R Scott McClure1, Susan B Brogly2, Katherine Lajkosz3, Darrin Payne4, Stephen F Hall3, Ana P Johnson3. 1. Division of Cardiac Surgery, Libin Cardiovascular Institute, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada. Electronic address: scott.mcclure@ahs.ca. 2. Department of Surgery, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada; Institute for Clinical and Evaluative Sciences, Queen's University, Kingston, Ontario, Canada. 3. Institute for Clinical and Evaluative Sciences, Queen's University, Kingston, Ontario, Canada. 4. Department of Surgery, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
Abstract
OBJECTIVES: To determine hospital incidence, mortality, and management for thoracic aortic dissections and aneurysms. METHODS: A population-based retrospective cohort study of anonymously linked data for residents of Ontario, Canada, was carried out. Incident cases of thoracic aortic dissections and aneurysms were identified between 2002 and 2014. Treatment and mortality trends were assessed. RESULTS: There were 5966 aortic dissections (Type A n = 2289 [38%] and Type B n = 3632 [61%]). Overall incidence proportion for aortic dissections was 4.6 per 100,000. There were 9392 thoracic aortic aneurysms with an overall incidence proportion of 7.6 per 100,000. The incidence for both dissections and aneurysms significantly increased over the 12-year study. Only 53% (1204 out of 2289) of Type A dissections underwent surgery. Type B dissection treatment was 83% (3000 out of 3632) medical, 10% (370 out of 3632) surgery, and 7% (262 out of 3632) endovascular. Thoracic aortic aneurysm treatment was 53% (4940 out of 9392) surgery, 44% (4129 out of 9392) medical, and 3% (323 out of 9392) endovascular. Thirty-five percent of known descending thoracic aortic aneurysms (323 out of 924) received a stent graft. Cardiac surgeons performed 87% of the open surgical repairs. Vascular surgeons performed 91% of the endovascular procedures. All-cause 3-year mortality significantly decreased for both aortic dissections (44% to 40%) and aneurysms (30% to 22%). All-cause hospital mortality also decreased. Women had worse outcomes than men. CONCLUSIONS: The incidence of thoracic aortic dissections and aneurysms increased over time but all-cause hospital and late outcomes improved. Gender differences exist. Men incur more disease but women have higher hospital mortality. Surgery was primarily referred to cardiac surgeons. Endovascular therapy was primarily referred to vascular surgeons.
OBJECTIVES: To determine hospital incidence, mortality, and management for thoracic aortic dissections and aneurysms. METHODS: A population-based retrospective cohort study of anonymously linked data for residents of Ontario, Canada, was carried out. Incident cases of thoracic aortic dissections and aneurysms were identified between 2002 and 2014. Treatment and mortality trends were assessed. RESULTS: There were 5966 aortic dissections (Type A n = 2289 [38%] and Type B n = 3632 [61%]). Overall incidence proportion for aortic dissections was 4.6 per 100,000. There were 9392 thoracic aortic aneurysms with an overall incidence proportion of 7.6 per 100,000. The incidence for both dissections and aneurysms significantly increased over the 12-year study. Only 53% (1204 out of 2289) of Type A dissections underwent surgery. Type B dissection treatment was 83% (3000 out of 3632) medical, 10% (370 out of 3632) surgery, and 7% (262 out of 3632) endovascular. Thoracic aortic aneurysm treatment was 53% (4940 out of 9392) surgery, 44% (4129 out of 9392) medical, and 3% (323 out of 9392) endovascular. Thirty-five percent of known descending thoracic aortic aneurysms (323 out of 924) received a stent graft. Cardiac surgeons performed 87% of the open surgical repairs. Vascular surgeons performed 91% of the endovascular procedures. All-cause 3-year mortality significantly decreased for both aortic dissections (44% to 40%) and aneurysms (30% to 22%). All-cause hospital mortality also decreased. Women had worse outcomes than men. CONCLUSIONS: The incidence of thoracic aortic dissections and aneurysms increased over time but all-cause hospital and late outcomes improved. Gender differences exist. Men incur more disease but women have higher hospital mortality. Surgery was primarily referred to cardiac surgeons. Endovascular therapy was primarily referred to vascular surgeons.
Authors: Nicholas S Burris; Zhangxing Bian; Jeffrey Dominic; Jianyang Zhong; Ignas B Houben; Theodorus M J van Bakel; Himanshu J Patel; Brian D Ross; Gary E Christensen; Charles R Hatt Journal: Radiology Date: 2021-10-19 Impact factor: 11.105
Authors: Ying Huang; Hartzell V Schaff; Joseph A Dearani; Gustavo S Oderich; Thomas C Bower; Manju Kalra; Kevin L Greason; Alberto Pochettino; Jason K Viehman; William S Harmsen; Peter Gloviczki; Randall R DeMartino Journal: Mayo Clin Proc Date: 2021-08-20 Impact factor: 11.104
Authors: R Scott McClure; Robert F Berry; Francois Dagenais; Thomas L Forbes; Jasmine Grewal; Michelle Keir; Darren Klass; Vamshi K Kotha; M Sean McMurtry; Randy D Moore; Darrin Payne; Kenton Rommens Journal: CJC Open Date: 2021-02-11