title: Direct admission to the operating room: an efficient strategy for patients with diagnosed or highly suspected acute type a aortic dissection.
abstract: BACKGROUND
  Acute type A aortic dissection (ATAAD) is a life-threatening condition with a poor acute prognosis, which requires rapid and effective surgical management. The aim of this study is to assess our strategy with regard to this condition.
  
  
  METHODS
  According to a regional emergency protocol, patients with diagnosed or highly suspected ATAAD are directly transferred to the cardiac operating room. Transesophageal echocardiography is performed under anaesthesia, and the patient then undergoes surgery if the diagnosis is confirmed. The present retrospective study examines the implementation of this management strategy between January 1, 1990 and December 31, 2009.
  
  
  RESULTS
  Out of 380 patients, 245 were directly admitted to the operating room. Three hundred twelve cases of ATAAD, 15 cases of aneurysm of the ascending aorta, 9 cases of acute type B dissection, 4 cases of chronic dissection, 4 cases of hemopericardium, and 7 other diagnoses were observed. In 10 cases, no etiology was found. Nineteen patients died before surgery could be performed. Out of the 307 cases of ATAAD undergoing surgery, 15 patients were operated with cardiac massage (14 cases of aortic rupture). This management strategy was justified in 93.1% of patients (228/245) directly admitted to the operating room, because of the need for surgery or aortic rupture.
  
  
  CONCLUSIONS
  Our management strategy enabled patients with ATAAD to receive effective and unselective treatment. Despite appropriate management, the large number of patients still dying before surgery, or undergoing surgery with cardiac massage, justifies and consolidates the need for immediate treatment of this condition.
authors.affiliation: Cardiac Surgery Clinic, Cardiovascular and Thoracic Department, CHU Grenoble, Université Joseph Fourier-Grenoble 1, Grenoble, France. ochavanon@chu-grenoble.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Chavanon
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Baguet
authors.forename: Pierre
authors.initials: P
authors.lastname: Albaladéjo
authors.forename: Dominique
authors.initials: D
authors.lastname: Blin
authors.forename: Gerald
authors.initials: G
authors.lastname: Vanzetto
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000706:statistics & numerical data*; D010343:Patient Admission; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures; D055815:Young Adult