Current Surgical Management of Acute Type A Aortic Dissection in China: A Multicenter Registry Study

Rui Zhao; Juntao Qiu; Lu Dai; Jian Song; Shuya Fan; Fangfang Cao; Jiawei Qiu; Zhiyun Xu; Ruixing Fan; Yingqiang Guo; Tianxiang Gu; Xionggang Jiang; Decai Li; Chenhui Qiao; Ziying Chen; Bing Song; Cuntao Yu

doi:10.1016/j.jacasi.2022.08.009

Current Surgical Management of Acute Type A Aortic Dissection in China: A Multicenter Registry Study

JACC Asia. 2022 Nov 29;2(7):869-878. doi: 10.1016/j.jacasi.2022.08.009. eCollection 2022 Dec.

Authors

Rui Zhao¹, Juntao Qiu¹, Lu Dai¹, Jian Song¹, Shuya Fan¹, Fangfang Cao¹, Jiawei Qiu¹, Zhiyun Xu², Ruixing Fan³, Yingqiang Guo⁴, Tianxiang Gu⁵, Xionggang Jiang⁶, Decai Li⁷, Chenhui Qiao⁸, Ziying Chen⁹, Bing Song¹⁰, Cuntao Yu¹

Affiliations

¹ Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
³ Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁴ Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China.
⁵ Cardiac Surgery, First Hospital of China Medical University, Shenyang, China.
⁶ Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁷ Shandong Provincial Hospital, School of Medicine, Shandong University, Jinan, China.
⁸ Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁹ Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
¹⁰ Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, China.

Abstract

Background: Many countries and regions have established multicenter registration studies to improve the outcomes of acute type A aortic dissection (ATAAD).

Objectives: The aims of this study were to report actual preoperative management, surgery type, and early outcomes of surgical treatment for ATAAD in China.

Methods: This cohort study uses data from the China Registry of Type A Aortic Dissection, a national clinical registry to investigate management of patients with Stanford type A aortic dissection. The data, including surgical management and outcomes of patients with ATAAD, were analyzed from January 2018 to December 2021.

Results: A total of 1,058 patients with ATAAD were enrolled in this study between January 2018 and December 2021. The mean age of all patients was 51.6 ±11.7 years. The median interval from onset to hospital was 10.65 hours (IQR: 6-24 hours), and the median interval from entering the emergency room to starting operation was 13 hours (IQR: 4.08-28.7 hours). Total arch repair was performed in 938 patients (88.7%), and frozen elephant trunk repair was performed in 800 patients (75.6%). The incidence of early mortality was 7.6%.

Conclusions: The population of patients with ATAAD in China experienced a longer interval from onset to arrival at the hospital, received more extensive aortic arch repair, and showed a relatively lower early mortality. These findings suggest that there may be a huge survivor bias in patients with ATAAD in China, more efforts should be made to promote prehospital emergency care and preoperative management of Chinese ATAAD patients. (A multicenter registration study of aortic dissection in China; ChiCTR1800015338).

Keywords: ATAAD, acute type A aortic dissection; FET, frozen elephant trunk; TAAD, type A aortic dissection; TAR, total arch replacement; aortic dissection; aortic surgery; multicenter study.