Early outcomes of acute retrograde dissection in the aortic arch and the ascending aorta – data from IRAD Foeke JH Nauta, MD, PhD Resident Cardiothoracic Surgery, Academic Medical Center, Amsterdam Disclosure Speaker name: Foeke JH Nauta I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest 2 Acute Retrograde Dissection - IRAD Background • Management of acute aortic dissection (AD) is predominantly based on the Debakey and Stanford classifications: 3 Acute Retrograde Dissection - IRAD Background • Management of acute aortic dissection (AD) is predominantly based on the Debakey and Stanford classifications: Acute open surgery Endovascular/Medical 1,2 1,2 1Hiratzka, AHA Guidelines 2010 2Erbel, ESC Guidelines 2014 4 Acute Retrograde Dissection - IRAD Background Retrograde Type A AD 5 Acute Retrograde Dissection - IRAD Background Retrograde Type A AD Spontaneous or post-TEVAR 6 Acute Retrograde Dissection - IRAD Background Retrograde Type A AD • Presentations and outcomes may differ from classic type A dissection 7 Acute Retrograde Dissection - IRAD Background Retrograde Type A AD • Presentations and outcomes may differ from classic type A dissection • However, guidelines recommend urgent surgical repair for both entities, associated with high mortality (17-25%)3,4 3Kim, et al. Circulation 2014 4Trimarchi, et al. JTCVS 2005 8 Acute Retrograde Dissection - IRAD Background Retrograde Type A AD •• PPrreesseennttaattiioonnss aanndd oouuttccoommeess mmaayy ddiiffffeerr ffrroomm ccllaassssiicc ttyyppee AA ddiisssseeccttiioonn •• HHoowweevveerr,, gguuiiddeelliinneess rreeccoommmmeenndd uurrggeenntt ssuurrggiiccaall rreeppaaiirr ffoorr bbootthh eennttiittiieess,, aassssoocciiaatteedd wwiitthh hhiigghh mmoorrttaalliittyy ((1177--2255%%))33,,44 • Could these patients benefit from a less invasive approach? 3Kim, et al. Circulation 2014 4Trimarchi, et al. JTCVS 2005 9 Acute Retrograde Dissection - IRAD Background Circulation 2014 N = 49 patients 10