Mortality and treatment of aortic dissection

People with unhealthy cardiovascular system are often more susceptible to various high-level diseases. Aortic dissection is one of the serious heart diseases with a certain mortality rate. Aortic dissection occurs suddenly, and the patient will experience very obvious pain. If aortic dissection is not treated in time, it is very likely to lead to the patient's death.

1. Mortality rate of aortic dissection

Most cases of aortic dissection die within hours to days after onset. The hourly mortality rate in the first 24 hours is 1%-2%, depending on the location, range and severity of the lesion. The more distal the lesion, the smaller the range and the less bleeding, the better the prognosis. The mortality rate of aortic dissection is very high, among which type A aortic dissection is the arterial disease with the highest mortality rate, with a high mortality and complication rate.

Treatment of aortic dissection

Currently, there are four main surgical procedures for aortic root dissection: ascending aorta replacement, aortic sinus and aortic valvuloplasty, root replacement with aortic valve preservation, and aortic root replacement. Ascending aorta replacement can preserve the sinus; aortic sinus and aortic valvuloplasty are simple to operate, with short operation time and few complications. No anticoagulant drugs are required after the operation, but the possibility of secondary operation (due to recurrent dissection, root tumor dilatation, aortic valve insufficiency, etc.) is as high as 25%-45%; aortic valve-preserving root replacement (David operation) can completely remove the aortic root and retain the native valve without anticoagulation-related complications, but the operation time is long and the operation is complicated; aortic root replacement (Bentall operation) can completely remove the aortic root and valve, the surgical technical difficulty is relatively small, the intraoperative risk is not high, but long-term anticoagulation is required and the quality of life is relatively poor.

3. Clinical manifestations of aortic dissection

(1) Chest pain: 90% of patients experience sudden, persistent, progressively worsening severe chest pain; the pain may be like stabbing, tearing, or cutting. Patients often cannot tolerate it, and sublingual nitroglycerin is ineffective. Electrocardiogram ruled out acute myocardial infarction.

(2) The patient is pale, sweating profusely, nervous or fainting, and the extremities are cold and wet. However, blood pressure is usually maintained at a high level or slightly decreased, which is more common when dissecting hematoma ruptures into hollow organs.

(3) Gastrointestinal symptoms: If the dissection affects the distal part of the aorta, the patient may experience abdominal pain, vomiting, hematemesis, or bloody stools. It is caused by ischemic colon lesions caused by dissection hematoma compressing the mesenteric artery.

(4) Neuropsychiatric symptoms: If the hematoma involves the opening of the carotid artery or the innominate artery, it may cause temporary cerebral ischemia or even stroke.

(5) Pulselessness or weakened pulse in the limbs: This is caused by hematoma involving the innominate artery, subclavian artery, or common iliac artery and compressing their openings.