{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T18:17:10Z","timestamp":1781115430066,"version":"3.54.1"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11_suppl_1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2013,9,10]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Prior cardiac surgery (PCS) can complicate the presentation and management of patients with type A acute aortic dissection (TAAAD). This report from the International Registry of Acute Aortic Dissection examines this hypothesis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              A total of 352 of 2196 patients with TAAAD (16%) enrolled in the International Registry of Acute Aortic Dissection had cardiac surgery before dissection, including coronary artery bypass grafting (34%), aortic or mitral valve surgery (36%), aortic surgery (42%), and other cardiac surgery (16%). Those with PCS were older, had a higher frequency of diabetes mellitus, hypertension, and atherosclerosis, and presented later from symptom onset to hospital presentation and diagnosis (all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05). In-hospital mortality was significantly higher for PCS patients (34% versus 23%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Five-year mortality was independently predicted by PCS (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.05\u20133.95), age &gt;70 years (HR, 2.65; 95% CI, 1.40\u20135.05), medical management (HR, 5.10; 95% CI, 2.43\u201310.71), distal communication (HR, 2.64; 95% CI, 1.35\u20135.14), and coma (HR, 9.50; 95% CI, 2.05\u201344.05). Among patients with PCS, in-hospital (43% medical versus 30% surgical;\n              <jats:italic>P<\/jats:italic>\n              =0.033) and intermediate-term mortality was higher in patients with medical versus surgical management. Propensity-matched analysis revealed significant increase in mortality with medical management, but not with PCS.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>PCS delays presentation, diagnosis, and treatment of TAAAD and is an important adverse risk factor for early and intermediate-term mortality. This effect may be because of increased medical management in this patient population.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.112.000342","type":"journal-article","created":{"date-parts":[[2013,9,12]],"date-time":"2013-09-12T21:37:10Z","timestamp":1379021830000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Outcomes of Patients Presenting With Acute Type A Aortic Dissection in the Setting of Prior Cardiac Surgery"],"prefix":"10.1161","volume":"128","author":[{"given":"Nicholas R.","family":"Teman","sequence":"first","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Russo","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek P.","family":"Ehrlich","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Truls","family":"Myrmel","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Gilbert R.","family":"Upchurch","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Greason","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Fillinger","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Forteza","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George Michael","family":"Deeb","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel G.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim A.","family":"Eagle","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric M.","family":"Isselbacher","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph A.","family":"Nienaber","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Himanshu J.","family":"Patel","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Surgery (N.R.T., G.M.D., H.J.P.), Department of Internal Medicine (K.A.E.), Michigan Cardiovascular Outcomes Research and Reporting Program (D.G.M.), University of Michigan Health System, Ann Arbor, MI; Department of Surgery, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (M.D.P.); Department of Surgery, University of Chicago Medical Center, Chicago, IL (M.J.R.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.4065\/79.2.176"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.7.897"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(01)01144-7"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2004.05.086"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccl.2010.02.010"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8191.2010.01061.x"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-008-0305-7"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(99)70420-4"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2006.05.065"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2010.02.015"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.12.076"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2011.266692"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezs342"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000138219.67028.2a"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.112.000342","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:41:51Z","timestamp":1715582511000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.112.000342"}},"subtitle":["An Analysis From the International Registry of Acute Aortic Dissection"],"short-title":[],"issued":{"date-parts":[[2013,9,10]]},"references-count":14,"journal-issue":{"issue":"11_suppl_1","published-print":{"date-parts":[[2013,9,10]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.112.000342"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.112.000342","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,9,10]]},"assertion":[{"value":"2013-09-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}