Abstract 2130: Acute Type A Aortic Dissection: Does A Primary Tear in the Aortic Arch Affect Management and Outcomes? Insights From The International Registry of Acute Aortic Dissection (IRAD)
Background: The recognition and management of acute type A aortic dissection has improved over the last four decades. However, the implications of a primary tear located in the aortic arch versus the ascending aorta are not known.
Methods: We studied 798 consecutive patients classified with acute type A aortic dissection enrolled in IRAD from 1996 to 2003 to characterize the prevalence, presentation, management, and outcomes of patients with an arch tear (AT) compared to those with an ascending aortic tear (AscT). AT was defined by the presence of the most proximal primary tear in the aortic arch while an AscT was defined as having a primary tear proximal to the arch.
Results: Fifty-one (6.4%) patients had an AT with an overall mean age of 61.7 years. Compared to the 747 (93.6%) patients with an AscT, patients with an AT were more likely to have a history of prior aortic dissection, prior aortic aneurysm, and prior aortic surgery (Table⇓). Clinical presentation was similar between both groups, however on imaging, patients with an AT were less likely to have aortic regurgitation or coronary artery compromise and were less likely to be managed with surgery. Overall mortality for an AT was similar to that of an AscT, however patients with ATs treated medically were significantly more likely to survive to hospital discharge. After multivariate adjustment for age and gender in patients treated medically, an AT was an independent predictor of survival (OR 4.09; 95% CI, 1.26–13.28; p<0.02).
Conclusions: There are several differences in the clinical features, management and outcomes among patients with aortic arch primary tears versus ascending aorta primary tears. Primary tear location may be an important consideration to help further refine the management of acute type A aortic dissections.