IRAD Investigator Meeting - Aortic Dissections 2012 IRAD Presentation Version 5.… · Acute Type B...
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IRAD Investigator Meeting American College of Cardiology 2012
Transcript of IRAD Investigator Meeting - Aortic Dissections 2012 IRAD Presentation Version 5.… · Acute Type B...
IRAD Investigator Meeting American College of Cardiology 2012
Agenda {
I. Database Update II. Notes on Variables III. Participating Sites IV. IRAD Expansion V. IRAD IVC VI. Patient Education VII. Dynamic Imaging VIII. Publications Update IX. Manuscripts in Preparation X. ACC 2012 Presentations XI. Upcoming Meetings XII. 2011 in Review XIII. Future Directions
Agenda
Database Update {
Type A
Type B
Total Patients
0
100
200
300
400
500
600
Mic
hig
an
Mas
s. G
en.
U. P
enn
.
S. O
rso
la
Val
l d
'Heb
ron
RB
K
San
Do
nat
o
Tro
mso
St.
Mic
hae
ls
Bri
gh
am &
Wo
men
's
Min
nea
po
lis
Hea
rt
To
ky
o
Ep
pen
do
rf-R
ost
ock
Cal
gar
y
May
o
Was
h. U
.
Vie
nn
a
Had
assa
h
U. M
ass.
San
Gio
van
ni
e R
ug
gi
12 d
e O
ctu
bre
Du
ke
Dar
tmo
uth
U. C
olo
rad
o
U. C
hic
ago
Bic
hat
U. V
irg
inia
Gra
z
U. P
itts
bu
rgh
U. M
inn
eso
ta
No. of Cases by Hospital
0
500
1000
1500
2000
2500
3000
3500
4000
Total Survived Followed Up
Total Follow-up
3867
3086 (79.8%)
1592 (51.6%)
Follow-up defined as a patient having at least one completed follow-up form.
Type A Dissection
0
500
1000
1500
2000
Survived Followed Up
Type B Dissection
0
500
1000
1500
2000
Survived Followed Up
1205
Follow-up by Type
1881
908 (48.3%)
684 (56.8%)
0
50
100
150
200
250
Mas
s. G
en.
Mic
hig
an
RB
K
S. O
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la
Val
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ron
San
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Min
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rt
Bri
gh
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men
's
Vie
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a
U. M
ass.
To
ky
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Was
h. U
.
12 d
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ctu
bre
Had
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h
May
o
Du
ke
U. P
enn
.
Dar
tmo
uth
U. C
hic
ago
Bic
hat
Gra
z
San
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U. C
olo
rad
o
U. P
itts
bu
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U. V
irg
inia
U. M
inn
eso
ta
Follow-up by Hospital
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%R
BK
U. M
ass.
12 d
e O
ctu
bre
Tro
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Ep
pen
do
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ock
Cal
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St.
Mic
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San
Do
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po
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rt
Mic
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a
Du
ke
Had
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h
Bri
gh
am &
Wo
men
's
Was
h. U
.
U. C
hic
ago
To
ky
o
May
o
U. P
enn
.
San
Gio
van
ni
e R
ug
gi
Dar
tmo
uth
U. C
olo
rad
o
Bic
hat
U. V
irg
inia
Gra
z
U. P
itts
bu
rgh
U. M
inn
eso
ta
% Follow-up by Hospital
Type B Follow-up
0
20
40
60
80
100
120
140
160
Mic
hig
an
Mas
s. G
en.
Val
l d
'Heb
ron
S. O
rso
la
Tro
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Ep
pen
do
rf-R
ost
ock
RB
K
San
Do
nat
o
St.
Mic
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ls
Cal
gar
y
To
ky
o
U. M
ass.
Min
nea
po
lis
Hea
rt
May
o
Was
h. U
.
Bri
gh
am &
Wo
men
's
Du
ke
Had
assa
h
12 d
e O
ctu
bre
U. P
enn
.
Vie
nn
a
San
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van
ni
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ug
gi
Dar
tmo
uth
U. C
olo
rad
o
U. C
hic
ago
Bic
hat
U. V
irg
inia
Gra
z
U. P
itts
bu
rgh
U. M
inn
eso
ta
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%12
de
Oct
ub
re
RB
K
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S. O
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Mas
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Mic
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Bri
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ago
Bic
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Gra
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inn
eso
ta
% Type B Follow-up
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%R
BK
Tro
mso
S. O
rso
la
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l d
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ron
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pen
do
rf-R
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ock
St.
Mic
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gar
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Mas
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en.
Mic
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an
San
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o
Bri
gh
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Wo
men
's
Min
nea
po
lis
Hea
rt
May
o
To
ky
o
Was
h. U
.
U. P
enn
.
% Type B Follow-up Sites with >100 Cases
0
20
40
60
80
100
120
140
RB
K
Mas
s. G
en.
S. O
rso
la
San
Do
nat
o
Mic
hig
an
Val
l d
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ron
St.
Mic
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ls
Min
nea
po
lis
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rt
Tro
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Cal
gar
y
Bri
gh
am &
Wo
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's
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nn
a
Ep
pen
do
rf-R
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ock
12 d
e O
ctu
bre
U. M
ass.
Was
h. U
.
Had
assa
h
To
ky
o
Du
ke
May
o
U. C
hic
ago
U. P
enn
.
San
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van
ni
e R
ug
gi
Dar
tmo
uth
U. C
olo
rad
o
Bic
hat
U. V
irg
inia
Gra
z
U. P
itts
bu
rgh
U. M
inn
eso
ta
Type A Follow-up
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
RB
K
U. M
ass.
12 d
e O
ctu
bre
Tro
mso
Cal
gar
y
Min
nea
po
lis
Hea
rt
Mas
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San
Do
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h
Bri
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ky
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May
o
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enn
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Bic
hat
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U. P
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U. M
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ta
% Type A Follow-up
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%R
BK
Tro
mso
Cal
gar
y
Min
nea
po
lis
Hea
rt
Mas
s. G
en.
Ep
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do
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ock
San
Do
nat
o
Val
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St.
Mic
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S. O
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Mic
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Bri
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men
's
Was
h. U
.
To
ky
o
May
o
U. P
enn
.
% Type A Follow-up Sites with >100 Cases
Notes on Variables {
Only diagnostic imaging studies should be included in the imaging studies section
No data from intra-operative or intra-procedure studies should be listed.
Acute Form Variables
Participating Sites {
Active IRAD Sites
IRAD Expansion {
Interested Sites
33 Sites Have inquired about joining the
IRAD registry.
New IRAD Sites Centers in the Process of Enrolling
University of Osaka, Osaka, Japan
Royal Prince Alfred Hospital, Sydney, Australia
Henry Ford Hospital, Detroit, Michigan
University of Sao Paulo, Sao Paulo, Brazil
Cedars-Sinai Medical Center, Los Angeles, California
Advocate Christ Medical Center, Chicago, Illinois
University of Maryland, Baltimore, Maryland
Methodist Hospitals of Memphis, Memphis, Tennessee
New IRAD Sites Centers in the Process of Enrolling
Interested sites that are recommended by a current IRAD member may join, if they agree to do the following:
Establish a dedicated study coordinator at their site
Commit to pay ~$5,000 annually, to cover expenses incurred from managing a larger database
Adding New Sites - Requirements
{ Publications Update
I. Ascending Thoracic Aorta Dimension and Outcomes in Acute Type B Dissection (from the International Registry of Acute Aortic Dissection [IRAD]).
American Journal of Cardiology. 2011.
II. The Role of Preoperative Coronary Angiography in the Setting of Type A Acute Aortic Dissection: Insights from the International Registry of Acute Aortic Dissection.
American Heart Journal. 2011.
Recently Published Manuscripts
III. Sensitivity of the Aortic Dissection Detection (ADD) Risk Score, A Novel Guideline-Based Tool for Identification of Acute Aortic Dissection at Initial Presentation.
Circulation. 2011.
IV. Descending Aortic Diameter of 5.5 cm or Greater is Not an Accurate Predictor of Acute Type B Aortic Dissection.
Journal of Thoracic and Cardiovascular Surgery. 2011.
Recently Published Manuscripts
V. Type-Selective Benefits of Medications in Treatment of Acute Aortic Dissection (from the International Registry of Acute Aortic Dissection[IRAD]).
American Journal of Cardiology. 2011.
VI. Correlates of Delayed Recognition and Treatment of Acute Type A Aortic Dissection: The International Registry of Acute Aortic Dissection (IRAD).
Circulation. 2011.
Recently Published Manuscripts
VII. Acute Type B Aortic Dissection in the Absence of Aortic Dilatation.
Journal of Vascular Surgery. 2012.
VIII.Clinical Presentation, Management and Short-Term Outcome of Patients with Type A Acute Dissection Complicated by Mesenteric Malperfusion. Observations from the International Registry of Acute Aortic Dissection.
Journal of Thoracic and Cardiovascular Surgery. 2012.
Recently Published Manuscripts
Manuscripts in Preparation {
1. Medical vs. Endovascular Tx in TB AoD
2. Age and Complications in TB AoD
3. Aortic Dimensions and Body Size
4. Marfan Syndrome in AoD
5. 24 Hour Mortality
6. Trends in AoD: 3000 Patients
7. Medical Management of TA AoD
8. BAV in AoD
9. Stroke in AoD
10. New Time Classification
11. Left Renal Artery Involvement in Type A
12. Normal Diameters
13. Non-Operative TA Patients
14. False Lumen Thrombosis in TA AoD
15. Spinal Cord Ischemia
16. Mortality Models for TA AoD
17. Young Women with AoD
18. Renal Insufficiency
19. Intramural Hematoma
20. Predictors of Aortic Growth
21. Medications in Marfan Patients
22. Pre-Procedure Neurological Deficits
23. Size and Dissection Risk in Marfan and BAV
24. Differences in Cannulation Strategy
25. Imaging Over 15 Years of IRAD
26. Racial Differences
27. Aortic Regurgitation on Follow-Up
28. Type A Dissection with Myocardial Infarction
29. Iatrogenic Aortic Dissection
30. Redissection on Follow-Up
31. CXR Sensitivity
32. Patient Education Surveys
33. Long-Term Follow-Up in Marfan Syndrome
34. Pregnancy in Aortic Dissection
35. Surgery in Elderly Type A Patients
Invasive Treatment Cohort
IRAD-IVC
{
Cases Enrolled to Date
668 cases enrolled
0
100
200
300
400
500
600
700
800
AHA
2010
ACC
2011
AHA
2011
Current
284
462
616
668
Cannulation Abstract
First IRAD submission using IVC data
Submitted to the AATS Aortic Symposium conference
Compared axillary vs. femoral cannulation in Type A dissection repair
Findings: Cannulation strategy did
not affect survival or malperfusion-related morbidity
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Mortality
Mortality by Site of Cannulation
Right
Axillary
Femoral
p=non-significant
Pre-op stratification of Type A patients
Pre-op stratification of Type B patients
Variation in outcomes among IRAD site following TAAoD repair
Fate of aortic valve following TAAoD
Is EEG monitoring mandatory during circulatory arrest in TAAoD?
Outcomes following aortic valve sparing operation in patients presenting with aortic valve incompetence in TAAoD
Open repair vs. closed repair
Future Project Ideas
Comparing antegrade cerebral perfusion, retrograde cerebral perfusion and deep hypothermic circulatory arrest without brain perfusion
Limited resection versus aggressive resection of descending dissection
Use of glue as a risk factor?
Elephant trunk repair vs. standard ascending aortic replacement in TAAoD
Long-term outcome of un-operated root in patients < 60 years of age?
Long-term outcome of un-operated arch in patients < 60 years of age?
Future Project Ideas
Survey Results
Patient Education
{
Patient Education Surveys
26 responses
50% use some sort of guidelines to determine appropriate patient activity
Majority recommended avoiding weight lifting
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Aerobic Recommendations
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Isometric Recommendations
{ Survey Results
Dynamic Imaging
Imaging Survey
Distributed to AHA attendees and emailed to IRAD investigators
Most expressed a desire to work with imaging specialists at their site
Ultimate goal: develop standardized imaging protocols
Echocardiography and CT imaging capabilities varied
ACC 2012 IRAD Presentations
{
Poster Presentations:
Temporal Trends in Imaging in Acute Aortic Dissection
Aortic Dissection During Pregnancy
Acute Type A Dissection Causing Acute Myocardial Infarction
Long-Term Follow-Up in Marfan Patients after Successful Surgery for Acute Type A Aortic Dissection
ACC 2012 IRAD Presentations
Poster Presentations (continued):
Mortality and Outcomes of Patients Presenting with and without Iatrogenic Aortic Dissections
Acute Renal Failure and its Early and Late Implications in Acute Aortic Dissection
Is Size a Good Predictor of Dissection Risk in Patients with Marfan Syndrome of Bicuspid Aortic Valves?
ACC 2012 (continued)
Upcoming Meetings {
Attendees Confirmed: 33
Chair: Kim A. Eagle, MD
Co-Chairs: Santi Trimarchi, MD
Eduardo Bossone, MD
Patrick O’Gara, MD
Joseph Bavaria, MD
Charing Cross Aorta 2012: April 12-13, London, England
Joseph Bavaria
Eduardo Bossone
Lori Conklin
Nimesh Desai
Marco Di Eusanio
Kim Eagle
Arturo Evangelista
Mark Fillinger
Alberto Forteza
James Froehlich
Dan Gilon
Martin Grabenwoger
Lisa Hackbarth
Eric Isselbacher
Frederik Jonker
Eva Kline-Rogers
Amit Korach
Sheila McGreal
Emil Missov
Franz Moll
Dan Montgomery
Truls Myrmel
Patrick O’Gara
Himanshu Patel
Mark Peterson
Linda Pitler
Brett Reece
Hasan Siddiqi
Sonja Sierpath
Peter Taylor
Santi Trimarchi
Elise Woznicki
Syed Yusuf
Charing Cross Attendees
IRAD IVC Meeting:
Wednesday, April 25th, 4:00-6:00 p.m.
The Hilton New York
Investigator dinner to follow (sponsored by GORE)
Attendees Confirmed: 8
AATS Aortic Symposium 2012: April 26-27, New York City
Oral Presentation:
Patients with Type A Acute Aortic Dissection Presenting with Major Brain Injury: Should we Operate on Them?
Presentation on Demand:
Outcomes Following Repair for Acute Type A Dissection are Independent of Cannulation Strategy: Femoral vs. Right Axillary Artery
AATS Aortic Symposium 2012 (continued)
Two abstracts submitted:
The Use of Chest X-Ray as a Diagnostic Tool in Acute Aortic Dissection
Racial Differences in Acute Aortic Dissection
ESC 2012: August 25-29, Munich
Funding {
W.L. Gore & Associates, Inc.
Varbedian Aortic Research Fund
Hewlett Foundation
Mardigian Foundation
UM Faculty Group Practice
Terumo
Current IRAD Funding Sources
2011 in Review {
16 abstracts accepted for presentation
8 manuscripts published in peer-reviewed journals
3 investigator meetings, with one dedicated solely to the Interventional Cohort
16 topics suggested for the AHA 2012 submission
32 projects in preparation
IRAD by the Numbers
In 2011 (compared to 2010):
135.2% increase in IVC data
26.1% increase in overall patient enrollment
10.9% increase in follow-up forms completed
50.0% increase in yearly manuscript publication
16.7% increase in annual abstract acceptance
So far in 2012, there has been a 28.6% increase in accepted abstracts when compared to 2011
IRAD by the Numbers
3 international investigators visited the coordinating center:
Toru Suzuki – Medications in Aortic Dissection; Medications in Marfan Syndrome Patients
Truls Myrmel and Magnus Larsen – False Lumen Thrombosis and Left Renal Artery Involvement
4 investigators plan to visit MCORRP:
Linda Pape – Trends in IRAD
Magnus Larsen – Left Renal Artery Involvement, Aortic Rupture on Follow-Up
Jip Tolenaar – Aortic Arch Dissection
IRAD by the Numbers
Future Directions {
Standardize training for data abstraction
Improve follow-up percentages
Enroll 1000 patients into the IVC registry; publish subgroup-focused papers and incorporate new surgical data into other IRAD projects.
Registry Aims for 2012
Expand IRAD to new sites using the pay-to-play model, focusing on geographical diversity and high-enrolling surgical and endovascular centers of excellence
Begin work on IRAD imaging protocols
Disseminate information gleaned from the patient education survey
Registry Aims for 2012
