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6 The Anbar 2nd International Medical Conference (AIMCO 2022)
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Acute aortic dissection (AAD) is a serious emergency. This prospective study aims to reveal the clinical characteristics and outcomes of medical and surgical treatments of AAD at the Ibn Al-Bitar Cardiac Centre.

Over a 30-month period ending on Feb 27, 2019, 33 patients (27 males) admitted within 14 days after the onset of AAD symptoms were enrolled. The diagnosis was based on clinical findings and was confirmed by echocardiography and/or CT aortography. Intensive medical therapy was immediately initiated. Stanford classification was applied. Uncomplicated type B aortic dissections (AD) were managed conservatively while complicated type B and all type A dissections were referred for surgery. Perioperative data were entered into a Microsoft Excel-designed database, and the results were collected and statistically analyzed.

The male-to-female ratio was 9:2. The age range was 22–75 years, with a mean age of 48.8 ± 13.9 years. The main risk factors were hypertension (66.66%), smoking (42.42%), and Marfan’s syndrome (15.15%). In 84.84% of the cases, chest pain was the presenting symptom. CT aortography revealed dissection of the thoracic aorta in 91% of the cases and the abdominal aorta in 51.5% of the cases. A total of 24 (72.7%) patients had type A AD, and 7 (21.2%) patients had type B AD, whereas two (6.1%) had Non-A Non-B categories. Among those with type B AD, 71.42% had complications. For 48.5% of the patients, surgery was offered. The overall mortality rate was 48.5%, matching the rates that had been already published. Surgery had a lower mortality rate than medical treatment (37.5% vs. 62.5%). The mortality rate of type A was higher than type B (58.3% vs. 28.6%).

Urgent surgery performed by expert surgeons is essential to save victims of AAD primarily type A dissection.

© 2022 Mishlish, Al-Mandalawi, Alwan, Taha, licensee HBKU Press.
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2022-12-06
2024-04-27
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References

  1. Qanadli SD, Malekzadeh S, Villard N, Jouannic AM, Bodenmann D, Tozzi P, et al. A new clinically driven classification for acute aortic dissection. Front Surg. 2020 7::37. https://doi.org/10.3389/fsurg.2020.00037.
     [Google Scholar]
  2. Criado FJ. Aortic dissection: a 250-year perspective. Tex Heart Inst J. 2011; 38:(6):694–700. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233335/
     [Google Scholar]
  3. Khayat M, Cooper KJ, Khaja MS, Gandhi R, Bryce YC, Williams DM. Endovascular management of acute aortic dissection. Cardiovasc diagn therapy. 2018; 8:(Suppl 1):S97–107. https://doi.org/10.21037/cdt.2017.10.07.
     [Google Scholar]
  4. Rozas BAA, Fieldhouse MWS, Bertolo RIC, Hernandez PAR, Aravena IOR, Grossi HAS. Atypical presentation and late diagnosis of acute aortic dissection without timely surgical treatment: case report and literature review. Medwave. 2018; 18:(5):e7249. https://doi.org/10.5867/medwave.2018.05.7249.
     [Google Scholar]
  5. Sherif HM. Dissecting the dissection: towards more comprehensive decision-making methodology for thoracic aortic disease. Aorta. 2015; 3:(3):108–17. https://doi.org/10.12945/j.aorta.2015.14.060.
     [Google Scholar]
  6. De Leon Ayala IA, Chen YF. Acute aortic dissection: an update. Kaohsiung J Med Sci. 2012; 28:(6): 299–305. https://doi.org/10.1016/j.kjms.2011.11.010.
     [Google Scholar]
  7. Evangelista A, Isselbacher EM, Bossone E, Gleason TG, Eusanio MD, Sechtem U, et al. Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research. Circulation. 2018; 137:(17):1846–60. https://doi.org/10.1161/CIRCULATIONAHA.117.031264
     [Google Scholar]
  8. Meyers DG, Neuberger JS, He J. Cardiovascular effect of bans on smoking in public places: a systematic review and meta-analysis. J Am Coll Cardiol. 2009; 54:(14):1249–55. https://doi.org/10.1016/j.jacc.2009.07.022.
     [Google Scholar]
  9. Ansari R, Mehraeen E, Sabahi A. Need and priority assessment of Kerman’s teaching hospitals to implementation of RFID technology. J Health Biomed Inform. 2015; 2:(3):141–8. http://eprints.kmu.ac.ir/id/eprint/25058
     [Google Scholar]
  10. Mehta RH, Suzuki T, Hagan PG, Bossone E, Gilon D, Llovet A, et al. Predicting death in patients with acute type a aortic dissection. Circulation. 2002; 105:(2):200–6. https://doi.org/10.1161/hc0202.102246.
     [Google Scholar]
  11. Fattori R, Tsai TT, Myrmel T, Evangelista A, Cooper JV, Trimarchi S, et al. Complicated acute type B dissection: is surgery still the best option? JACC: Cardiovasc Interv. 2008; 1:(4):395–402. https://doi.org/10.1016/j.jcin.2008.04.009.
     [Google Scholar]
  12. Urbanowicz TK, Budniak W, Buczkowski P, Perek B, Walczak M, Tomczyk J, et al. Brain activity monitoring by compressed spectral array during deep hypothermic circulatory arrest in acute aortic dissection surgery. Kardiochirurgia i Torakochirurgia Polska = Pol J Cardio-Thor Surg. 2014; 11:(4):409–13. https://doi.org/10.5114/kitp.2014.47341.
     [Google Scholar]
  13. Sansone F, Morgante A, Ceresa F, Salamone G, Patane F. Prognostic implications of acute renal failure after surgery for type A acute aortic dissection. Aorta. 2015; 3:(3):91–7. https://doi.org/10.12945/j.aorta.2015.14.022.
     [Google Scholar]
  14. Luebke T, Brunkwall J. Type B aortic dissection: a review of prognostic factors and meta-analysis of treatment options. Aorta. 2014; 2:(6):265–78. https://doi.org/10.12945/j.aorta.2014.14-040.
     [Google Scholar]
  15. Kamman AV, Yang B, Kim KM, Williams DM, Deeb GM, Patel HJ. Visceral malperfusion in aortic dissection: the michigan ex-perience. Semin Thorac Cardiovasc Surg. 2017 Summer; 29:(2):173–8. https://doi.org/10.1053/j.semtcvs.2016.10.002.
     [Google Scholar]
  16. David TE. Surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2015; 150:(2):279–83. https://doi.org/10.1016/j.jtcvs.2015.06.009.
     [Google Scholar]
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Acute aortic dissection: Clinical characteristics and outcomes
Journal of Emergency Medicine, Trauma and Acute Care 2022, 13 (2022); https://doi.org/10.5339/jemtac.2022.aimco.13
/content/journals/10.5339/jemtac.2022.aimco.13
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Keyword(s): acute aortic syndrome, aortic dissection, Iraq and Stanford classification

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