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Master Thesis

Prise en charge diagnostique et thérapeutique de la dissection aortique aiguë de type A au centre hospitalier universitaire Grenoble Alpes et évolution depuis 2010

Abstract : Background: Acute type A aortic dissection (ATAAD) is a life-threatening disease requiring urgent surgery. It is regionally managed by an emergency network (REseau Nord Alpin des Urgences-RENAU) in which our centre participates. Objectives: 1) To assess the local management of patients operated for ATAAD over the last decade, and the hospital morbi-mortality. 2) To analyse the risk factors of operative mortality. Method: Observational retrospective single-centre study including the patients operated for ATAAD from 01/01/2010 to 12/31/2019. Multivariate analysis of the risk factors of operative mortality, summarized by their adjusted odds ratio (OR). Results: Two hundred and twenty patients were included. The computed tomography scan was the diagnostic examination in 70.2% of the cases. The direct transfer to the operating room was achieved in 74.0% of the cases. A malperfusion was present in 43.2% of patients, 29.2% were in shock. A procedure on the aortic root or the arch was performed in 29.0% and 39.2% of the cases, respectively. Operative mortality was 19.1% and the risk factors were: an age over 70 years (OR 2.2, p=0.034), a preoperative cardiac arrest (OR 15.8, p=0.025), a femoro-femoral cannulation (OR 2.8, p=0.048), a postoperative low flow (OR 4.1, p=0.0057), stroke or coma (OR 4.2, p=0.0056), or digestive ischemia (OR 11.1, p=0.0017). Conclusion: The RENAU permits the rapid transfer to the operating room of ATAAD, whose diagnosis was facilitated by the democratization of the scan. Operative mortality was still high but acceptable considering the important part of patients admitted to the operating room with critical clinical condition.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03337159
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Tuesday, September 14, 2021 - 9:13:15 AM
Last modification on : Thursday, September 16, 2021 - 3:24:59 AM

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  • HAL Id : dumas-03337159, version 1

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Fahd Bennani. Prise en charge diagnostique et thérapeutique de la dissection aortique aiguë de type A au centre hospitalier universitaire Grenoble Alpes et évolution depuis 2010. Médecine humaine et pathologie. 2021. ⟨dumas-03337159⟩

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