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Rapid diagnosis of aortic dissections could save many lives in Germany every year


New concept for aortic dissection treatment seems to work effectively
A relatively unknown disease is likely to affect twice as many people as previously thought. The so-called acute life-threatening aortic dissection leads to the death of hundreds of patients every year because it is recognized too late or not at all. The researchers at the German Heart Center Berlin (DHZB) have now developed a concept for coordinating the diagnosis and treatment of the disease. This concept already led to the rescue of significantly more people in 2016 than in previous years.

The scientists at the German Heart Center Berlin (DHZB) discovered in their investigation that a new concept for diagnosing and treating aortic dissection can save many lives every year. The doctors released a press release on the results of their study.

What is acute type A aortic dissection?
The complicated technical term "acute type A aortic dissection" stands for a life-threatening illness. The inner wall layer of the main artery (aorta) tears at the heart and detaches, explains the authors. The resulting space fills with blood. The gap then continues to grow along the aorta. This effect allows branches of the aorta to be closed, the experts add.

If left untreated, the disease often leads to death within 48 hours
The greatest danger with aortic dissection is bleeding into the pericardium. Such bleeding can quickly lead to cardiac arrest, the researchers warn. For this reason, the disease must be operated on as soon as possible in a specialized heart center. However, if the disease remains untreated, in a large part of the cases it leads to the patient's death within 48 hours, the authors explain.

Examination with a computer tomograph can detect the disease
A quick and reliable diagnosis of acute aortic dissection is unfortunately not straightforward. The symptoms (especially a severe chest pain) can even be misinterpreted by experienced emergency doctors as signs of a heart attack, the researchers explain. An examination with a computer tomograph (CT) can provide clarity. However, such a technology is not available in good time everywhere.

Consequences of incorrect treatment
Treating aortic dissection like a heart attack can have fatal consequences, explains Stephan Kurz from the DHZB. A heart attack is the result of a blood clot and is therefore treated with medicines that thin the blood, the doctors say. In aortic dissection, the bleeding is further accelerated. This can make further care considerably more difficult, adds the expert.

Doctors examined the data of over 1,600 patients
For their investigation, the researchers at the Clinic for Cardiac, Thoracic and Vascular Surgery at the DHZB analyzed the patient files and emergency doctor protocols of over 1,600 patients who were treated for an acute type A dissection. In addition, more than 14,000 autopsy reports from the Charité Institute of Forensic Medicine and the pathology department of the so-called Vivantes network were evaluated, the scientists report. The aim was to record how many patients in Berlin and Brandenburg had died of aortic dissection. The results of the study show that there is an urgent need for action.

Aortic dissection occurs more than twice as often as previously thought
It was found that the mean time from the appearance of the first symptoms to the start of the operation was over eight hours. The researchers were also able to find out that aortic dissection is highly likely to occur much more frequently than previously thought. According to the Federal Statistical Office, there are 4.6 cases per 100,000 inhabitants annually. However, the extrapolation of the data collected in the study is more than twice as high (11.9 cases), the researchers explain. The scientists also report that they assume that there are over 200 people who die each year from the disease in Berlin and Brandenburg. The reason for this is the late diagnosis or incorrect treatment of acute aortic dissection, according to author Stephan Kurz.

Medical hotline is to support doctors
A medical hotline for all doctors in Berlin and Brandenburg should now be available around the clock in a coordinating and advisory capacity. The time from the event to the operation will be shortened significantly. Under a uniform number, a specialist in anesthesia or cardiac surgery is available around the clock as a contact person for the staff of the regional emergency services, the scientists explain. Colleagues on site can be supported in this way and the preparation for the intervention at the DHZB is also coordinated more effectively. Standard procedures were developed and coordinated with the responsible emergency services, emergency doctors and emergency services, say the doctors. So these experts were further sensitized to the disease.

Processes have been optimized
The processes of admission, anesthesia, surgical care and further treatment in the intensive care unit at the DHZB were further improved and standardized, the authors report. An DHZB emergency website also provides guidelines for the faster transmission of data on patients and treatment. The newly elaborated concept has already led to a significant improvement in the diagnosis and primary care of aortic dissection, the researchers explain. The number of patients operated on for an acute type A dissection rose at the DHZB from an average of 80 cases in previous years to 138 cases in 2016. This corresponds to an increase of more than 70 percent. In addition, the time before the first symptoms appeared before the start of the operation could be reduced by an average of 20 percent, the authors explain. Normally, many patients would not have survived without the improved diagnosis and efficient transfer to the DHZB, explains the clinical director Prof. Dr. Volkmar Falk.

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Video: Acute Type A Aortic Dissection Repair (January 2022).