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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Aortic Regurgitation I: Introduction01:15

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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Aneurysm IV: Nursing Management01:22

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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Aortic Regurgitation III: Medical Management01:25

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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Aortic Regurgitation IV: Nursing Management01:17

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A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
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Readmissions after acute type B aortic dissection.

Brett J Carroll1, Marc Schermerhorn2, Kevin F Kennedy3

  • 1Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.

Journal of Vascular Surgery
|December 17, 2019
PubMed
Summary

Over a quarter of patients experience nonelective readmission within 90 days of acute type B aortic dissection. Readmission rates remain high across all initial treatments, with aortic disease being the most common cause.

Keywords:
ReadmissionsThoracic aortic dissectionThoracic endovascular repair

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Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Public Health

Background:

  • Acute type B aortic dissection (TBAD) is a life-threatening condition.
  • Treatment options include medical management, open surgical repair, and thoracic endovascular aortic repair (TEVAR).
  • Nationwide data on readmission rates following TBAD is limited.

Purpose of the Study:

  • To assess the national burden of nonelective 90-day readmissions after acute type B aortic dissection.
  • To identify predictors of readmission.
  • To analyze causes and outcomes of readmissions.

Main Methods:

  • Analysis of adults hospitalized with TBAD from 2010-2014 using the Nationwide Readmissions Database.
  • Identification of TBAD cases using ICD-9-CM codes.
  • Hierarchical logistic regression to determine readmission predictors.

Main Results:

  • A total of 6,937 patients were included; 62.6% received medical management, 21.0% open repair, and 16.4% TEVAR.
  • The nonelective 90-day readmission rate was 25.1% (23.6% medical, 26.9% open repair, 28.7% TEVAR).
  • The primary cause for readmission was new or recurrent aortic dissection (24.8%), with a 5.0% mortality rate during readmission.

Conclusions:

  • High rates of nonelective 90-day readmissions occur after acute type B aortic dissection, regardless of initial treatment.
  • Aortic disease is the leading cause of readmission, especially in medically managed patients.
  • Further research into interventions, including multidisciplinary aortic teams, is needed to reduce readmissions.