Surgery lowered the death rate from aortic rupture

A study finds that a patient’s chance of surviving a ruptured aorta is significantly improved, but the condition remains fatal if it is not recognized early and surgically repaired.

A team of researchers examined the early death rates of more than 5,600 patients admitted to hospital and examined hourly with acute type A aortic dissection between 1996 and 2018 from the International Registry of Acute Aortic Anatomy. Fatal dissection often occurs when the blood rushes through the tear to climb Aortawhich leads to the separation of its layers.

The results are published in heart gamma It reveals that 5.8% of patients with acute type A aortic dissection died within the first two days after arriving at hospital, with a mortality rate of 0.12% per hour. The rate is much lower than reported in the 1950s, which estimated that 37% of patients died within the first 48 hours, with a 1-2% increase in mortality per hour.

says Kim Eagle, author of the research paper and director of the University of Michigan Health Frankel Cardiovascular Center.

Of all patients, 91% either had surgery or were destined for surgery, while the others were treated medically due to advanced age and complications, such as stroke and kidney failure. Nearly 24% of those receiving medical treatment alone died within two days, compared to 4.4% of patients treated with surgical repair – a mortality rate more than 5 times higher.

“It is possible that patients who underwent medical treatment were not candidates for surgery because of their comorbidities,” says Pu Yang, a professor of cardiac surgery at the University of Michigan Medical School, who was not involved in the study. “Medically managed patients can die from complications associated with aortic dissection—such as poor perfusion, cardiac tamponade, aortic rupture, and acute aortic insufficiency, which can be treated with surgery—or from their existing medical conditions that can be exacerbated by aortic dissection.”

Only 1% of patients deemed OK for surgery died before the operation. These patients died an average of approximately nine hours after being admitted to the hospital, which exceeds the average of six hours for surgery for all patients.

Transfer between hospitals is required in more than 70% of aortic dissections, causing inherent delays. Prior to this study, Eagle says, premature death from this condition was thought to be so prohibitive that working urgently, even in hospitals with limited volumes of aortic dissection surgery and resources, was the preferred strategy.

However, there is evidence that surgery in a small-sized hospital can double the risk of death while undergoing repair compared to larger providers. In addition, mortality rates for open repair of acute type A aortic dissection are approximately three times higher when the procedure is not performed by a dedicated aortic surgeon.

“Hospital mortality in a high-volume center like UM, where aortic dissection patients are cared for only by highly experienced aortic surgeons, can be as high as 5%, while the same patient undergoing surgery in a low-volume center may be as high as 5%. to 20% or higher,” says Eagle. “With this new information, it is clear that the ‘cost,’ or risk, of delaying four to six hours due to transfers is more than offset by the reduced risk of surgery in experienced hospitals.”

Cases are rare. Approximately three out of every 100,000 people have an aortic dissection each year. The condition most commonly affects older men, and a person with a tear may feel “a knife-like pain in the back,” according to Erad.

It is estimated that up to 50% of patients will die before they reach hospital, making the overall mortality rate for aortic dissection much higher.

“There is a need to identify populations at high risk for aortic dissection, such as those with a family history of aortic aneurysms and dissection, especially at a younger age, or known disease-causing genetic variants, so that we can optionally replace the proximal aorta to prevent aortic dissection-type A sharp,” Yang says. “For young people under 55 who have severe chest pain, we have to establish whether patients have aortic dissection or otherwise.”

The International Aortic Anatomy Registry was established at the University of Michigan in 1996. There are currently 58 aortic centers around the world that participate in this ongoing collaboration.

Additional co-authors are from the Minneapolis Heart Institute Foundation. Royal Brompton & Harefield NHS Foundation Trust; University of Toronto; University of Washington School of Medicine; Fondazione IRCCS Ca’ Grand Ospedale Maggiore Policlinico; Tromsø University Hospital; Perelman School of Medicine; University of Calgary; Medical University of Vienna; Brigham and Women’s Hospital; Hadassah Hebrew University Medical Center; and Massachusetts General Hospital.

Eagle reports on grants from WL Gore & Associates, Medtronic, and Terumo while the study is being conducted.

Source: Noah Fromson to University of Michigan