ReviewThe Annals of thoracic surgery2021
When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A Review.
Review in The Annals of thoracic surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 42 citations in OpenAlex.
- Development and validation of a risk prediction model for postoperative pneumonia in adult patients undergoing Stanford type A acute aortic dissection surgery: a case control study.Journal of cardiothoracic surgery · 2022Trial
- Surgical outcomes in acute type A aortic dissection: the effect of 5-hour time window on malperfusion syndrome.BMC cardiovascular disorders · 2026Article
- Abrupt left coronary artery malperfusion secondary to acute type A aortic dissection after weaning from cardiopulmonary bypass: a case report.BMC cardiovascular disorders · 2025Article
- Emergency central aortic repair in acute type A aortic dissection complicated by malperfusion.Frontiers in surgery · 2025Article
- Acute type A aortic dissection with cerebral malperfusion: diagnosis and repair using a novel technique.The British journal of cardiology · 2025Article
- Management of Direct Oral Anticoagulants in Acute Type A Aortic Dissection.Aorta (Stamford, Conn.) · 2024Article
- The impact of onset-to-cut time in surgery for stable acute type A aortic dissection-a single-centre retrospective cohort study.Interdisciplinary cardiovascular and thoracic surgery · 2024Article
- Surgical choice for the treatment of partial intestinal ischemic necrosis caused by acute type a aortic dissection combined with malperfusion of superior mesenteric artery.Journal of cardiothoracic surgery · 2024Review
- Delayed surgery for acute type A aortic dissection: a retrospective review of an alternative surgical strategy in the COVID-19 era.Journal of cardiothoracic surgery · 2024Article
- The Impact of Shared Decision-Making on the Quality of Decision Making in Aortic Dissection: A before-and-after Comparison Study.Reviews in cardiovascular medicine · 2023Article
- Current Clinical Implications of Frailty and Sarcopenia in Vascular Surgery: A Comprehensive Review of the Literature and Consideration of Perioperative Management.Annals of vascular diseases · 2022Article
- Prior intake of new oral anticoagulants adversely affects outcome following surgery for acute type A aortic dissection.Interactive cardiovascular and thoracic surgery · 2022Article
- Demographic and Regional Trends of Mortality in Patients With Aortic Dissection in the United States, 1999 to 2019.Journal of the American Heart Association · 2022Article
- Non-prompt surgery for patients with acute type A aortic dissection without pre-operative shock and malperfusion.Frontiers in cardiovascular medicine · 2022Article
- Case report: Diagnosis and emergency surgery on a young patient with extensive aortic dissection without any risk factors.BMC cardiovascular disorders · 2021Article
- Dissecting the Management and Outcomes of Thoracic Aortovascular Disease During the COVID-19 Pandemic.Annals of vascular surgery · 2021Article
- Noteworthy Literature of 2020: COVID Effects in Cardiac Surgery.Seminars in cardiothoracic and vascular anesthesia · 2021Review
- Serum sodium on admission affects postoperative in-hospital mortality in acute aortic dissection patients.PloS one · 2021Observational
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAcute type A aortic dissection (ATAAD) is a surgical emergency with an operative mortality of up to 30%, a rate that has not changed meaningfully in more than 2 decades. A growing body of research has highlighted several comorbidities and presenting factors in which delay or permanent deferral of surgery may be considered; however, modern comprehensive summative reviews are lacking. The urgency and timing of this review are underscored by significant challenges in resource use posed by the coronavirus disease 2019 (COVID-19) pandemic. This review provides an update on the current understanding of risk assessment, surgical candidacy, and operative timing in patients with ATAAD.
methodsA literature search was conducted through PubMed and Embase databases to identify relevant studies relating to risk assessment in ATAAD. Articles were selected by group consensus on the basis of quality and relevance.
resultsSeveral patient factors have been identified that increase risk in ATAAD repair. In particular, frailty, advanced age, previous cardiac surgery, and use of novel anticoagulant medications have been studied. The understanding of malperfusion syndromes has also expanded significantly, including recommendations for surgical delay. Finally, approaches to triage have been significantly influenced by resource limitations related to the ongoing COVID-19 pandemic. Although medical management remains a reasonable option in carefully selected patients at prohibitive risk for open surgery, endovascular therapies for treatment of ATAAD are rapidly evolving.
conclusionsEarly surgical repair remains the preferred treatment for most patients with ATAAD. However, improvements in risk stratification should guide appropriate delay or permanent deferral of surgery in select individuals.
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