When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A Review
| Autor: | Ashraf A. Sabe, Ryan P. Plichta, G. Chad Hughes, Edward Percy, Tsuyoshi Kaneko |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty PETTICOAT Provisional Extension to Induce Complete Attachment CM Cerebral Malperfusion MEDLINE 030204 cardiovascular system & hematology TEVAR Thoracic Endovascular Aortic Repair Article FEIBA Factor Eight Inhibitor Bypass Activity Time-to-Treatment 03 medical and health sciences 0302 clinical medicine ATAAD Acute Type A Aortic Dissection medicine Humans Surgical emergency DOACs Direct Oral Anticoagulants Surgical repair Aortic dissection Aortic Aneurysm Thoracic business.industry COVID-19 IRAD International Registry of Acute Aortic Dissection MPS Malperfusion Syndrome NOACs Novel/non-Vitamin K Oral Anticoagulants medicine.disease Triage STS Society of Thoracic Surgeons Surgery Aortic Dissection 030228 respiratory system Cardiothoracic surgery Acute Disease Practice Guidelines as Topic Candidacy Risk assessment business Cardiology and Cardiovascular Medicine Vascular Surgical Procedures Algorithms |
| Zdroj: | The Annals of Thoracic Surgery |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2020.08.002 |
| Popis: | Background Acute type A aortic dissection (ATAAD) is a surgical emergency with an operative mortality of up to 30%, a rate that has not changed meaningfully in more than 2 decades. A growing body of research has highlighted several comorbidities and presenting factors in which delay or permanent deferral of surgery may be considered; however, modern comprehensive summative reviews are lacking. The urgency and timing of this review are underscored by significant challenges in resource use posed by the coronavirus disease 2019 (COVID-19) pandemic. This review provides an update on the current understanding of risk assessment, surgical candidacy, and operative timing in patients with ATAAD. Methods A literature search was conducted through PubMed and Embase databases to identify relevant studies relating to risk assessment in ATAAD. Articles were selected by group consensus on the basis of quality and relevance. Results Several patient factors have been identified that increase risk in ATAAD repair. In particular, frailty, advanced age, previous cardiac surgery, and use of novel anticoagulant medications have been studied. The understanding of malperfusion syndromes has also expanded significantly, including recommendations for surgical delay. Finally, approaches to triage have been significantly influenced by resource limitations related to the ongoing COVID-19 pandemic. Although medical management remains a reasonable option in carefully selected patients at prohibitive risk for open surgery, endovascular therapies for treatment of ATAAD are rapidly evolving. Conclusions Early surgical repair remains the preferred treatment for most patients with ATAAD. However, improvements in risk stratification should guide appropriate delay or permanent deferral of surgery in select individuals. |
| Databáze: | OpenAIRE |
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