{Reference Type}: Journal Article
{Title}: Acute Aortic Dissection: Observational Lessons Learned From 11 000 Patients.
{Author}: Bossone E;Eagle KA;Nienaber CA;Trimarchi S;Patel HJ;Gleason TG;Pai CW;Montgomery DG;Pyeritz RE;Evangelista A;Braverman AC;Brinster DR;Gilon D;Di Eusanio M;Ehrlich MP;Harris KM;Myrmel T;Isselbacher EM;
{Journal}: Circ Cardiovasc Qual Outcomes
{Volume}: 0
{Issue}: 0
{Year}: 2024 Aug 15
{Factor}: 8.271
{DOI}: 10.1161/CIRCOUTCOMES.123.010673
{Abstract}: <B>UNASSIGNED: </B>Over the past 25 years, diagnosis and therapy for acute aortic dissection (AAD) have evolved. We aimed to study the effects of these iterative changes in care.<BR><B>UNASSIGNED: </B>Patients with nontraumatic AAD enrolled in the International Registry of Acute Aortic Dissection (61 centers; 15 countries) were divided into time-based tertiles (groups) from 1996 to 2022. The impact of changes in diagnostics, therapeutic care, and in-hospital and 3-year mortality was assessed. Cochran-Armitage trend and Jonckheere-Terpstra tests were conducted to test for any temporal trend.<BR><B>UNASSIGNED: </B>Each group consisted of 3785 patients (mean age, ≈62 years old; ≈65.5% males); nearly two-thirds had type A AAD. Over time, the rates of hypertension increased from 77.8% to 80.4% (P=0.002), while smoking (34.1% to 30.6%, P=0.033) and atherosclerosis decreased (25.6%-16.6%; P<0.001). Across groups, the percentage of surgical repair of type A AAD increased from 89.1% to 92.5% (P<0.001) and was associated with decreased hospital mortality (from 24.1% in group 1 to 16.7% in group 3; P<0.001). There was no difference in 3-year survival (P=0.296). For type B AAD, stent graft therapy (thoracic endovascular aortic repair) was used more frequently (22.3%-35.9%; P<0.001), with a corresponding decrease in open surgery. Endovascular in-hospital mortality decreased from 9.9% to 6.2% (P=0.003). As seen with the type A AAD cohort, overall 3-year mortality for patients with type B AAD was consistent over time (P=0.084).<BR><B>UNASSIGNED: </B>Over 25 years, substantial improvements in-hospital survival were associated with a more aggressive surgical approach for patients with type A AAD. Open surgery has been partially supplanted by thoracic endovascular aortic repair for complicated type B AAD, and in-hospital mortality has decreased over the time period studied. Postdischarge survival for up to 3 years was similar over time.