Type A Aortic Dissection
Conditions
Keywords
Aortic dissection
Brief summary
Acute Stanford type A aortic dissection (TAAD) is a life-threatening condition. Surgery is usually performed as a salvage procedure and is associated with significant postoperative early mortality and morbidity. Understanding the patient's conditions and treatment strategies which are associated with these adverse events is essential for an appropriate management of acute TAAD.
Detailed description
Twenty centers from eight European centers of cardiac surgery have collaborated to create a multicentre observational registry (ERTAAD), which will enroll consecutive patients who underwent surgery for acute TAAD from January 2005 to March 2021. The investigators will compare patient's comorbidities, condition at referral, surgical strategies and perioperative treatments in patients with and without early and late adverse events. The primary clinical outcome will be in-hospital mortality, late mortality and reoperations on the aorta. Secondary outcomes will be stroke, acute kidney injury, surgical site infection, reoperation for bleeding, transfusion of blood products and length of stay in the intensive care unit.
Interventions
PROCEDURESurgery on the ascending aorta with or without repair of the aortic root and/or aortic arch
Surgical repair of the ascending aorta with or without surgical repair of the aortic root and/or aortic arch
Sponsors
University Hospitals, Leicester
University Hospital Southampton NHS Foundation Trust
Azienda Ospedaliera Universitaria Integrata Verona
Centre Hospitalier Universitaire de Besancon
Assistance Publique - Hôpitaux de Paris
Ziekenhuis Oost-Limburg
University Hospital Muenster
University of Hamburg-Eppendorf
Institute for Clinical and Experimental Medicine
Northern General Hospital, Herries Road, Sheffield
Liverpool Heart and Chest Hospital NHS Foundation Trust
University Hospital, Udine, Italy
Heart Center Leipzig - University Hospital
Cliniques universitaires Saint-Luc- Université Catholique de Louvain
AZ Sint-Jan AV
University Hospital, Antwerp
Universitaire Ziekenhuizen KU Leuven
University of Turin, Italy
University of Barcelona
Helsinki University Central Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Type A aortic dissection or intramural hematoma involving the aortic root/ascending aorta; * Patients aged \> 18 years: * Symptoms started within 7 days from surgery; * Primary surgical repair of acute type A aortic dissection; * Any other major cardiac surgical procedure concomitant with surgery for type A aortic dissection.
Exclusion criteria
* Patients aged \< 18 years; * Onset of symptoms \> 7 days from surgery; * Prior procedure for type A aortic dissection; * Retrograde type A aortic dissection (with primary tear located in the descending aorta); * Concomitant endocarditis; * Type A aortic dissection secondary to blunt or penetrating chest trauma.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mortality rate | During the index hospital stay until last follow-up control | All-cause mortality |
| Cumulative incidence of reoperation on the aorta | During the index hospital stay until last follow-up control | Any surgical and endovascular procedure on any segment of the aorta for aortic dissection or its related complication |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of surgical site infection | From date of procedure until the date of hospital discharge, assessed up to 3 months | Proven infection involving deep sternal wound tissues and/or mediastinum. |
| Incidence of reoperation for bleeding | From date of procedure until the date of hospital discharge, assessed up to 3 months | Chest reopening for excessive bleeding. |
| Incidence and amount of blood transfusion | From date of procedure until the date of hospital discharge, assessed up to 3 months | Transfusions of red blood cells |
| Incidence of stroke | From date of procedure until the date of hospital discharge, assessed up to 3 months | change in the level of consciousness, hemiplegia, hemiparesis, numbness, or sensory loss affecting one side of the body, dysphasia or aphasia, hemianopia, amaurosis fugax, or other neurological signs or symptoms consistent with stroke duration of a focal or global neurological deficit ≥ 24 h; OR \<24 h if available neuroimaging documents a new brain hemorrhage or infarct; OR the neurological deficit results in death. |
| Incidence of global brain ischemia | From date of procedure until the date of hospital discharge, assessed up to 3 months | Diffuse hypoxic damage as diagnosed at brain imaging and electroencephalography. |
| Incidence of paraplegia/paraparesis | From date of procedure until the date of hospital discharge, assessed up to 3 months | Bilateral weakness and/or multimodality sensory disturbance below the level of the ischemic spinal lesion. |
| Length of stay in the intensive care unit | From date of procedure until the date of hospital discharge, assessed up to 3 months | Duration of stay in the intensive care unit |
| Incidence of acute kidney injury | From date of procedure until the date of hospital discharge, assessed up to 3 months | It will be defined according to postoperative change in serum creatinine levels and its severity will be stratified according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria |
Countries
Belgium, Czechia, Finland, France, Germany, Italy, Spain, United Kingdom
Outcome results
None listed