Decision making and management of acute type-A dissection presenting with shock or cardiac arrest.
Takuro TsukubePublished in: Asian cardiovascular & thoracic annals (2022)
While the outcome of aortic repair for acute type-A aortic dissection has improved, overall mortality among patients who developed acute type-A aortic dissection remains extremely high. Hypotension in acute type-A aortic dissection patients is a critical condition that is associated with increased in-hospital mortality and neurologic events. The underlying causes of shock include acute aortic regurgitation, cardiac tamponade, and myocardial infarction. The most reasonable initial approach is to administer intravenous fluids to improve blood pressure, increase preload and cardiac output, and ensure adequate end-organ perfusion. Cardiac tamponade-induced hypotension associated with aortic rupture has been identified as a major risk factor for perioperative mortality in patients with acute type-A aortic dissection. In addition, the most serious complications of acute type-A aortic dissection include preoperative cardiopulmonary arrest, especially out-of-hospital cardiopulmonary arrest. Recent advances in rapid transportation and diagnosis, and the introduction of extracorporeal cardiopulmonary resuscitation, have resulted in an increase in the number of patients with cardiopulmonary arrest related to acute type-A aortic dissection. However, controversy continues to surround treatment strategies, surgical indications, and the timing of surgery on such patients. This review, therefore, discusses decision-making and the managerial issues surrounding acute type-A dissection presenting with shock, cardiac tamponade, and cardiac arrest.
Keyphrases
- aortic dissection
- cardiac arrest
- cardiopulmonary resuscitation
- decision making
- blood pressure
- end stage renal disease
- left ventricular
- heart failure
- ejection fraction
- chronic kidney disease
- healthcare
- emergency department
- low dose
- newly diagnosed
- type diabetes
- cardiovascular disease
- patients undergoing
- adipose tissue
- oxidative stress
- cardiac surgery
- case report
- patient reported outcomes
- coronary artery disease
- prognostic factors
- pulmonary hypertension
- pulmonary artery
- acute kidney injury
- hepatitis b virus
- respiratory failure
- skeletal muscle
- high dose
- hypertensive patients
- coronary artery bypass
- insulin resistance
- transcatheter aortic valve replacement