title: Differences in clinical presentation, management, and outcomes of acute type a aortic dissection in patients with and without previous cardiac surgery.
abstract: BACKGROUND
  There are less data on the clinical and diagnostic imaging characteristics, management, and outcomes of patients with previous cardiac surgery (PCS) presenting with acute type A aortic dissection (AAD).
  
  
  RESULTS
  In 617 patients with AAD, we evaluated the differences in the clinical characteristics, management, and in-hospital outcomes of the cohorts with and without PCS. A history of PCS was present in 100 of 617 patients. Patients with PCS were more likely to be males (P=0.02), older (P=0.014), and to have a history of previous aortic dissection (P<0.001) or aneurysms (P<0.001). In contrast, PCS patients were less likely to have presenting chest pain (P<0.001). Cardiac tamponade was less common in PCS patients (P=0.007). Fewer AAD patients with PCS underwent surgical repair (P=0.001). Hospital mortality was not adversely influenced by PCS (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.81 to 2.63), but a trend for increased death was seen in patients with previous aortic valve replacement (AVR) (OR, 2.31; 95% CI, 0.98 to 5.43). Age 70 years or older, previous AVR, shock, and renal failure identified PCS patients at risk for death.
  
  
  CONCLUSIONS
  Our study highlights differences in clinical characteristics, management, and outcomes of AAD patients with PCS. Importantly, PCS, with the exception of previous AVR, does not adversely influence early outcomes of AAD patients, including those undergoing surgical repair. However, because of otherwise dismal outcomes with medical management of AAD, our data indicate that a history of PCS (even that of previous AVR) should not preclude physicians from recommending surgical correction of type A aortic dissection in appropriate patients.
authors.affiliation: University of Michigan, Ann Arbor, Mich, USA.
authors.forename: J Stewart
authors.initials: JS
authors.lastname: Collins
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Jianming
authors.initials: J
authors.lastname: Fang
authors.forename: Jeanna V
authors.initials: JV
authors.lastname: Cooper
authors.forename: Dean E
authors.initials: DE
authors.lastname: Smith
authors.forename: Patrick T
authors.initials: PT
authors.lastname: O'Gara
authors.forename: Truls
authors.initials: T
authors.lastname: Myrmel
authors.forename: Dan
authors.initials: D
authors.lastname: Gilon
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.forename: Marc
authors.initials: M
authors.lastname: Penn
authors.forename: Linda A
authors.initials: LA
authors.lastname: Pape
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy; D001014:Aortic Aneurysm / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy; D001021:Aortic Valve / Q000601:surgery; D002305:Cardiac Tamponade / Q000209:etiology; D019090:Case Management; D002637:Chest Pain / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D012008:Recurrence; D012307:Risk Factors; D012769:Shock / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013575:Syncope / Q000209:etiology; D016896:Treatment Outcome