Abstract 757: Aortic Dissection: Value And Impact Of Large International Registries?
Background: Acute Type A aortic dissection (AADA) is a rare and life-threatening event, requiring immediate surgery in experienced cardiovascular centers. In order to increase the number of patients and therefore the power of statistical analyses, several centers, all over the world, collect their data since 1996 in the International Registry of Aortic Dissection (IRAD). Based on these data, several recommendations and guidelines have been published. Aim of the present study was to look at the case-load and the outcome of the IRAD-centers and to compare the results with reports of single centers with a large experience in this field.
Patients and Methods: A systematic PubMed review was performed, looking at all publications submitted by IRAD. Number of patients with AADA, involved centers and outcome has been analyzed and compared to publications of high volume centers in surgery of AADA.
Results: IRAD reported within 96 months 885 AADA from 18 centers (average 5.8 pts/center/y). 80% of the patients underwent surgery and surgical mortality was 23.9%, overall mortality was above 30%, and remained stable over the years. In higher case-load centers (17.8 to 21.4 pts/center/year) mortality varies between 5.0% and 15.9% in the same time period, with an actual mortality under 10%. Immediate surgical repair is performed in 96% to 100% of the patients, while only established stroke is considered by some centers to be an absolute contraindication to surgery
Conclusions: Experience and case-load in surgical repair of AADA is very important. Pooling data of low-volume centers and drawing general conclusions on further therapeutic strategies should be considered carefully.