IRAD Investigator Meeting American College of Cardiology 2012
{ Agenda
Agenda Database Update I. Notes on Variables II. Participating Sites III. IRAD Expansion IV. IRAD IVC V. Patient Education VI. Dynamic Imaging VII. VIII. Publications Update Manuscripts in Preparation IX. ACC 2012 Presentations X. Upcoming Meetings XI. 2011 in Review XII. XIII. Future Directions
{ Database Update
Total Patients Type A Type B
100 200 300 400 500 600 0 No. of Cases by Hospital Michigan Mass. Gen. U. Penn. S. Orsola Vall d'Hebron RBK San Donato Tromso St. Michaels Brigham & Women's Minneapolis Heart Tokyo Eppendorf-Rostock Calgary Mayo Wash. U. Vienna Hadassah U. Mass. San Giovanni e Ruggi 12 de Octubre Duke Dartmouth U. Colorado U. Chicago Bichat U. Virginia Graz U. Pittsburgh U. Minnesota
Total Follow-up Follow-up defined as a patient having at least one completed follow-up form. 4000 3867 3500 3086 (79.8%) 3000 2500 2000 1592 (51.6%) 1500 1000 500 0 Total Survived Followed Up
Follow-up by Type Type A Dissection Type B Dissection 2000 2000 1881 1500 1500 1205 908 (48.3%) 1000 1000 684 (56.8%) 500 500 0 0 Survived Followed Up Survived Followed Up
100 150 200 250 50 0 Follow-up by Hospital Mass. Gen. Michigan RBK S. Orsola Vall d'Hebron San Donato Tromso St. Michaels Eppendorf-Rostock Calgary Minneapolis Heart Brigham & Women's Vienna U. Mass. Tokyo Wash. U. 12 de Octubre Hadassah Mayo Duke U. Penn. Dartmouth U. Chicago Bichat Graz San Giovanni e Ruggi U. Colorado U. Pittsburgh U. Virginia U. Minnesota
100.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 0.0% % Follow-up by Hospital RBK U. Mass. 12 de Octubre Tromso Eppendorf-Rostock Calgary Vall d'Hebron Mass. Gen. St. Michaels San Donato S. Orsola Minneapolis Heart Michigan Vienna Duke Hadassah Brigham & Women's Wash. U. U. Chicago Tokyo Mayo U. Penn. San Giovanni e Ruggi Dartmouth U. Colorado Bichat U. Virginia Graz U. Pittsburgh U. Minnesota
100 120 140 160 20 40 60 80 0 Type B Follow-up Michigan Mass. Gen. Vall d'Hebron S. Orsola Tromso Eppendorf-Rostock RBK San Donato St. Michaels Calgary Tokyo U. Mass. Minneapolis Heart Mayo Wash. U. Brigham & Women's Duke Hadassah 12 de Octubre U. Penn. Vienna San Giovanni e Ruggi Dartmouth U. Colorado U. Chicago Bichat U. Virginia Graz U. Pittsburgh U. Minnesota
100.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 0.0% % Type B Follow-up 12 de Octubre RBK Tromso S. Orsola Vall d'Hebron Eppendorf-Rostock St. Michaels U. Mass. Calgary Mass. Gen. Michigan San Donato Hadassah Brigham & Women's Duke Minneapolis Heart Mayo Tokyo Wash. U. U. Penn. Vienna San Giovanni e Ruggi Dartmouth U. Colorado U. Chicago Bichat U. Virginia Graz U. Pittsburgh U. Minnesota
100.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 0.00% Sites with >100 Cases % Type B Follow-up RBK Tromso S. Orsola Vall d'Hebron Eppendorf-Rostock St. Michaels Calgary Mass. Gen. Michigan San Donato Brigham & Women's Minneapolis Heart Mayo Tokyo Wash. U. U. Penn.
100 120 140 20 40 60 80 0 Type A Follow-up RBK Mass. Gen. S. Orsola San Donato Michigan Vall d'Hebron St. Michaels Minneapolis Heart Tromso Calgary Brigham & Women's Vienna Eppendorf-Rostock 12 de Octubre U. Mass. Wash. U. Hadassah Tokyo Duke Mayo U. Chicago U. Penn. San Giovanni e Ruggi Dartmouth U. Colorado Bichat U. Virginia Graz U. Pittsburgh U. Minnesota
100.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 0.0% % Type A Follow-up RBK U. Mass. 12 de Octubre Tromso Calgary Minneapolis Heart Mass. Gen. Eppendorf-Rostock San Donato Vall d'Hebron St. Michaels S. Orsola Vienna Michigan Duke Hadassah Brigham & Women's Wash. U. U. Chicago Tokyo Mayo U. Penn. San Giovanni e Ruggi Dartmouth U. Colorado Bichat U. Virginia Graz U. Pittsburgh U. Minnesota
100.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 0.00% Sites with >100 Cases % Type A Follow-up RBK Tromso Calgary Minneapolis Heart Mass. Gen. Eppendorf-Rostock San Donato Vall d'Hebron St. Michaels S. Orsola Michigan Brigham & Women's Wash. U. Tokyo Mayo U. Penn.
{ Notes on Variables
Acute Form 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.
{ 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
Adding New Sites - Requirements 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
{ Publications Update
Recently Published Manuscripts Ascending Thoracic Aorta Dimension and I. Outcomes in Acute Type B Dissection (from the International Registry of Acute Aortic Dissection [IRAD]). American Journal of Cardiology. 2011. The Role of Preoperative Coronary II. 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 Type-Selective Benefits of Medications in V. 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.
{ Manuscripts in Preparation
Medical vs. Endovascular Tx in TB AoD 1. Age and Complications in TB AoD 2. Aortic Dimensions and Body Size 3. Marfan Syndrome in AoD 4. 24 Hour Mortality 5. Trends in AoD: 3000 Patients 6. Medical Management of TA AoD 7. BAV in AoD 8. Stroke in AoD 9. 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
IRAD-IVC { Invasive Treatment Cohort
Cases Enrolled to Date 800 668 700 616 600 668 500 462 400 284 300 cases enrolled 200 100 0 AHA ACC AHA Current 2010 2011 2011
Cannulation Abstract First IRAD submission Mortality by Site of Cannulation using IVC data 100.0% Submitted to the AATS 90.0% Aortic Symposium 80.0% conference 70.0% Right Compared axillary vs. 60.0% Axillary femoral cannulation in 50.0% 40.0% Type A dissection repair Femoral 30.0% Findings: 20.0% Cannulation strategy did 10.0% not affect survival or 0.0% malperfusion-related Mortality morbidity p=non-significant
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