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Applying the concept of “door to balloon” to the management of ascending aortic dissections. Introducing the notion of “door to CT to OR” as a new strategy to improve surgical outcomes
Background:
Mortality associated with Ascending Aortic Dissections (AAD) is well documented. Deaths due to inter-hospital transfer or delay in management are not included in any registries. We introduce the concept of “door to CT to OR” to improve results.
Methods:
From January 2006 to June 2011 we treated 26 patients with AADs. There were 21 males and 5 females with a mean age of 60.2 years. Awareness of AAD among the Emergency Department (ED) staff coupled with a CT scanner in the ED allowed for a rapid diagnosis in 22 cases.
Results:
The 30-day mortality rate was 7.7% (2 patients). One was paraplegic upon arrival and died six weeks post-surgery. The other expired due to a complex stroke. Five patients developed shock during transfer to the operating room or during anesthetic induction. They all survived. Four patients improved following pericardiotomy, allowing for cannulation and initiation of Cardio Pulmonary Bypass (CPB). Table 1
Conclusion:
We introduce the concept of “door to CT to OR”. Expeditious diagnosis and treatment of AAD is critical in improving outcomes. This approach emulates the door-to-balloon concept in the management of acute infarction.
Institutions with cardiac surgical capabilities should develop protocols to expedite the treatment of these patients and establish relationships to facilitate transfers from those facilities that do not provide cardiac surgery

	AAD only 20 PTS	AAD + AVR 4 PTS	AAD + AVR + CABG 2 PTS
Age ( years)	60.4	55.5	67.5
Sex ( male)	15 (75%)	3 (75%)	2 (100%)
Prior Operation	0	2 (50%)	1 (50%)
Preoperative Shock	5 (25%)	0	0
History of Stroke	3 (15%)	0	0
Renal Insufficiency	2 (10%)	0	0
In Hospital and 30 day Mortality	1 (5%)	1 (25%)	0
Overall Mortality		2/26 = 7.7%