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Early Mortality High for Aortic Dissection Patients Not Planned for Surgery

At 48 hours, mortality was 23.7 percent for those medically treated versus 4.4 percent for those surgically treated

FRIDAY, Sept. 23, 2022 (HealthDay News) — The overall mortality rate for type A acute aortic dissection (TAAAD) is about 6 percent at 48 hours, according to a study published online Aug. 24 in JAMA Cardiology.

Kevin M. Harris, M.D., from Minneapolis Heart Institute at Abbott Northwestern Hospital, and colleagues examined early mortality rates in the initial 48 hours after hospital arrival for 5,611 patients with TAAAD identified from the International Registry of Acute Aortic Dissection (1996 to 2018).

The researchers found that 91.4 percent of patients were intended to be treated surgically, while 8.6 percent were intended to be treated medically. Advanced age (141 patients), comorbidities (281 patients), and patient preference (81 patients) were the top reasons for medical management. Mortality for all patients within the first 48 hours was 5.8 percent. Mortality was 0.5 percent per hour (23.7 percent at 48 hours) for those medically managed versus 4.4 percent for those whose intended treatment was surgical. However, in the surgical group, 1 percent of patients died before the operation.

“Hospital mortality at a high-volume center like University of Michigan, where aortic dissection patients are taken care [of] only by highly experienced aortic surgeons, can be as low as 5 percent, while the same patient operated on at a low-volume center may be 20 percent or higher,” a coauthor said in a statement. “With this new information, it is clear that the ‘cost,’ or risk, of a four- to six-hour delay caused by transfers is more than offset by the lower risk of surgery at experienced hospitals.”

Several authors disclosed financial ties to the health care technology and global materials science industries.

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