hypertension (group I; n=69) and patients without clinical complications at presentation (group II; n=296) were compared. “High-risk” patients with classic complications were excluded from this analysis. The overall in-hospital mortality was 6.5% and was increased in group I compared with group II (17.4% versus 4.0%; P=0.0003). The in-hospital ...
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Simple Risk Models to Predict Surgical Mortality in Acute Type A Aortic Dissection: The International Registry of Acute Aortic Dissection Score
The Annals of thoracic surgery, 2007Co-Authors: Vincenzo Rampoldi, Santi Trimarchi, Christoph A. Nienaber, Eduardo Bossone, Truls Myrmel, Kim A. Eagle, Giuseppe Sangiorgi, Carlo De Vincentiis, Jeanna V CooperAbstract:Background Surgical mortality for acute type A Aortic Dissection is frequently related to preoperative clinical conditions. We report a predictive score to identify risk of death that may be helpful to assist surgeons who are considering whether to proceed with surgical correction in the case of patients in extreme clinical risk. Methods Surgical outcome of 682 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2003 was analyzed. Two different models were used. The initial model included only preoperative variables such as demographics, history, symptoms, signs, and diagnostic methods (model 1). The second model also tested intraoperative hemodynamic and surgical variables (model 2). A bedside risk prediction tool to predict operative mortality in individual patients was developed. Results The overall in-hospital surgical mortality was 23.9%. Independent preoperative predictors of mortality in model 1 were age greater than 70 years, prior cardiac surgery, hypotension (systolic blood pressure less than 100 mm Hg) or shock at presentation, migrating pain, cardiac tamponade, any pulse deficit, and electrocardiogram with findings of myocardial ischemia or infarction. In model 2, other predictors of surgical death were intraoperative hypotension, a right ventricle dysfunction at surgery, and a necessity to perform coronary revascularization. An independent predictor for favorable surgical outcome was right hemiarch replacement. Conclusions Surgery in unstable patients with acute type A Aortic Dissection can be highly unsuccessful. The International Registry of Acute Aortic Dissection risk models predict in-hospital mortality using a multivariable risk prediction tool, useful for surgeons and patients as they consider their surgical risk and the pros and cons of embarking on high-risk surgery.
Rossella Fattori - One of the best experts on this subject based on the ideXlab platform.
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survival after endovascular therapy in patients with type b Aortic Dissection a report from the international registry of acute Aortic Dissection irad
Jacc-cardiovascular Interventions, 2013Co-Authors: Rossella Fattori, Eric M. Isselbacher, Kim A. Eagle, Daniel Montgomery, Luigi Lovato, Stephan Kische, Marco Di Eusanio, Huseyin Ince, Christoph A. NienaberAbstract:Objectives This study sought to evaluate long-term survival in type B Aortic Dissection patients treated with thoracic endovascular Aortic repair (TEVAR) therapy. Background Historical data have supported medical therapy in type B acute Aortic Dissection (TBAAD) patients. Recent advances in TEVAR appear to improve in-hospital mortality. Methods We examined 1,129 consecutive patients with TBAAD enrolled in IRAD (International Registry of Acute Aortic Dissection) between 1995 and 2012 who received medical (n = 853, 75.6%) or TEVAR (n = 276, 24.4%) therapy. Results Clinical history was similar between groups. TEVAR patients were more likely to present with a pulse deficit (28.3% vs. 13.4%, p Conclusions Results from IRAD show that TEVAR is associated with lower mortality over a 5-year period than medical therapy for TBAAD. Further randomized trials with long-term follow-up are needed.
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interdisciplinary expert consensus document on management of type b Aortic Dissection
Journal of the American College of Cardiology, 2013Co-Authors: Rossella Fattori, Paola De Rango, Arturo Evangelista, H. Rousseau, Christoph A. Nienaber, Martin Czerny, Marc A.a.m. SchepensAbstract:An expert multidisciplinary panel in the treatment of type B Aortic Dissection reviewed available literature to develop treatment algorithms using a consensus method. Data from 63 studies published from 2006 to 2012 were retrieved for a total of 1,548 patients treated medically, 1,706 patients who underwent open surgery, and 3,457 patients who underwent thoracic endovascular repair (TEVAR). For acute (first 2 weeks) type B Aortic Dissection, the pooled early mortality rate was 6.4% with medical treatment and increased to 10.2% with TEVAR and 17.5% with open surgery, mostly for complicated cases. Limited data for treatment of subacute (2 to 6 weeks after onset) type B Aortic Dissection showed an early mortality rate of 2.8% with TEVAR. In chronic (after 6 weeks) type B Aortic Dissection, 5-year survival of 60% to 80% was expected with medical therapy because complications were likely. If interventional treatment was applied, the pooled early mortality rate was 6.6% with TEVAR and 8.0% with open surgery. Medical treatment of uncomplicated acute, subacute, and chronic type B Aortic Dissection is managed with close image monitoring. Hemodynamic instability, organ malperfusion, increasing periAortic hematoma, and hemorrhagic pleural effusion on imaging identify patients with complicated acute type B Aortic Dissection requiring urgent Aortic repair. Recurrence of symptoms, Aortic aneurysmal dilation (>55 mm), or a yearly increase of >4 mm after the acute phase are predictors of adverse outcome and need for delayed Aortic repair (“complicated chronic Aortic Dissections”). The expert panel is aware that this consensus document provides proposal for strategies based on nonrobust evidence for management of type B Aortic Dissection, and that literature results were largely heterogeneous and should be interpreted cautiously.
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correlates of delayed recognition and treatment of acute type a Aortic Dissection the international registry of acute Aortic Dissection irad
Circulation, 2011Co-Authors: Kevin M Harris, Thomas T Tsai, Eric M. Isselbacher, Rossella Fattori, Kim A. Eagle, Craig Strauss, Alan T Hirsch, Hadas Shiran, A Evangelista, Jeanna V CooperAbstract:Background—In acute Aortic Dissection, delays exist between presentation and diagnosis and, once diagnosed, definitive treatment. This study aimed to define the variables associated with these delays. Methods and Results—Acute Aortic Dissection patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and January 2007 were evaluated for factors contributing to delays in presentation to diagnosis and in diagnosis to surgery. Multiple linear regression was performed to determine relative delay time ratios (DTRs) for individual correlates. The median time from arrival at the emergency department to diagnosis was 4.3 hours (quartile 1–3, 1.5–24 hours; n=894 patients) and from diagnosis to surgery was 4.3 hours (quartile 1–3, 2.4–24 hours; n=751). Delays in acute Aortic Dissection diagnosis occurred in female patients; those with atypical symptoms that were not abrupt or did not include chest, back, or any pain; patients with an absence of pulse deficit or hypotension; or t...
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Aortic diameter 5 5 cm is not a good predictor of type a Aortic Dissection observations from the international registry of acute Aortic Dissection irad
Circulation, 2007Co-Authors: Linda Pape, Gabriel Meinhardt, Jae Kuen Oh, Patrick T Ogara, Thomas T Tsai, Arturo Evangelista, Santi Trimarchi, Eric M. Isselbacher, Rossella Fattori, Eduardo BossoneAbstract:Background— Studies of Aortic aneurysm patients have shown that the risk of rupture increases with Aortic size. However, few studies of acute Aortic Dissection patients and Aortic size exist. We used data from our registry of acute Aortic Dissection patients to better understand the relationship between Aortic diameter and type A Dissection. Methods and Results— We examined 591 type A Dissection patients enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2005 (mean age, 60.8 years). Maximum Aortic diameters averaged 5.3 cm; 349 (59%) patients had Aortic diameters <5.5 cm and 229 (40%) patients had Aortic diameters <5.0 cm. Independent predictors of Dissection at smaller diameters (<5.5 cm) included a history of hypertension (odds ratio, 2.17; 95% confidence interval, 1.03 to 4.57; P=0.04), radiating pain (odds ratio, 2.08; 95% confidence interval, 1.08 to 4.0; P=0.03), and increasing age (odds ratio, 1.03; 95% confidence interval, 1.00 to 1.05; P=0.03). Marfan syndrome pati...
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long term survival in patients presenting with type b acute Aortic Dissection insights from the international registry of acute Aortic Dissection
Circulation, 2006Co-Authors: Thomas T Tsai, Arturo Evangelista, Santi Trimarchi, Eric M. Isselbacher, Rossella Fattori, Jeanna V Cooper, Udo Sechtem, Truls Myrmel, Stuart Hutchison, Dean E SmithAbstract:Background— Follow-up survival studies in patients with acute type B Aortic Dissection have been restricted to a small number of patients in single centers. We used data from a contemporary registry of acute type B Aortic Dissection to better understand factors associated with adverse long-term survival. Methods and Results— We examined 242 consecutive patients discharged alive with acute type B Aortic Dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. Kaplan-Meier survival curves were constructed, and Cox proportional hazards analysis was performed to identify independent predictors of follow-up mortality. Three-year survival for patients treated medically, surgically, or with endovascular therapy was 77.6±6.6%, 82.8±18.9%, and 76.2±25.2%, respectively (median follow-up 2.3 years, log-rank P=0.61). Independent predictors of follow-up mortality included female gender (hazard ratio [HR],1.99; 95% confidence interval [CI], 1.07 to 3.71; P=0.03), a hist...