Acute Aortic Dissection: Observational Lessons Learned From 11 000 Patients.

Area of Science:

• Cardiovascular Medicine
• Surgical Innovation
• Clinical Outcomes Research

Background:

• Acute aortic dissection (AAD) diagnosis and treatment have undergone significant evolution over the past 25 years.
• Understanding the impact of these changes on patient outcomes is crucial for refining clinical practice.

Purpose of the Study:

• To evaluate the effects of evolving diagnostic and therapeutic strategies on in-hospital and 3-year mortality in patients with nontraumatic acute aortic dissection.
• To analyze temporal trends in AAD management and associated survival rates.

Main Methods:

• Analysis of data from the International Registry of Acute Aortic Dissection (1996-2022) involving 61 centers across 15 countries.
• Patients were stratified into time-based tertiles to assess changes in diagnostics, therapy, and mortality.
• Statistical tests including Cochran-Armitage trend and Jonckheere-Terpstra were used to identify temporal trends.

Main Results:

• For type A AAD, increased surgical repair rates correlated with decreased in-hospital mortality (24.1% to 16.7%), while 3-year survival showed no significant change.
• For type B AAD, thoracic endovascular aortic repair (TEVAR) use increased, replacing open surgery, and was associated with reduced in-hospital mortality (9.9% to 6.2%).
• Hypertension rates increased, while smoking and atherosclerosis decreased over the study period. 3-year survival for type B AAD remained consistent.

Conclusions:

• A more aggressive surgical approach for type A AAD has led to substantial improvements in in-hospital survival.
• Thoracic endovascular aortic repair has become a preferred treatment for complicated type B AAD, decreasing in-hospital mortality.
• Despite advances in acute care, 3-year post-discharge survival for AAD patients has not significantly improved over the past 25 years.