From the Guidelines
The prognosis of extensive aortic dissection type A with hemopericardium and stroke is extremely poor, with a mortality rate of up to 50% within the first 48 hours if left untreated, and even with prompt surgical intervention, perioperative mortality remains high at around 25%. The presence of hemopericardium and stroke are significant predictive factors for post-operative mortality, as they indicate a higher risk of complications such as cardiac tamponade and cerebral bleeding 1.
Key Considerations
- The evidence suggests that surgery is the treatment of choice for Type A aortic dissection, as it reduces 1-month mortality from 90% to 30% 1.
- However, the presence of complications such as hemopericardium and stroke increases the risk of post-operative mortality and morbidity.
- The use of beta-blockers, such as metoprolol or labetalol, is crucial for lifelong blood pressure control to prevent further complications.
- Regular imaging surveillance, such as CT or MRI, is necessary to monitor for potential complications, such as false aneurysms or progression of dissection.
Management and Outcomes
- The management of extensive aortic dissection type A with hemopericardium and stroke requires prompt surgical intervention, preferably with aortic valve-sparing repair or replacement, and addressing the extent of aortic repair, including the use of techniques such as "frozen elephant trunk" repair 1.
- Despite advances in surgical techniques, the prognosis remains poor, with a significant risk of mortality and morbidity, including chronic pain, reduced quality of life, and neurological deficits from the stroke.
- Long-term survival for those who survive the acute phase is approximately 60-80% at 5 years, highlighting the need for close monitoring and management to prevent further complications 1.
From the Research
Prognosis of Extensive Aortic Dissection Type A with Hemopericardium and Stroke
- The prognosis of extensive aortic dissection type A with hemopericardium and stroke is generally poor, with high mortality rates if not managed promptly and properly 2.
- Several factors can affect outcomes, including age, extent of the pathology, existence of connective tissue disorders, hypertension, diabetes mellitus, and surgeon experience 2.
- The presence of hemopericardium and stroke can further complicate the prognosis, as they are associated with increased morbidity and mortality rates 3, 4.
- Timely diagnosis and intervention are crucial for survival, and delayed diagnosis and treatment can lead to fatal outcomes 5.
- The use of certain medical therapies, such as clevidipine, may be beneficial in managing blood pressure and reducing the risk of complications 6.
- Surgical techniques, such as axillary cannulation and retrograde cerebral perfusion, may also be associated with improved outcomes and reduced risk of stroke 4.
Factors Affecting Outcomes
- Age: Older patients may have poorer outcomes due to increased comorbidities and reduced physiological reserve 2.
- Extent of the pathology: More extensive dissections may be associated with increased morbidity and mortality rates 2.
- Existence of connective tissue disorders: Patients with connective tissue disorders, such as Marfan syndrome, may be at increased risk of complications 2.
- Hypertension and diabetes mellitus: These comorbidities may increase the risk of complications and poor outcomes 2.
- Surgeon experience: Surgeons with more experience in managing aortic dissections may be associated with improved outcomes 2.
Management and Treatment
- Prompt diagnosis and intervention are crucial for survival, and delayed diagnosis and treatment can lead to fatal outcomes 5.
- Medical therapies, such as clevidipine, may be beneficial in managing blood pressure and reducing the risk of complications 6.
- Surgical techniques, such as axillary cannulation and retrograde cerebral perfusion, may also be associated with improved outcomes and reduced risk of stroke 4.
- The use of cerebral protection techniques, such as antegrade cerebral perfusion, may also be beneficial in reducing the risk of stroke 4.