Key result
In patients with acute aortic dissection, surgical treatment was associated with a lower mortality rate compared to medical management (37.5% vs. 62.5%).
Why the study?
Acute aortic dissection is a serious emergency, prompting evaluation of the clinical characteristics and outcomes of medical and surgical treatments at the Ibn Al-Bitar Cardiac Centre.
Does surgery reduce mortality compared to medical treatment in patients with acute aortic dissection?
Observational (n=33)
No
Does surgery reduce mortality compared to medical treatment in patients with acute aortic dissection?
In a prospective cohort of acute aortic dissection, overall mortality was high (48.5%), with surgical treatment showing lower mortality than medical management.
Surgery was associated with lower mortality in acute aortic dissection; hypothesis-generating and should not change practice without randomized trials.
Background: 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. Methods: 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. Results: 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%). Conclusions: Urgent surgery performed by expert surgeons is essential to save victims of AAD primarily type A dissection.
No takes yet. Share an insight, caveat, or question.
Mishlish et al. (2022) conducted an observational in Acute aortic dissection (n=33). Surgery vs. Medical treatment was evaluated on Mortality. In patients with acute aortic dissection, surgical treatment was associated with a lower mortality rate compared to medical management (37.5% vs. 62.5%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: