A Comparative Study of the Early and Short-Term Outcomes of Aortic Replacement in Patients with Stanford type A Aortic Dissection and Ascending Aortic Aneurysm.
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Published
Sep 25, 2022
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Pure and Applied Science
How to Cite
[1]E. Anwar, S. Haji Saeed, and A. ., “A Comparative Study of the Early and Short-Term Outcomes of Aortic Replacement in Patients with Stanford type A Aortic Dissection and Ascending Aortic Aneurysm.”, Kurdistan Journal of Applied Research, pp. 1-10, Sep. 2022.
Main Article Content
Abstract
Ascending aortic replacement is a challenging and complex surgery. The mortality, morbidity, and outcomes depend on the causes of the ascending aortic pathology and the type of operation. The research was conducted in a single-center, prospective, observational cohort study of patients undergoing ascending aortic replacement due to dissection or aneurysm. In the hospital, mortality, morbidity, and short-term outcomes were measured. A total of 85 patients were included in this study. Of them, 65.9% were male, and 34.1% were female. Thirty-three patients had Stanford type A aortic dissection (STAAD), whereas 52 had ascending aortic aneurysm (ASAA). Early mortality was (21.21% and 1.9%) for STAAD and ASAA, respectively, while the survival rate after one year was (75.8% and 96.15 %) for ascending dissection and aneurysm, respectively. The results of our study show higher early surgical mortality and morbidity and a lower short-term survival rate for STAAD surgery compared with ASAA surgery.
Keywords
Aorta, Ascending Aorta, Aortic Dissection, Ascending Aortic Aneurysm. Early Mortality and Morbidity.
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Article Details
References
[1] P. Komutrattananont, P. Mahakkanukrauh, and S. Das, “Morphology of the human aorta
and age-related changes: anatomical facts,” Anatomy & Cell Biology, vol. 52, no. 2, pp. 109–
114, Jun. 2019, doi: 10.5115/acb.2019.52.2.109.
[2] H. J. White, S. Bordes, and J. Borger, “Anatomy, Abdomen and Pelvis, Aorta,” PubMed,
2020. https://www.ncbi.nlm.nih.gov/books/NBK537319/
[3] H. Murillo, M. J. Lane, R. Punn, D. Fleischmann, and C. S. Restrepo, “Imaging of the
Aorta: Embryology and Anatomy,” Seminars in Ultrasound, CT and MRI, vol. 33, no. 3, pp.
169–190, Jun. 2012, doi: 10.1053/j.sult.2012.01.013.
[4] D. Kamalakannan, H. S. Rosman, and K. A. Eagle, “Acute Aortic Dissection,” Critical
Care Clinics, vol. 23, no. 4, pp. 779–800, Oct. 2007, doi: 10.1016/j.ccc.2007.07.002.
[5] I. A. De León Ayala and Y.-F. Chen, “Acute aortic dissection: An update,” The
Kaohsiung Journal of Medical Sciences, vol. 28, no. 6, pp. 299–305, Jun. 2012, doi:
10.1016/j.kjms.2011.11.010.
[6] R. S. Elsayed, R. G. Cohen, F. Fleischman, and M. E. Bowdish, “Acute Type A Aortic
Dissection,” Cardiology Clinics, vol. 35, no. 3, pp. 331–345, Aug. 2017, doi:
10.1016/j.ccl.2017.03.004.
[7] S. Upadhye and K. Schiff, “Acute Aortic Dissection in the Emergency Department:
Diagnostic Challenges and Evidence-Based Management,” Emergency Medicine Clinics of
North America, vol. 30, no. 2, pp. 307–327, May 2012, doi: 10.1016/j.emc.2011.12.001.
[8] E. Saliba, Y. Sia, A. Dore, and I. El Hamamsy, “The ascending aortic aneurysm: When
to intervene?” IJC Heart & Vasculature, vol. 6, pp. 91–100, Mar. 2015, doi:
10.1016/j.ijcha.2015.01.009.
[9] J. K. Ehrman, A. B. Fernandez, J. Myers, P. Oh, P. D. Thompson, and S. J. Keteyian,
“Aortic Aneurysm,” Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 40, no. 4,
pp. 215–223, Jul. 2020, doi: 10.1097/hcr.0000000000000521.
[10] M. J. Salameh, J. H. Black, and E. V. Ratchford, “Thoracic aortic aneurysm,” Vascular
Medicine, vol. 23, no. 6, pp. 573–578, Oct. 2018, doi: 10.1177/1358863x18807760.
[11] P. D. Patel and R. R. Arora, “Pathophysiology, diagnosis, and management of aortic
dissection,” Therapeutic Advances in Cardiovascular Disease, vol. 2, no. 6, pp. 439–468, Sep.
2008, doi: 10.1177/1753944708090830.
[12] E. L. Meredith and N. D. Masani, “Echocardiography in the emergency assessment of
acute aortic syndromes,” European Journal of Echocardiography, vol. 10, no. 1, pp. i31–i39,
Jan. 2009, doi: 10.1093/ejechocard/jen251.
[13] D. MUKHERJEE and K. EAGLE, “Aortic Dissection—An Update,” Current Problems
in Cardiology, vol. 30, no. 6, pp. 287–325, Jun. 2005, doi: 10.1016/j.cpcardiol.2005.01.002.
[14] C. R. Bonnichsen et al., “Aneurysms of the ascending aorta and arch: the role of imaging
in diagnosis and surgical management,” Expert Review of Cardiovascular Therapy, vol. 9, no.
1, pp. 45–61, Jan. 2011, doi: 10.1586/erc.10.168.
[15] S. Trimarchi et al., “Contemporary results of surgery in acute type A aortic dissection:
The International Registry of Acute Aortic Dissection experience,” The Journal of Thoracic
and Cardiovascular Surgery, vol. 129, no. 1, pp. 112–122, Jan. 2005, doi:
10.1016/j.jtcvs.2004.09.005.
[16]D. Hernandez-Vaquero et al., “Life Expectancy after Surgery for Ascending Aortic
Aneurysm,” Journal of Clinical Medicine, vol. 9, no. 3, p. 615, Feb. 2020, doi:
10.3390/jcm9030615.
[17] B. Chiappini, M. Schepens, and E. Tan, “Early and Late Outcomes of Acute Type A
Aortic Dissection: Analysis of Risk Factors in 487 Consecutive Patients,” ACC Current
Journal Review, vol. 14, no. 5, p. 45, May 2005, doi: 10.1016/j.accreview.2005.04.038.
[18] Z. S. Meharwal, S. N. Khanna, A. Choudhary, M. Mishra, Y. Mehta, and N. Trehan,
“Ascending Aortic Aneurysm Resection: 15 Years’ Experience,” Asian Cardiovascular and
Thoracic Annals, vol. 14, no. 4, pp. 300–305, Aug. 2006, doi: 10.1177/021849230601400407.
[19] “NIH Stroke Scale: National Institutes of Health (NIH) Stroke Scale,” eMedicine, Jun. 2022,
Accessed: Sep. 20, 2022. [Online]. Available: https://emedicine.medscape.com/article/2172609-
overview.
[20] J. A. Lopes and S. Jorge, “The RIFLE and AKIN classifications for acute kidney injury:
a critical and comprehensive review,” Clinical Kidney Journal, vol. 6, no. 1, pp. 8–14, Jan.
2013, doi: 10.1093/ckj/sfs160.
[21] R. S. McClure, S. B. Brogly, K. Lajkosz, D. Payne, S. F. Hall, and A. P. Johnson,
“Epidemiology and management of thoracic aortic dissections and thoracic aortic aneurysms
in Ontario, Canada: A population-based study,” The Journal of Thoracic and Cardiovascular
Surgery, vol. 155, no. 6, pp. 2254-2264.e4, Jun. 2018, doi: 10.1016/j.jtcvs.2017.11.105.
[22] T. Gudbjartsson et al., “Acute type A aortic dissection – a review,” Scandinavian
Cardiovascular Journal, vol. 54, no. 1, pp. 1–13, Sep. 2019, doi:
10.1080/14017431.2019.1660401.
[23] Y. Lu et al., “Management strategy of Type A Aortic Dissection in a developing center
from China: 16 years experiences,” Journal of Thoracic Disease, vol. 12, no. 11, pp. 6780–
6788, Nov. 2020, doi: 10.21037/jtd-20-1866.
[24] K. Kallenbach et al., “Treatment of ascending aortic aneurysms by different surgical
techniques: Comparison of early and long-term results,” The Thoracic and Cardiovascular
Surgeon, vol. 60, no. S 01, Jan. 2012, doi: 10.1055/s-0031-1297910.
[25] P. G. Hagan et al., “The International Registry of Acute Aortic Dissection (IRAD),”
JAMA, vol. 283, no. 7, p. 897, Feb. 2000, doi: 10.1001/jama.283.7.897.
[26] D. Pacini et al., “Acute aortic dissection: Epidemiology and outcomes,” International
Journal of Cardiology, vol. 167, no. 6, pp. 2806–2812, Sep. 2013, doi:
10.1016/j.ijcard.2012.07.008.
Article Sidebar
Published
Sep 25, 2022
Section
Pure and Applied Science
How to Cite
[1]
E. Anwar, S. Haji Saeed, and A. ., “A Comparative Study of the Early and Short-Term Outcomes of Aortic Replacement in Patients with Stanford type A Aortic Dissection and Ascending Aortic Aneurysm.”, Kurdistan Journal of Applied Research, pp. 1-10, Sep. 2022.
Main Article Content
Abstract
Ascending aortic replacement is a challenging and complex surgery. The mortality, morbidity, and outcomes depend on the causes of the ascending aortic pathology and the type of operation. The research was conducted in a single-center, prospective, observational cohort study of patients undergoing ascending aortic replacement due to dissection or aneurysm. In the hospital, mortality, morbidity, and short-term outcomes were measured. A total of 85 patients were included in this study. Of them, 65.9% were male, and 34.1% were female. Thirty-three patients had Stanford type A aortic dissection (STAAD), whereas 52 had ascending aortic aneurysm (ASAA). Early mortality was (21.21% and 1.9%) for STAAD and ASAA, respectively, while the survival rate after one year was (75.8% and 96.15 %) for ascending dissection and aneurysm, respectively. The results of our study show higher early surgical mortality and morbidity and a lower short-term survival rate for STAAD surgery compared with ASAA surgery.
Keywords
Aorta, Ascending Aorta, Aortic Dissection, Ascending Aortic Aneurysm. Early Mortality and Morbidity.Downloads
Download data is not yet available.
Article Details
References
[1] P. Komutrattananont, P. Mahakkanukrauh, and S. Das, “Morphology of the human aorta
and age-related changes: anatomical facts,” Anatomy & Cell Biology, vol. 52, no. 2, pp. 109–
114, Jun. 2019, doi: 10.5115/acb.2019.52.2.109.
[2] H. J. White, S. Bordes, and J. Borger, “Anatomy, Abdomen and Pelvis, Aorta,” PubMed,
2020. https://www.ncbi.nlm.nih.gov/books/NBK537319/
[3] H. Murillo, M. J. Lane, R. Punn, D. Fleischmann, and C. S. Restrepo, “Imaging of the
Aorta: Embryology and Anatomy,” Seminars in Ultrasound, CT and MRI, vol. 33, no. 3, pp.
169–190, Jun. 2012, doi: 10.1053/j.sult.2012.01.013.
[4] D. Kamalakannan, H. S. Rosman, and K. A. Eagle, “Acute Aortic Dissection,” Critical
Care Clinics, vol. 23, no. 4, pp. 779–800, Oct. 2007, doi: 10.1016/j.ccc.2007.07.002.
[5] I. A. De León Ayala and Y.-F. Chen, “Acute aortic dissection: An update,” The
Kaohsiung Journal of Medical Sciences, vol. 28, no. 6, pp. 299–305, Jun. 2012, doi:
10.1016/j.kjms.2011.11.010.
[6] R. S. Elsayed, R. G. Cohen, F. Fleischman, and M. E. Bowdish, “Acute Type A Aortic
Dissection,” Cardiology Clinics, vol. 35, no. 3, pp. 331–345, Aug. 2017, doi:
10.1016/j.ccl.2017.03.004.
[7] S. Upadhye and K. Schiff, “Acute Aortic Dissection in the Emergency Department:
Diagnostic Challenges and Evidence-Based Management,” Emergency Medicine Clinics of
North America, vol. 30, no. 2, pp. 307–327, May 2012, doi: 10.1016/j.emc.2011.12.001.
[8] E. Saliba, Y. Sia, A. Dore, and I. El Hamamsy, “The ascending aortic aneurysm: When
to intervene?” IJC Heart & Vasculature, vol. 6, pp. 91–100, Mar. 2015, doi:
10.1016/j.ijcha.2015.01.009.
[9] J. K. Ehrman, A. B. Fernandez, J. Myers, P. Oh, P. D. Thompson, and S. J. Keteyian,
“Aortic Aneurysm,” Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 40, no. 4,
pp. 215–223, Jul. 2020, doi: 10.1097/hcr.0000000000000521.
[10] M. J. Salameh, J. H. Black, and E. V. Ratchford, “Thoracic aortic aneurysm,” Vascular
Medicine, vol. 23, no. 6, pp. 573–578, Oct. 2018, doi: 10.1177/1358863x18807760.
[11] P. D. Patel and R. R. Arora, “Pathophysiology, diagnosis, and management of aortic
dissection,” Therapeutic Advances in Cardiovascular Disease, vol. 2, no. 6, pp. 439–468, Sep.
2008, doi: 10.1177/1753944708090830.
[12] E. L. Meredith and N. D. Masani, “Echocardiography in the emergency assessment of
acute aortic syndromes,” European Journal of Echocardiography, vol. 10, no. 1, pp. i31–i39,
Jan. 2009, doi: 10.1093/ejechocard/jen251.
[13] D. MUKHERJEE and K. EAGLE, “Aortic Dissection—An Update,” Current Problems
in Cardiology, vol. 30, no. 6, pp. 287–325, Jun. 2005, doi: 10.1016/j.cpcardiol.2005.01.002.
[14] C. R. Bonnichsen et al., “Aneurysms of the ascending aorta and arch: the role of imaging
in diagnosis and surgical management,” Expert Review of Cardiovascular Therapy, vol. 9, no.
1, pp. 45–61, Jan. 2011, doi: 10.1586/erc.10.168.
[15] S. Trimarchi et al., “Contemporary results of surgery in acute type A aortic dissection:
The International Registry of Acute Aortic Dissection experience,” The Journal of Thoracic
and Cardiovascular Surgery, vol. 129, no. 1, pp. 112–122, Jan. 2005, doi:
10.1016/j.jtcvs.2004.09.005.
[16]D. Hernandez-Vaquero et al., “Life Expectancy after Surgery for Ascending Aortic
Aneurysm,” Journal of Clinical Medicine, vol. 9, no. 3, p. 615, Feb. 2020, doi:
10.3390/jcm9030615.
[17] B. Chiappini, M. Schepens, and E. Tan, “Early and Late Outcomes of Acute Type A
Aortic Dissection: Analysis of Risk Factors in 487 Consecutive Patients,” ACC Current
Journal Review, vol. 14, no. 5, p. 45, May 2005, doi: 10.1016/j.accreview.2005.04.038.
[18] Z. S. Meharwal, S. N. Khanna, A. Choudhary, M. Mishra, Y. Mehta, and N. Trehan,
“Ascending Aortic Aneurysm Resection: 15 Years’ Experience,” Asian Cardiovascular and
Thoracic Annals, vol. 14, no. 4, pp. 300–305, Aug. 2006, doi: 10.1177/021849230601400407.
[19] “NIH Stroke Scale: National Institutes of Health (NIH) Stroke Scale,” eMedicine, Jun. 2022,
Accessed: Sep. 20, 2022. [Online]. Available: https://emedicine.medscape.com/article/2172609-
overview.
[20] J. A. Lopes and S. Jorge, “The RIFLE and AKIN classifications for acute kidney injury:
a critical and comprehensive review,” Clinical Kidney Journal, vol. 6, no. 1, pp. 8–14, Jan.
2013, doi: 10.1093/ckj/sfs160.
[21] R. S. McClure, S. B. Brogly, K. Lajkosz, D. Payne, S. F. Hall, and A. P. Johnson,
“Epidemiology and management of thoracic aortic dissections and thoracic aortic aneurysms
in Ontario, Canada: A population-based study,” The Journal of Thoracic and Cardiovascular
Surgery, vol. 155, no. 6, pp. 2254-2264.e4, Jun. 2018, doi: 10.1016/j.jtcvs.2017.11.105.
[22] T. Gudbjartsson et al., “Acute type A aortic dissection – a review,” Scandinavian
Cardiovascular Journal, vol. 54, no. 1, pp. 1–13, Sep. 2019, doi:
10.1080/14017431.2019.1660401.
[23] Y. Lu et al., “Management strategy of Type A Aortic Dissection in a developing center
from China: 16 years experiences,” Journal of Thoracic Disease, vol. 12, no. 11, pp. 6780–
6788, Nov. 2020, doi: 10.21037/jtd-20-1866.
[24] K. Kallenbach et al., “Treatment of ascending aortic aneurysms by different surgical
techniques: Comparison of early and long-term results,” The Thoracic and Cardiovascular
Surgeon, vol. 60, no. S 01, Jan. 2012, doi: 10.1055/s-0031-1297910.
[25] P. G. Hagan et al., “The International Registry of Acute Aortic Dissection (IRAD),”
JAMA, vol. 283, no. 7, p. 897, Feb. 2000, doi: 10.1001/jama.283.7.897.
[26] D. Pacini et al., “Acute aortic dissection: Epidemiology and outcomes,” International
Journal of Cardiology, vol. 167, no. 6, pp. 2806–2812, Sep. 2013, doi:
10.1016/j.ijcard.2012.07.008.
and age-related changes: anatomical facts,” Anatomy & Cell Biology, vol. 52, no. 2, pp. 109–
114, Jun. 2019, doi: 10.5115/acb.2019.52.2.109.
[2] H. J. White, S. Bordes, and J. Borger, “Anatomy, Abdomen and Pelvis, Aorta,” PubMed,
2020. https://www.ncbi.nlm.nih.gov/books/NBK537319/
[3] H. Murillo, M. J. Lane, R. Punn, D. Fleischmann, and C. S. Restrepo, “Imaging of the
Aorta: Embryology and Anatomy,” Seminars in Ultrasound, CT and MRI, vol. 33, no. 3, pp.
169–190, Jun. 2012, doi: 10.1053/j.sult.2012.01.013.
[4] D. Kamalakannan, H. S. Rosman, and K. A. Eagle, “Acute Aortic Dissection,” Critical
Care Clinics, vol. 23, no. 4, pp. 779–800, Oct. 2007, doi: 10.1016/j.ccc.2007.07.002.
[5] I. A. De León Ayala and Y.-F. Chen, “Acute aortic dissection: An update,” The
Kaohsiung Journal of Medical Sciences, vol. 28, no. 6, pp. 299–305, Jun. 2012, doi:
10.1016/j.kjms.2011.11.010.
[6] R. S. Elsayed, R. G. Cohen, F. Fleischman, and M. E. Bowdish, “Acute Type A Aortic
Dissection,” Cardiology Clinics, vol. 35, no. 3, pp. 331–345, Aug. 2017, doi:
10.1016/j.ccl.2017.03.004.
[7] S. Upadhye and K. Schiff, “Acute Aortic Dissection in the Emergency Department:
Diagnostic Challenges and Evidence-Based Management,” Emergency Medicine Clinics of
North America, vol. 30, no. 2, pp. 307–327, May 2012, doi: 10.1016/j.emc.2011.12.001.
[8] E. Saliba, Y. Sia, A. Dore, and I. El Hamamsy, “The ascending aortic aneurysm: When
to intervene?” IJC Heart & Vasculature, vol. 6, pp. 91–100, Mar. 2015, doi:
10.1016/j.ijcha.2015.01.009.
[9] J. K. Ehrman, A. B. Fernandez, J. Myers, P. Oh, P. D. Thompson, and S. J. Keteyian,
“Aortic Aneurysm,” Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 40, no. 4,
pp. 215–223, Jul. 2020, doi: 10.1097/hcr.0000000000000521.
[10] M. J. Salameh, J. H. Black, and E. V. Ratchford, “Thoracic aortic aneurysm,” Vascular
Medicine, vol. 23, no. 6, pp. 573–578, Oct. 2018, doi: 10.1177/1358863x18807760.
[11] P. D. Patel and R. R. Arora, “Pathophysiology, diagnosis, and management of aortic
dissection,” Therapeutic Advances in Cardiovascular Disease, vol. 2, no. 6, pp. 439–468, Sep.
2008, doi: 10.1177/1753944708090830.
[12] E. L. Meredith and N. D. Masani, “Echocardiography in the emergency assessment of
acute aortic syndromes,” European Journal of Echocardiography, vol. 10, no. 1, pp. i31–i39,
Jan. 2009, doi: 10.1093/ejechocard/jen251.
[13] D. MUKHERJEE and K. EAGLE, “Aortic Dissection—An Update,” Current Problems
in Cardiology, vol. 30, no. 6, pp. 287–325, Jun. 2005, doi: 10.1016/j.cpcardiol.2005.01.002.
[14] C. R. Bonnichsen et al., “Aneurysms of the ascending aorta and arch: the role of imaging
in diagnosis and surgical management,” Expert Review of Cardiovascular Therapy, vol. 9, no.
1, pp. 45–61, Jan. 2011, doi: 10.1586/erc.10.168.
[15] S. Trimarchi et al., “Contemporary results of surgery in acute type A aortic dissection:
The International Registry of Acute Aortic Dissection experience,” The Journal of Thoracic
and Cardiovascular Surgery, vol. 129, no. 1, pp. 112–122, Jan. 2005, doi:
10.1016/j.jtcvs.2004.09.005.
[16]D. Hernandez-Vaquero et al., “Life Expectancy after Surgery for Ascending Aortic
Aneurysm,” Journal of Clinical Medicine, vol. 9, no. 3, p. 615, Feb. 2020, doi:
10.3390/jcm9030615.
[17] B. Chiappini, M. Schepens, and E. Tan, “Early and Late Outcomes of Acute Type A
Aortic Dissection: Analysis of Risk Factors in 487 Consecutive Patients,” ACC Current
Journal Review, vol. 14, no. 5, p. 45, May 2005, doi: 10.1016/j.accreview.2005.04.038.
[18] Z. S. Meharwal, S. N. Khanna, A. Choudhary, M. Mishra, Y. Mehta, and N. Trehan,
“Ascending Aortic Aneurysm Resection: 15 Years’ Experience,” Asian Cardiovascular and
Thoracic Annals, vol. 14, no. 4, pp. 300–305, Aug. 2006, doi: 10.1177/021849230601400407.
[19] “NIH Stroke Scale: National Institutes of Health (NIH) Stroke Scale,” eMedicine, Jun. 2022,
Accessed: Sep. 20, 2022. [Online]. Available: https://emedicine.medscape.com/article/2172609-
overview.
[20] J. A. Lopes and S. Jorge, “The RIFLE and AKIN classifications for acute kidney injury:
a critical and comprehensive review,” Clinical Kidney Journal, vol. 6, no. 1, pp. 8–14, Jan.
2013, doi: 10.1093/ckj/sfs160.
[21] R. S. McClure, S. B. Brogly, K. Lajkosz, D. Payne, S. F. Hall, and A. P. Johnson,
“Epidemiology and management of thoracic aortic dissections and thoracic aortic aneurysms
in Ontario, Canada: A population-based study,” The Journal of Thoracic and Cardiovascular
Surgery, vol. 155, no. 6, pp. 2254-2264.e4, Jun. 2018, doi: 10.1016/j.jtcvs.2017.11.105.
[22] T. Gudbjartsson et al., “Acute type A aortic dissection – a review,” Scandinavian
Cardiovascular Journal, vol. 54, no. 1, pp. 1–13, Sep. 2019, doi:
10.1080/14017431.2019.1660401.
[23] Y. Lu et al., “Management strategy of Type A Aortic Dissection in a developing center
from China: 16 years experiences,” Journal of Thoracic Disease, vol. 12, no. 11, pp. 6780–
6788, Nov. 2020, doi: 10.21037/jtd-20-1866.
[24] K. Kallenbach et al., “Treatment of ascending aortic aneurysms by different surgical
techniques: Comparison of early and long-term results,” The Thoracic and Cardiovascular
Surgeon, vol. 60, no. S 01, Jan. 2012, doi: 10.1055/s-0031-1297910.
[25] P. G. Hagan et al., “The International Registry of Acute Aortic Dissection (IRAD),”
JAMA, vol. 283, no. 7, p. 897, Feb. 2000, doi: 10.1001/jama.283.7.897.
[26] D. Pacini et al., “Acute aortic dissection: Epidemiology and outcomes,” International
Journal of Cardiology, vol. 167, no. 6, pp. 2806–2812, Sep. 2013, doi:
10.1016/j.ijcard.2012.07.008.