Yunxing Xue1,2, Hoshun Chong1,2, Xiyu Zhu1,2, Fudong Fan1,2, Dongjin Wang1,2, Qing Zhou1,2. 1. Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China. 2. Nanjing Medical University Drum Tower Clinical Medical College, Nanjing 210008, China.
Abstract
BACKGROUND: Acute Stanford type A aortic dissection (ATAAD) is often misdiagnosed as an acute coronary syndrome (ACS), and antiplatelet therapy (APT) for ACS will influence the timing and outcome of ATAAD. We reviewed the surgical outcome of these misdiagnosed ATAAD patients. METHODS: From January 2011 to December 2015, 309 ATAAD patients received surgical therapy in our department, among whom 15 patients were misdiagnosed as ACS and took oral APT. We retrospectively reviewed the data of the perioperative and follow-up period. RESULTS: The average age of these 15 patients was 60.6±8.7 years old (9 males, 6 females). Five patients took aspirin orally, and 10 took aspirin and clopidogrel. Operations were performed 7, 3, and 1 day after stopping the agents in 2, 3, and 1 patient, respectively; the other 5 patients received emergency operation without stopping the agents. The cardiopulmonary bypass (CPB) time was 259.7±64.8 minutes, aortic cross-clamp time was 181.0±51.7 minutes, and selective cerebral perfusion and lower body arrest time were 34.9±8.1 minutes. There were two in-hospital deaths due to circulation failure (mortality 13.3%). The average drainage volume in the first 24 h after operation was 800.7±598.8 mL. During a mean follow-up period of 20.6±17.4 months, one patient had a sudden death. CONCLUSIONS: ATAAD misdiagnosed as ACS is not rare, and APT will increase the risk of bleeding in ATAAD patients. The decision of operation time relies on considering the balance between the rupture risk of aortic dissection and the hemorrhage risk of APT. The emergency operation for these patients will increase bleeding and transfusion.
BACKGROUND: Acute Stanford type A aortic dissection (ATAAD) is often misdiagnosed as an acute coronary syndrome (ACS), and antiplatelet therapy (APT) for ACS will influence the timing and outcome of ATAAD. We reviewed the surgical outcome of these misdiagnosed ATAAD patients. METHODS: From January 2011 to December 2015, 309 ATAAD patients received surgical therapy in our department, among whom 15 patients were misdiagnosed as ACS and took oral APT. We retrospectively reviewed the data of the perioperative and follow-up period. RESULTS: The average age of these 15 patients was 60.6±8.7 years old (9 males, 6 females). Five patients took aspirin orally, and 10 took aspirin and clopidogrel. Operations were performed 7, 3, and 1 day after stopping the agents in 2, 3, and 1 patient, respectively; the other 5 patients received emergency operation without stopping the agents. The cardiopulmonary bypass (CPB) time was 259.7±64.8 minutes, aortic cross-clamp time was 181.0±51.7 minutes, and selective cerebral perfusion and lower body arrest time were 34.9±8.1 minutes. There were two in-hospital deaths due to circulation failure (mortality 13.3%). The average drainage volume in the first 24 h after operation was 800.7±598.8 mL. During a mean follow-up period of 20.6±17.4 months, one patient had a sudden death. CONCLUSIONS: ATAAD misdiagnosed as ACS is not rare, and APT will increase the risk of bleeding in ATAAD patients. The decision of operation time relies on considering the balance between the rupture risk of aortic dissection and the hemorrhage risk of APT. The emergency operation for these patients will increase bleeding and transfusion.
Authors: Anna M Booher; Eric M Isselbacher; Christoph A Nienaber; Santi Trimarchi; Arturo Evangelista; Daniel G Montgomery; James B Froehlich; Marek P Ehrlich; Jae K Oh; James L Januzzi; Patrick O'Gara; Thoralf M Sundt; Kevin M Harris; Eduardo Bossone; Reed E Pyeritz; Kim A Eagle Journal: Am J Med Date: 2013-08 Impact factor: 4.965
Authors: Christian W Hamm; Jean-Pierre Bassand; Stefan Agewall; Jeroen Bax; Eric Boersma; Hector Bueno; Pio Caso; Dariusz Dudek; Stephan Gielen; Kurt Huber; Magnus Ohman; Mark C Petrie; Frank Sonntag; Miguel Sousa Uva; Robert F Storey; William Wijns; Doron Zahger Journal: Eur Heart J Date: 2011-08-26 Impact factor: 29.983
Authors: Raimund Erbel; Victor Aboyans; Catherine Boileau; Eduardo Bossone; Roberto Di Bartolomeo; Holger Eggebrecht; Arturo Evangelista; Volkmar Falk; Herbert Frank; Oliver Gaemperli; Martin Grabenwöger; Axel Haverich; Bernard Iung; Athanasios John Manolis; Folkert Meijboom; Christoph A Nienaber; Marco Roffi; Hervé Rousseau; Udo Sechtem; Per Anton Sirnes; Regula S von Allmen; Christiaan J M Vrints Journal: Eur Heart J Date: 2014-08-29 Impact factor: 29.983
Authors: Xin Liang Guan; Xiao Long Wang; Yu Yong Liu; Feng Lan; Ming Gong; Hai Yang Li; Ou Liu; Wen Jian Jiang; Yong Min Liu; Jun Ming Zhu; Li Zhong Sun; Hong Jia Zhang Journal: Ann Thorac Surg Date: 2015-10-23 Impact factor: 4.330