Abstract
BackgroundAcute Stanford type A aortic dissection (TAAD) is a life-threatening condition. Surgery is usually performed as a salvage procedure and is associated with significant postoperative early mortality and morbidity. Understanding the patient’s conditions and treatment strategies which are associated with these adverse events is essential for an appropriate management of acute TAAD.MethodsNineteen centers of cardiac surgery from seven European countries have collaborated to create a multicentre observational registry (ERTAAD), which will enroll consecutive patients who underwent surgery for acute TAAD from January 2005 to March 2021. Analysis of the impact of patient’s comorbidities, conditions at referral, surgical strategies and perioperative treatment on the early and late adverse events will be performed. The investigators have developed a classification of the urgency of the procedure based on the severity of preoperative hemodynamic conditions and malperfusion secondary to acute TAAD. The primary clinical outcomes will be in-hospital mortality, late mortality and reoperations on the aorta. Secondary outcomes will be stroke, acute kidney injury, surgical site infection, reoperation for bleeding, blood transfusion and length of stay in the intensive care unit.DiscussionThe analysis of this multicentre registry will allow conclusive results on the prognostic importance of critical preoperative conditions and the value of different treatment strategies to reduce the risk of early adverse events after surgery for acute TAAD. This registry is expected to provide insights into the long-term durability of different strategies of surgical repair for TAAD.Trial registrationClinicalTrials.gov Identifier: NCT04831073.
Highlights
Acute Stanford type A aortic dissection (TAAD) is a life-threatening condition
Early mortality has declined during the last years [2], the recent The Nordic Consortium for Acute Type A Aortic Dissection registry including 1189 patients operated from 2005 to 2015 in 8 centers showed that 30-day mortality after surgery for acute TAAD was as high as 18% [3]
Surgery for TAAD is often complicated by major adverse events such as stroke [5] and acute kidney failure [6], which may have a significant impact on late survival
Summary
Acute Stanford type A aortic dissection (TAAD) is a life-threatening condition. Surgery is usually performed as a salvage procedure and is associated with significant postoperative early mortality and morbidity. Surgery for TAAD is often complicated by major adverse events such as stroke [5] and acute kidney failure [6], which may have a significant impact on late survival In this scenario of significant postoperative mortality and morbidity, surgeon faces the controversial issue of the extent of surgical repair for acute TAAD by avoiding a major surgical repair, which may increase the risk of early adverse events, and by resecting segments of the aorta which otherwise may expose the patient to the risk of late aortic-related complications [7, 8]. Understanding the balance between the patient’s conditions which may not allow extensive procedure and those treatment strategies which may limit the risk of late adverse events in patients who remain alive long after the surgery is essential for an appropriate management of TAAD. We have planned the multicenter European registry of surgery for acute TAAD (ERTAAD) to evaluate the contemporary early outcomes and the durability of different surgical strategies for acute TAAD at 15 years in a large study population
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