Iatrogenic acute aortic dissection type A: Insight from the German registry for acute aortic dissection type A (GERAADA)

摘要

Objectives: Previous investigators have reported a grave prognosis for iatrogenic acute aortic dissection (iAADA), but such studies are limited by their small sample sizes. The purpose of the current study was to analyse the clinical characteristics, current management and surgical outcomes in a large number of iAADA patients identified through a multicentre registry. Methods: Between July 2006 and June 2010, 50 centres participated in the German Registry for Acute Aortic Dissection Type A (GERAADA). Of the 2137 patients included, 100 (5%) had iAADA. We compared the clinical features and 30-day outcomes of patients with iatrogenic and spontaneous acute aortic dissection type A (sAADA). Results: Patients with iAADA were older than those with sAADA (67.7 ± 9.4 vs 60.1 ± 13.7 years, P < 0.0001). Preoperative cardiac tamponade and hemiplegia or hemiparesis were less frequently observed in patients with iAADA (10 vs 21%, P = 0.003; 1 vs 7%, P = 0.04). Aortic dissection extended to the supra-aortic vessels (19 vs 38%, P = 0.0005) and to iliac arteries (7 vs 25%, P = 0.0002) less frequently in iAADA patients. Those with iAADA were less likely to undergo complex aortic surgery with composite graft implantation (8 vs 20%, P = 0.02), hemiarch (38 vs 47%, P = 0.04) or total arch replacement (9 vs 17%, P = 0.07). The rate of new onset of hemiplegia or hemiparesis after surgery was also lower in iAADA patients (4 vs 10%, P = 0.05). Thirty-day mortality did not differ between the two groups (16 vs 17% for iAADA vs sAADA, P = 0.53). Conclusions: Early-term surgical outcomes in current iAADA patients are better than those reported previously. Immediate surgical therapy results in acceptable outcomes similar to those in naturally occurring aortic dissection.