Long-term outcomes after recurrent acute thoracic aortic dissection: Insights from the International Registry of Aortic Dissection.

Objective: With an aging population and advancements in imaging, recurrence of thoracic aortic dissection is becoming more common.

Methods: All patients enrolled in the International Registry of Aortic Dissection from 1996 to 2023 with type A and type B acute aortic dissection were identified. Among them, initial dissection and recurrent dissection were discerned.

Twenty-five years of observations from the International Registry of Acute Aortic Dissection (IRAD) and its impact on the cardiovascular scientific community.

Objective: The International Registry of Acute Aortic Dissection (IRAD) celebrated its 25th anniversary in January 2021. This study evaluated IRAD's role in promoting the understanding and management of acute aortic dissection (AD) over these years.

Methods: IRAD studies were identified, analyzed, and ranked according to their citations per year (c/y) to determine the most-cited IRAD studies and topics.

Early Mortality in Type A Acute Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection.

Importance: Early data revealed a mortality rate of 1% to 2% per hour for type A acute aortic dissection (TAAAD) during the initial 48 hours. Despite advances in diagnostic testing and treatment, this mortality rate continues to be cited because of a lack of contemporary data characterizing early mortality and the effect of timely surgery.

Objective: To examine early mortality rates for patients with TAAAD in the contemporary era.

Location of Aortic Enlargement and Risk of Type A Dissection at Smaller Diameters.

Background: Previous work has demonstrated that more than one-half of acute type A aortic dissections (ATADs) occur at a maximal aortic diameter (MAD) of <5.5 cm. However, no analysis has investigated whether ATAD risk at smaller MADs is more common with modest dilation of the aortic root (AR) or supracoronary ascending aorta (AA) in patients without genetically triggered aortopathy.

Clinical Features and Outcomes of Pregnancy-Related Acute Aortic Dissection.

Importance: Women with aortopathy conditions are at risk for pregnancy-related aortic dissection, and these conditions may not be recognized until after the aortic dissection occurs.

Objective: To examine the clinical characteristics, imaging features, and outcomes in women with pregnancy-related acute aortic dissection.

Design, Setting, And Participants: A cohort study, comprising data from the International Registry of Acute Aortic Dissection (IRAD) (February 1, 1998, to February 28, 2018).

Quadricuspid Aortic Valvulopathy and Acute Type A Aortic Dissection.

This case report describes a 55-year-old male who presented with acute Type A aortic dissection. He underwent emergent surgical repair, and his intraoperative transesophageal echocardiography revealed a quadricuspid aortic valve. His aortic root measured 45 mm.

The Clinical Impact of Imaging Surveillance and Clinic Visit Frequency after Acute Aortic Dissection.

Background:  Guidelines recommend frequent follow-up after acute aortic dissection (AAD), but optimal rates of follow-up are not clear.

Methods:  We examined rates of imaging and clinic visits in 267 individuals surviving AAD during recommended intervals (≤1, > 1-3, > 3-6, > 6-12 months, then annually), frequency of adverse imaging findings, and the relationship between follow-up and mortality.

Results:  Type A and B AAD were noted in 46 and 54% of patients, respectively.

Head and Neck Pain in Patients Presenting with Acute Aortic Dissection.

Background:  Head and neck pain is an atypical presentation of acute aortic dissection. Classic teaching associates this pain with proximal dissections, but this has not been extensively studied.

Methods:  Patients enrolled in the International Registry of Acute Aortic Dissection from January 1996 to March 2015 were included in this study.

Comparison of Outcomes in DeBakey Type AI Versus AII Aortic Dissection.

The DeBakey classification divides type A acute aortic dissection (AAD) into type I and type II; the latter limited to the ascending aorta. We endeavored to examine differences in DeBakey groups in a contemporary registry. We divided 1,872 patients with noniatrogenic AAD from the International Registry of Acute Aortic Dissection into type I (n = 1691, 90.

Presenting Systolic Blood Pressure and Outcomes in Patients With Acute Aortic Dissection.

Background: Presenting systolic blood pressure (SBP) is a powerful predictor of mortality in many cardiovascular settings, including acute coronary syndromes, cardiogenic shock, and acute heart failure.

Objectives: This study evaluated the association of presenting SBP with in-hospital outcomes, specifically all-cause mortality, in acute aortic dissection (AAD).

Methods: The study included 6,238 consecutive patients (4,167 with type A and 2,071 with type B AAD) enrolled in the International Registry of Acute Aortic Dissection.

Extended versus limited arch replacement in acute Type A aortic dissection.

Objectives: The recommended extent of surgical resection and reconstruction of the arch in acute DeBakey Type I aortic dissection is an ongoing controversy. However, several recent reports indicate a trend towards a more extensive arch operation in several institutions. We have analysed the recent data from the International Registry of Acute Aortic Dissection to assess the choice of procedure over time and to evaluate the surgical outcome in a 'real-world' database.

False positive computed tomographic angiography for Stanford type A aortic dissection.

Background: Computed tomographic angiography (CTA) has emerged as the defacto imaging test to rule out acute aortic dissection; however, it is not without flaws. We report a case of a false-positive CTA with respect to Stanford Type A aortic dissection.

Case: A 52 year-old male presented with sudden onset shortness of breath.

Streptococcus constellatus community acquired pneumonia with subsequent isolated pulmonic valve endocarditis and abscess formation in a structurally normal heart.

Pulmonic valve infective endocarditis in isolation is a rare clinical entity. The formation of an abscess in the right ventricular outflow tract as a consequence of vegetations affecting the pulmonic valve in a structurally normal heart is extremely rare and has not been reported. We report a case of isolated pulmonic valve endocarditis complicated by a regional abscess formed within the right ventricular outflow tract caused by Streptococcus Constellatus (S.

Acute ischaemic stroke or transient ischaemic attack and the need for inpatient echocardiography.

Objectives: To determine the diagnostic yield of echocardiography and its utility in changing medical management; and to derive a risk score to guide its use in patients with in-hospital stroke or transient ischaemic attack (TIA).

Methods: We carried out a retrospective chart review from January 2009 to June 2010 of patients with acute ischaemic stroke or TIA who had undergone transthoracic echocardiography (TTE) or transoesophageal echocardiography (TOE). Clinical and imaging findings at baseline were noted and 'potential clinically relevant findings' identified on TTE and TOE.

Unique congenital malformation of the mitral valve associated with anomalous coronary arteries and stroke.

A 55-year-old male presented with stroke. Transesophageal echocardiogram and cardiac computed tomography revealed an unrecognized congenital malformation of the anterior mitral leaflet associated with anomalous left coronary circumflex artery, arising from the right coronary artery, diagnosed first by echocardiogram. This case represents a unique unforeseen mitral valve anomaly that might be considered as potential cardiac source of embolism.

Pulse pressure and type A acute aortic dissection in-hospital outcomes (from the International Registry of Acute Aortic Dissection).

Little is known about the relation between type A acute aortic dissection (TAAAD) and pulse pressure (PP), defined as the difference between systolic and diastolic blood pressure. In this study, we explored the association between PP and presentation, complications, and outcomes of patients with TAAAD. PP at hospital presentation was used to divide 1,960 patients with noniatrogenic TAAAD into quartiles: narrowed (≤39 mm Hg, n=430), normal (40 to 56 mm Hg, n=554), mildly elevated (57 to 75 mm Hg, n=490), and markedly elevated (≥76 mm Hg, n=486).

Thoracic aortic frontier: review of current applications and directions of thoracic endovascular aortic repair (TEVAR).

Thoracic endovascular aortic repair, a minimally invasive technique is replacing the maximally invasive gold standard of thoracotomy and replacement of the descending thoracic aorta. With experience, indications have expanded to encroach on the arch and even ascending aorta. This review highlights the current state of technology, discusses controversies, and takes the perspective of a forward-thinking review to describe novel, innovative techniques that might make the entire thoracic aorta amenable to minimally invasive repair.

Acute mitral regurgitation: unforeseen new complication of the Impella LP 5.0 ventricular assist device and review of literature.

Impella LP 5.0 (Abiomed) is a relatively new technology that has been used over the last few years as a ventricular assist device to provide full circulatory support for patients presenting with cardiogenic shock. There is limited evidence available in literature with regard to insertion approaches, safety, complications and long-term clinical outcomes.

Stroke and outcomes in patients with acute type A aortic dissection.

Background: Stroke is a highly dreaded complication of type A acute aortic dissection (TAAAD). However, little data exist on its incidence and association with prognosis.

Methods And Results: We evaluated 2202 patients with TAAAD (mean age 62 ± 14 years, 1487 [67.

Extent of preoperative false lumen thrombosis does not influence long-term survival in patients with acute type A aortic dissection.

Background: Partial thrombosis of the false lumen has been related to aortic growth, reoperations, and death in the chronic phase of type B and repaired type A aortic dissections. The impact of preoperative false lumen thrombosis has not been studied previously. We used data from a contemporary, multinational database on aortic dissections to evaluate whether different degrees of preoperative false lumen thrombosis influenced long-term prognosis.

Painless Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection.

Introduction: The classical presentation of a patient with Type B acute aortic dissection (TBAAD) is characterized by severe chest, back, or abdominal pain, ripping or tearing in nature. However, some patients present with painless acute aortic dissection, which can lead to a delay in diagnosis and treatment. We utilized the International Registry on Acute Aortic Dissections (IRAD) database to study these patients.

Aortic expansion after acute type B aortic dissection.

Background: A considerable number of patients with acute type B aortic dissection (ABAD) treated with medical management alone will exhibit aortic enlargement during follow-up, which could lead to aortic aneurysm and rupture. The purpose of this study was to investigate predictors of aortic expansion among ABAD patients enrolled in the International Registry of Acute Aortic Dissection.

Methods: We analyzed 191 ABAD patients treated with medical therapy alone enrolled in the registry between 1996 and 2010, with available descending aortic diameter measurements at admission and during follow-up.

Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection.

Background: Few data exist on clinical/imaging characteristics, management, and outcomes of patients with type A acute dissection and mesenteric malperfusion.

Methods: Patients with type A acute dissection enrolled in the International Registry for Acute Dissection (IRAD) were evaluated to assess differences in clinical features, management, and in-hospital outcomes according to the presence/absence of mesenteric malperfusion. A mortality model was used to identify predictors of in-hospital mortality in patients with mesenteric malperfusion.

Descending aortic diameter of 5.5 cm or greater is not an accurate predictor of acute type B aortic dissection.

Objective: The risk of acute type B aortic dissection is thought to increase with descending thoracic aortic diameter. Currently, elective repair of the descending thoracic aorta is indicated for an aortic diameter of 5.5 cm or greater.