Aortic Dissection
Conditions
Keywords
Malperfusion syndrome, Aortic dissection, Optimized strategies, Central repair, Endovascular reperfusion
Brief summary
An investigator-initiated, randomized, multicenter, two-arm, open-label study of consecutive patients presenting with acute type A aortic dissection (ATAAD) and malperfusion syndrome (MPS). Objectives: The present study aimed to investigate the difference in all-cause mortality after optimized treatment strategies (OTS) versus traditional treatment strategies (TTS) for ATAAD patients with MPS. Background: The mortality of ATAAD with MPS is high. However, the management strategies of MPS patients still not to be confirmed. Compare with TTS, OTS as a strategy for ATAAD patients with MPS might have be beneficial results.
Detailed description
A total of 236 subjects with ATAAD complicated with MPS who met inclusion criteria and do not have any exclusion criterion will be randomized to optimized treatment strategies (OTS) group and traditional treatment strategies (TTS) group. 1. Patients randomized to OTS group will be treated with optimized treatment strategies. The optimized strategies based on 6-hour threshold from symptom onset. For malperfused patients with symptom onset within 6 hours, central repair will be performed immediately. Additional stenting will be used in patients with persistent malperfusion. For malperfused patients with symptom onset beyond 6 hours, individualized delayed central repair according to the different types of MPS will be performed after organ function improved and the patient could tolerate central repair. 2. Patients randomized to TTS group will treated with traditional treatment strategies. Immediate central repair will performed for patients with coronary and cerebral malperfusion syndrome. However, for patients with mesenteric and lower extremity malperfusion syndrome, interventional therapy will be administered through fenestration and/or stenting to first alleviate organ ischemia. Once the patients had a resolution of organ failure, corrective open aortic repair will be performed.
Interventions
PROCEDUREOptimized treatment strategies
The optimized strategies based on 6-hour threshold from symptom onset. For malperfused patients with symptom onset within 6 hours, central repair will be performed immediately. Additional stenting will be used in patients with persistent malperfusion. For malperfused patients with symptom onset beyond 6 hours, individualized delayed central repair according to the different types of MPS will be performed after organ function improved and the patient could tolerate central repair.
PROCEDURETraditional treatment strategies
Immediate central repair will be performed for patients with coronary and cerebral malperfusion syndrome. However, for patients with mesenteric and lower extremity malperfusion syndrome, interventional therapy will be administered through fenestration and/or stenting to first alleviate organ ischemia. Once the patients had a resolution of organ failure, corrective open aortic repair will be performed.
Sponsors
Xiamen Cardiovascular Hospital, Xiamen University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Parallel Assignment
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Provision of informed consent prior to any study specific procedures; * Acute type A aortic dissection is confirmed by computed tomography angiography; * The symptoms onset within 2 weeks; * Patients are diagnosed with ATAAD, with a new diagnosis of malperfusion syndrome ,by meeting both of the following criteria: 1. Radiographic findings reveal occlusion of the corresponding arteries (including either coronary artery, either carotid artery, celiac trunk, superior mesenteric artery or either iliac artery); 2. Clinical features of end organ ischemia (altered consciousness, paralysis, melena, abdominal pain, tenderness to palpation, loss of sensory or motor function of the lower extremities) OR laboratory findings suggestive of end organ ischemia (elevated cardiac enzymes, lactate, myoglobin, or creatine kinase).
Exclusion criteria
* Age \<18 yr and \>80 yr; * Unstable condition with cardiac tamponade or aortic rupture on admission; * Multiple types of malperfusion syndrome on admission; * Bloody stools or melena on admission; * Bilaterally fixed dilated pupils, hemorrhagic infarction or herniation of brain on admission; * Cardiopulmonary arrest and required continuous uninterrupted cardiopulmonary resuscitation on admission; * Irreversible multiple organ failure on admission; * Life expectancy \< 1 year; * Patients and (or) their families refused surgery;
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Operative Mortality (OM) | 30-day | Patients who died within 30 days |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of composite of Major Adverse Events (MAE) | 30-day | Number of participants with MAE which will include the composite rate of low cardiac output syndrome, new cerebrovascular accident, intestinal ischemia, lower limb necrosis, multiple organ failure according to Common Terminology Criteria for Adverse Events v4.0 (CTCAE) |
| Rate of composite of Major Adverse Pulmonary Events (MAPE) | 30-day | Number of participants with MAPE which will include the composite rate of intubation \>48 hours, pneumonia, reintubation, tracheostomy according to the Common Terminology Criteria for Adverse Events v4.0 (CTCAE) |
| Rate of reintervention | 3 year | The number of participants who will require reoperation for distal aorta |
| Mid-term survival | 3 year | The secondary endpoint of the study is the evaluation of mid-term survival |
Countries
China
Outcome results
None listed