Outcomes of Surgical Versus Conservative Management in Stanford Type a Aortic Dissection: A Single-Center Retrospective Study
Acute aortic dissection (AAD) is a critical cardiovascular emergency marked by the rupture of the aortic intima, resulting in blood infiltration into the media and the formation of a false lumen. AAD incidence varies by area, emphasizing the need for better diagnostics and epidemiological investigat...
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MDPI AG
2025-03-01
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| author | Irina-Anca Eremia Mihnea-Ioan-Gabriel Popa Cătălin-Alexandru Anghel Teodora-Adriana Stroe Eduard-Alexandru Eremia Andreea Nicoleta Marinescu Remus Iulian Nica Silvia Nica |
| author_facet | Irina-Anca Eremia Mihnea-Ioan-Gabriel Popa Cătălin-Alexandru Anghel Teodora-Adriana Stroe Eduard-Alexandru Eremia Andreea Nicoleta Marinescu Remus Iulian Nica Silvia Nica |
| author_sort | Irina-Anca Eremia |
| collection | DOAJ |
| description | Acute aortic dissection (AAD) is a critical cardiovascular emergency marked by the rupture of the aortic intima, resulting in blood infiltration into the media and the formation of a false lumen. AAD incidence varies by area, emphasizing the need for better diagnostics and epidemiological investigations. Bucharest University Emergency Hospital’s Emergency Department conducted this retrospective cohort analysis from May 2021 to May 2023. We examined 26 Stanford Type A aortic dissection patients to establish in-hospital mortality and one-year survival rates. The primary objective was to analyze demographic, clinical, and paraclinical factors and their impact on patient outcomes. A total of 57.7% of the study group was male and had a mean age of 58.2 years, and 69.2% of patients had hypertension, indicating its importance as a risk factor. Acute chest discomfort was reported by 53.8%, neurological problems by 30.8%, and syncope or hypotension by 42.3%. CT angiography and transthoracic echocardiogram (TTE) confirmed the diagnosis and assessed dissection severity. Pericardial effusion (19.2%) and moderate to severe aortic regurgitation (26.9%) were notable. Management varied by dissection intensity and location. Emergency surgery was performed in 61.5% of patients within 24 h of diagnosis, resulting in a 12.5% in-hospital death rate. Conservatively managed patients had a 60.0% in-hospital death rate. Timely intervention is crucial, since the surgical cohort had an 87.5% one-year survival rate compared to 30% for the conservatively managed cohort. Acute renal damage (25%), protracted mechanical ventilation (31.3%), and advanced supportive care infections were postoperative sequelae. Conservative care exacerbated visceral ischemia (20%) and heart failure (10%). Advanced age and hypotension upon admission were independent mortality predictors, emphasizing the need for early risk assessment and personalized treatment. Multimodal imaging, timely surgical referral, and excellent postoperative care improve AAD outcomes, according to this study. |
| format | Article |
| id | doaj-art-690660683d374f63b451626d64e84172 |
| institution | DOAJ |
| issn | 2075-1729 |
| language | English |
| publishDate | 2025-03-01 |
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| spelling | doaj-art-690660683d374f63b451626d64e841722025-08-20T02:42:21ZengMDPI AGLife2075-17292025-03-0115346210.3390/life15030462Outcomes of Surgical Versus Conservative Management in Stanford Type a Aortic Dissection: A Single-Center Retrospective StudyIrina-Anca Eremia0Mihnea-Ioan-Gabriel Popa1Cătălin-Alexandru Anghel2Teodora-Adriana Stroe3Eduard-Alexandru Eremia4Andreea Nicoleta Marinescu5Remus Iulian Nica6Silvia Nica7Department of Family Medicine III, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaDepartment of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaEmergency Department, Emergency University Hospital Bucharest, 050098 Bucharest, RomaniaFaculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaFaculty of Medicine, Ludwig Maximilian University of Munich, 80336 Munich, GermanyDepartment of Radiology and Medical Imaging, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaDiscipline of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaDepartment of Emergency and First Aid, Emergency University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaAcute aortic dissection (AAD) is a critical cardiovascular emergency marked by the rupture of the aortic intima, resulting in blood infiltration into the media and the formation of a false lumen. AAD incidence varies by area, emphasizing the need for better diagnostics and epidemiological investigations. Bucharest University Emergency Hospital’s Emergency Department conducted this retrospective cohort analysis from May 2021 to May 2023. We examined 26 Stanford Type A aortic dissection patients to establish in-hospital mortality and one-year survival rates. The primary objective was to analyze demographic, clinical, and paraclinical factors and their impact on patient outcomes. A total of 57.7% of the study group was male and had a mean age of 58.2 years, and 69.2% of patients had hypertension, indicating its importance as a risk factor. Acute chest discomfort was reported by 53.8%, neurological problems by 30.8%, and syncope or hypotension by 42.3%. CT angiography and transthoracic echocardiogram (TTE) confirmed the diagnosis and assessed dissection severity. Pericardial effusion (19.2%) and moderate to severe aortic regurgitation (26.9%) were notable. Management varied by dissection intensity and location. Emergency surgery was performed in 61.5% of patients within 24 h of diagnosis, resulting in a 12.5% in-hospital death rate. Conservatively managed patients had a 60.0% in-hospital death rate. Timely intervention is crucial, since the surgical cohort had an 87.5% one-year survival rate compared to 30% for the conservatively managed cohort. Acute renal damage (25%), protracted mechanical ventilation (31.3%), and advanced supportive care infections were postoperative sequelae. Conservative care exacerbated visceral ischemia (20%) and heart failure (10%). Advanced age and hypotension upon admission were independent mortality predictors, emphasizing the need for early risk assessment and personalized treatment. Multimodal imaging, timely surgical referral, and excellent postoperative care improve AAD outcomes, according to this study.https://www.mdpi.com/2075-1729/15/3/462postoperative complicationsin-hospital mortalitysurgical managementStanford Type Aacute aortic dissection |
| spellingShingle | Irina-Anca Eremia Mihnea-Ioan-Gabriel Popa Cătălin-Alexandru Anghel Teodora-Adriana Stroe Eduard-Alexandru Eremia Andreea Nicoleta Marinescu Remus Iulian Nica Silvia Nica Outcomes of Surgical Versus Conservative Management in Stanford Type a Aortic Dissection: A Single-Center Retrospective Study Life postoperative complications in-hospital mortality surgical management Stanford Type A acute aortic dissection |
| title | Outcomes of Surgical Versus Conservative Management in Stanford Type a Aortic Dissection: A Single-Center Retrospective Study |
| title_full | Outcomes of Surgical Versus Conservative Management in Stanford Type a Aortic Dissection: A Single-Center Retrospective Study |
| title_fullStr | Outcomes of Surgical Versus Conservative Management in Stanford Type a Aortic Dissection: A Single-Center Retrospective Study |
| title_full_unstemmed | Outcomes of Surgical Versus Conservative Management in Stanford Type a Aortic Dissection: A Single-Center Retrospective Study |
| title_short | Outcomes of Surgical Versus Conservative Management in Stanford Type a Aortic Dissection: A Single-Center Retrospective Study |
| title_sort | outcomes of surgical versus conservative management in stanford type a aortic dissection a single center retrospective study |
| topic | postoperative complications in-hospital mortality surgical management Stanford Type A acute aortic dissection |
| url | https://www.mdpi.com/2075-1729/15/3/462 |
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