Details

Autor(en) / Beteiligte

• Bossone, Eduardo, MD, PhD
• Pyeritz, Reed E., MD, PhD
• Braverman, Alan C., MD
• Peterson, Mark D., MD, PhD
• Ehrlich, Marek, MD
• O’Gara, Patrick, MD
• Suzuki, Toru, MD, PhD
• Trimarchi, Santi, MD, PhD
• Gilon, Dan, MD
• Greason, Kevin, MD
• Desai, Nimesh D., MD
• Montgomery, Daniel G., BS
• Isselbacher, Eric M., MD
• Nienaber, Christoph A., MD
• Eagle, Kim A., MD

Titel

Shock Complicating Type A Acute Aortic Dissection: Clinical Correlates, Management and Outcomes

Ist Teil von

• The American heart journal, 2016-06, Vol.176, p.93-99

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2016

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Aims Shock is among the most dreaded and common complications of type A acute aortic dissection (TAAAD). However, clinical correlates, management and short- and long-term outcomes of TAAAD patients presenting with shock in real-world clinical practice are not known. Methods and Results We evaluated 2704 patients with TAAAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between January 1, 1996 and August 18, 2012. On admission, 407 (15.1%) TAAAD patients presented with shock. Most in-hospital complications (coma, myocardial or mesenteric ischemia or infarction, and cardiac tamponade) were more frequent in shock patients. In-hospital mortality was significantly higher in TAAAD patients with than without shock (30.2% versus 23.9%, p = 0.007), regardless of surgical or medical treatment. The majority of shock patients underwent surgical repair, with medically managed patients demonstrating older age and more complications at presentation. Estimates using Kaplan-Meier survival analysis indicated that the majority (89%) of TAAAD patients with shock discharged alive from the hospital survived 5 years, a rate similar to that of TAAAD patients without shock (82%, p = 0.609). Conclusions Shock occurred in 1 out of 7 TAAAD patients and was associated with higher rates of in-hospital adverse events and mortality. However, TAAAD survivors with or without shock showed similar long-term mortality. Successful early and aggressive management of shock in TAAAD patients has the potential for improving long-term survival in this patient population.