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Cardiology

Management of Thoracic Aortic Dissection

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JAMA

Published Online: February 16, 2023

JAMA Clinical Guidelines Synopsis

Article Information and Disclosures

Irbaz Hameed, MD¹;

Adam S. Cifu, MD²;

Prashanth Vallabhajosyula, MD, MS¹

Author Affiliations

¹Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
²University of Chicago, Chicago, Illinois

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ATAAD and TBAD (involving the ascending and descending aorta, respectively) are associated with high morbidity and mortality. Patients often present emergently in critical condition. Health care clinicians across different specialties encounter aortic dissection, and initial management is important to patient survival and long-term outcome.¹^,2 This article summarizes 2 guidelines on initial management and stabilization of patients presenting with ATAAD or TBAD.

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Article Information

Corresponding Author: Prashanth Vallabhajosyula, MD, MS, Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar St, New Haven, CT 06510 (prashanth.vallabhajosyula@yale.edu).

Published Online: February 16, 2023. doi:10.1001/jama.2023.0265

Conflict of Interest Disclosures: Dr Vallabhajosyula reported advisory board membership with Terumo Corp. No other disclosures were reported.

References

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Codner JA , Lou X , Duwayri YM , et al. The distance of the primary intimal tear from the left subclavian artery predicts aortic growth in uncomplicated type B aortic dissection. J Vasc Surg. 2019;69(3):692-700. doi:10.1016/j.jvs.2018.05.245 PubMed Google Scholar Crossref

Liu D , Luo H , Lin S , Zhao L , Qiao C . Comparison of the efficacy and safety of thoracic endovascular aortic repair with open surgical repair and optimal medical therapy for acute type B aortic dissection: a systematic review and meta-analysis. Int J Surg. 2020;83:53-61. doi:10.1016/j.ijsu.2020.08.051 PubMed Google Scholar Crossref

Nienaber CA , Rousseau H , Eggebrecht H , et al; INSTEAD Trial. Randomized comparison of strategies for type B aortic dissection: the Investigation of Stent Grafts in Aortic Dissection (INSTEAD) trial. Circulation. 2009;120(25):2519-2528. doi:10.1161/CIRCULATIONAHA.109.886408 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.