German Registry for Acute Aortic Dissection Type A (GERAADA) – Lessons Learned from the Registry

Abstract

A German registry for acute aortic dissection type A (GERAADA) was initiated by the Working Group for Aortic Surgery and Interventional Vascular Surgery of the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in July 2006. This web-based database was developed to record the data of patients who had undergone surgery for aortic dissection type A. From analyzing the data, we aim to learn how to improve surgical treatment and to identify parameters affecting patient outcome. In the beginning, 33 cardiac centers participated via online access to the registry on the GSTCVS’ homepage. Since then, 43 centers in Germany, Switzerland and Austria have begun entering data on the pre- and intraoperative status of their patients, postoperative complications, mid-term results and circumstances of death. We have succeeded in interpreting the initial results and trends from the registry now available to all of the participating centers, which benefit from this shared pool of analyzed data by optimizing their therapy regimes and comparing their success with that in the other centers.

Key words

aortic dissection type A - deep hypothermic circulatory arrest (DHCA) - cerebral perfusion - database - registry - multicenter clinical trial - patient outcome

References

• 1 Nienaber C A, Eagle K A. Aortic dissection: new frontiers in diagnosis and management, part I: from etiology to diagnostic strategies.  Circulation. 2003;  108 628-635
• 2 Conzelmann L O, Kayhan N, Mehlhorn U, Weigang E, Dahm M, Vahl C F. Re-evaluation of direct true lumen cannulation in surgery for acute type A aortic dissection.  Ann Thorac Surg. 2009;  87 1182-1186
• 3 Khaladj N, Shrestha M, Peterss S, Strueber M, Karck M, Pichlmaier M, Haverich A, Hagl C. Ascending aortic cannulation in acute aortic dissection type A: the Hanover experience.  Eur J Cardiothorac Surg. 2008;  34 792-796
• 4 Strauch J T, Spielvogel D, Lauten A, Zhang N, Rinke S, Weisz D, Bodian C A, Griepp R B. Optimal temperature for selective cerebral surgery.  J Thorac Cardiovasc Surg. 2005;  130 74-82
• 5 Urbanski P P, Lenos A, Weigang E, Lindemann Y, Zacher M, Diegeler A. Carotid artery cannulation in aortic surgery.  J Thorac Cardiovasc Surg. 2006;  132 1398-1403
• 6 Küçüker S A, Özatik M A, Saritaş A, Taşdemir O. Arch repair with unilateral antegrade cerebral perfusion.  Eur J Cardiothorac Surg. 2005;  27 638-643
• 7 Numata S, Ogino H, Sasaki H, Hanafusa Y, Hirata M, Ando M, Kitamura S. Total arch replacement using antegrade selective cerebral perfusion with right axillary artery perfusion.  Eur J Cardiothorac Surg. 2003;  23 771-775
• 8 Immer F F, Moser B, Krähenbühl E S, Englberger L, Stalder M, Eckstein F S, Carrel T. Arterial access through the right subclavian artery in surgery of the aortic arch improves neurologic outcome and mid-term quality of life.  Ann Thorac Surg. 2008;  85 1614-1618
• 9 Ji S, Yang J, Ye X, Wang X. Brain protection by using innominate artery cannulation during aortic arch surgery.  Ann Thorac Surg. 2008;  86 1030-1032
• 10 Jakob H, Tsagakis K, Szabo A, Wiese I, Thielmann M, Herold U. Rapid and safe direct cannulation of the true lumen of the ascending aorta in acute type A aortic dissection.  J Thorac Cardiovasc Surg. 2007;  134 244-245
• 11 Anagnostopoulos C E, Prabhakar M J, Kittle C F. Aortic dissections and dissecting aneurysms.  Am J Cardiol. 1972;  30 263
• 12 Borst H G, Walterbusch G, Schaps D. Extensive aortic replacement using “elephant-trunk” prosthesis.  Thorac Cardiovasc Surg. 1983;  31 37-40
• 13 Czerny M, Fleck T, Zimpfer D, Kilo J, Sandner D, Cejna M, Lammer J, Wolner E, Grabenwoger M. Combined repair of an aortic arch aneurysm by sequential transposition of the supra-aortic branches and endovascular stent-graft placement.  J Thorac Cardiovasc Surg. 2003;  126 916-918
• 14 Urbanski P P. Cannulation of the left common carotid artery for proximal arch repair.  J Thorac Cardiovasc Surg. 2003;  126 887-888
• 15 Weigang E, Nienaber C A, Rehders T C, Ince H, Vahl C F, Beyersdorf F. Management of patients with aortic dissection.  Dtsch Arztebl Int. 2008;  105 639-645
• 16 Weigang E, Parker J, Czerny M, Peivandi A A, Dorweiler B, Beyersdorf F, Siegenthaler M P. Endovascular aortic arch repair after aortic arch de-branching.  Ann Thorac Surg. 2009;  87 603-607
• 17 Kallenbach K, Karck M, Oelze T, Salcher R, Hagl C, Leyh R G, Haverich A. Evolving strategies for treatment of acute aortic dissection type A.  Circulation. 2004;  110 (Suppl. II) II-243-II-249