TY - JOUR
T1 - Analysis of Acute Type A Aortic Dissection in Japan Registry of Aortic Dissection (JRAD)
AU - Inoue, Yosuke
AU - Matsuda, Hitoshi
AU - Uchida, Keiji
AU - Komiya, Tatsuhiko
AU - Koyama, Tadaaki
AU - Yoshino, Hideaki
AU - Ito, Toshiaki
AU - Shiiya, Norihiko
AU - Saiki, Yoshikatsu
AU - Kawaharada, Nobuyoshi
AU - Nakai, Michikazu
AU - Iba, Yutaka
AU - Minatoya, Kenji
AU - Ogino, Hitoshi
N1 - Funding Information:
Other than 9 of the authors? facilities, the following 7 facilities contributed to JRAD; (1) Sakakibara Heart Institute, Tokyo, Japan; (2) Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan; (3) Saiseikai Kumamoto Hospital, Kumamoto, Japan; (4) Department of Cardiovascular Surgery, Iwate Medical University, Morioka, Japan; (5) Department of Cardiovascular Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; (6) Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Japan; and (7) Department of Thoracic and Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan. Prof Ogino organized JRAD and is responsible for the data management. JRAD has been carried out as a part of the study; ?The establishment of the index to visualize the evidence practice gap in acute aortic dissection?, which was supported by Japan Agency for Medical Research and Development (19ek0210086h0003). The authors wish to thank Ms Yoko Sumida (data manager) and Dr Yoshihiro Miyamoto, Center for Cerebral and Cardiovascular Disease Information, National Cerebral Cardiovascular Center, Suita, Japan, for their support in the data collection for JRAD.
PY - 2020/9
Y1 - 2020/9
N2 - Background: In 2011, the Japanese Registry of Acute Aortic Dissection (JRAD) was started in accordance with the model of the International Registration of Acute Aortic Dissection. The aim of this study was to report actual clinical early and midterm outcomes of treatment for acute type A aortic dissection in Japan. Methods: Between 2011 and 2016, 1217 patients (67.9 years-old, 584 male, 241 >80 years old) who had acute type A aortic dissection within 14 days after the onset of symptoms were enrolled. Results: Among 75% patients managed surgically, 68% underwent surgical procedure with cardiopulmonary bypass. Surgery was not indicated in 25% patients. Overall, 12% died in the hospital, 10.8% after surgical treatment and 16.6% after medical treatment. Multivariable analysis of in-hospital mortality revealed the following risk factors: age older than 80 years (odds ratio, 2.37; P < .01); shock vital status on arrival (odds ratio, 1.89; P = .01); disturbance of consciousness, including coma (odds ratio, 3.32; P < .01); and cardiac arrest, for which resuscitation was needed on arrival (odds ratio, 4.86; P < .01). Conclusions: JRAD data revealed the actual clinical setting for the treatment of acute type A dissection in Japan. Early surgical results were favorable, with a low in-hospital morality rate, and midterm outcomes in selected medically treated patients were equivalent. Preoperative severe conditions, including shock, need for preoperative cardiopulmonary resuscitation, and disturbance of consciousness, as well as advanced age, were risk factors for in-hospital mortality even though the referral interval was brief.
AB - Background: In 2011, the Japanese Registry of Acute Aortic Dissection (JRAD) was started in accordance with the model of the International Registration of Acute Aortic Dissection. The aim of this study was to report actual clinical early and midterm outcomes of treatment for acute type A aortic dissection in Japan. Methods: Between 2011 and 2016, 1217 patients (67.9 years-old, 584 male, 241 >80 years old) who had acute type A aortic dissection within 14 days after the onset of symptoms were enrolled. Results: Among 75% patients managed surgically, 68% underwent surgical procedure with cardiopulmonary bypass. Surgery was not indicated in 25% patients. Overall, 12% died in the hospital, 10.8% after surgical treatment and 16.6% after medical treatment. Multivariable analysis of in-hospital mortality revealed the following risk factors: age older than 80 years (odds ratio, 2.37; P < .01); shock vital status on arrival (odds ratio, 1.89; P = .01); disturbance of consciousness, including coma (odds ratio, 3.32; P < .01); and cardiac arrest, for which resuscitation was needed on arrival (odds ratio, 4.86; P < .01). Conclusions: JRAD data revealed the actual clinical setting for the treatment of acute type A dissection in Japan. Early surgical results were favorable, with a low in-hospital morality rate, and midterm outcomes in selected medically treated patients were equivalent. Preoperative severe conditions, including shock, need for preoperative cardiopulmonary resuscitation, and disturbance of consciousness, as well as advanced age, were risk factors for in-hospital mortality even though the referral interval was brief.
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U2 - 10.1016/j.athoracsur.2019.12.051
DO - 10.1016/j.athoracsur.2019.12.051
M3 - Article
C2 - 32035913
AN - SCOPUS:85085185043
VL - 110
SP - 790
EP - 798
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 3
ER -