The Nordic Consortium for Acute type A Aortic Dissection (NORCAAD): objectives and design^*

Figures & data

Table 1. Variables collected by participating NORCAAD centers.

	Essential	Non-essential
Demographics	Sex Age Day and time of admission Day and time of diagnosis	Day and time of first symptoms
Past medical history	Hypertension Known history of thoracic aortic aneurysm Connective tissue disease Bicuspid aortic valve Family history of dissection Family history of thoracic aneurysm History of type B dissection Diabetes mellitus Hyperlipidemia History of stroke History of transient ischemic attack Chronic kidney disease COPD Coronary artery disease Atrial fibrillation History of smoking Height Weight	Evidence of untreated hypertension Size of known aneurysm Location of aneurysm Prior aortic surgery Prior cardiac surgery History of vascular disease
Preoperative medications	Aspirin Clopidogrel Ticagrelor Warfarin Any antihypertensive medications	Fondaparinux Low molecular weight heparin Thrombolysis within 24 h of surgery Betablockers ACE inhibitors Angiotensin receptor II inhibitors
Clinical symptoms at presentation	Systolic blood pressure (SBP) Diastolic blood pressure (DBP) Acute chest and/or back pain Cardiogenic shock Initial SBP <90 mmHg Cardiopulmonary arrest 24 h prior to operation Hemopericardium at time of surgery Signs of pericardial tamponade Any malperfusion syndrome^a Cardiac malperfusion Gastrointestinal malperfusion Renal malperfusion Extremity malperfusion Cerebral malperfusion Spinal malperfusion DeBakey classification^b Intramural hematoma Iatrogenic dissection Penn Classification^c	Syncope
Methods of diagnosis	Primary imaging method Computed tomography (CT), Transthoracic echocardiogram (TTE) Transesophageal echo (TEE) Magnetic resonance imaging (MRI) Aortography Coronary catheterization	Additional imaging methods Largest diameter of aorta
Operative variables	Day and time of primary surgery Proximal repair AV resuspension + ascending graft Ascending graft replacement only Mechanical composite root Biological composite root Valve sparing root replacement Remodeling – ad modum Yacoub Reimplantation – ad modum David AVR + ascending (root not replaced) Ascending graft only (prior AVR) Distal repair Ascending aorta Hemiarch Total arch Additional aortic repair Aortic wrapping with mesh Intraluminal graft Suture of aortic layers only Elephant trunk Frozen elephant trunk Aortic valve annuloplasty Open distal anastomosis Hypothermic circulatory arrest (HCA) HCA techniques HCA only Antegrade cerebral perfusion Retrograde cerebral perfusion Combination of techniques Location of primary tear Excision of primary tear Additional procedures performed Operative time (skin to skin) Cardiopulmonary bypass time Cross-clamp time HCA time Lowest temperature of HCA Redo sternotomy Arterial cannulation sites  Femoral  Axillary/innominate  Ascending aorta’  Ventricle  Other Venous cannulation sites  Femoral  Right atrium  Bicaval  Other	Time interval First symptoms until surgery Admission to surgery Diagnosis until surgery Indication for root replacement Use of glue Use of felt Time of  Retrograde cerebral perfusion  Antegrade cerebral perfusion Use of neurocerebral monitoring
Postoperative complications^d	Reoperation for bleeding Revision of prior cardiac operation Deep sternal wound infection Renal replacement therapy (RRT) Respiratory failure Stroke Reoperation for bleeding Myocardial infarction/necrosis  CK-MB >70 μg/L, new Q wave,  interventricular conduction delays Stroke Transient neurological ischemia (TIA) Superficial sternal wound infection Deep sternal infection Postoperative mediastinitis Sternal dehiscence Septicemia Acute kidney injury (RIFLE)^e Ventilator support >48 h Tracheostomy Pneumonia Acute limb ischemia Cardiac arrest Cardiac tamponade Postoperative atrial fibrillation (POAF)	Interval time for reoperation Number of reoperations for bleeding Sternum left open for bleeding control Revision of primary operation Non-cardiac operation Coma for >24 h no sedation Focal neurological deficits Changes in mental status Delirium, agitation, confusion Lower extremity infection Urinary tract infection (UTI) Time on ventilator Number of reintubations Pulmonary embolism Pneumothorax Pleural effusion requiring drainage Heart block requiring pacemaker Anticoagulation complication Gastrointestinal complications Multisystem organ failure (MSOF) Gastrostomy or jejunostomy tube Deep venous thrombosis
Bleeding and blood transfusion	Bleeding for the first 24 h Transfusion requirement Packed red blood cells Platelets Fresh frozen plasma Fibrinogen Recombinant factor VIIa Tranexamic acid Aprotinin	Bleeding for the first 12 h Total bleeding volume
Laboratory test results	Highest value preoperative and postoperative  CK-MB  Serum creatinine  Lactate.
Outcome data	Survival status at time of discharge Survival 30 days after surgery Intraoperative death Day of discharge from hospital Mortality status on 31 December 2014 Alive Dead Unknown Day of death	Cause of death Cardiac Bleeding Neurological Other Unknown Length of stay in hospital Length of stay in intensive care unit
Echocardiography data		Preoperative aortic insufficiency (0–4) Preoperative ejection fraction (%) Postrepair aortic insufficiency Aortic insufficiency (0–4) on last echo
Reoperation data		Proximal reoperation Type of proximal operation AVR Root replacement Ascending graft Indication for proximal reoperation Severe aortic insufficiency Proximal pseudoaneurysm Endocarditis Graft infection Root aneurysm Other Date of proximal reoperation Distal reoperation Type of distal reoperation TAAA repair Hemiarch Total arch TEVAR Combination of TEVAR and other Indication for distal reoperation TAAA extent 1 TAAA extent 2 Distal pseudoaneurysm Graft infection Aneurysm undefined Date of distal reoperation Patient died following reoperation

Non-essentials variables were collected ad lib. COPD: chronic obstructive pulmonary disease; ACE: angiotensin-converting enzyme; AV: aortic valve; TAAA: thoracoabdominal aortic aneurysm, TEVAR: thoracic endovascular aneurysm repair.

^a Clinical malperfusion syndromes with documented dissection flap at or proximal to relevant organ system: Cardiac malperfusion (ST-changes, myocardial ischemia on echocardiogram or CK-MB >70 μg/L); Gastrointestinal malperfusion (mesenteric ischemia or ischemia of the liver); Renal malperfusion (anuria with documented occlusion of renal arteries); Extremity malperfusion (lack of pulses and loss of sensory or motor function of relevant extremity); Cerebral malperfusion (preoperative stroke with lateralizing symptoms or other neurological deficits); Spinal malperfusion (paraplegia).

^b DeBakey class I (Dissection involving ascending, arch, descending and abdominal aorta), DeBakey class II (Dissection involving ascending and arch only).[13]

^c Penn Class (A: No ischemia, B: Localizes ischemia, C: Generalized ischemia, B&C: Both localized and general ischemia).[14]

^d All complications apply to the time period between surgical repair of the dissection and discharge from the hospital and were defined as in the Society of Thoracic Surgeon dataset.[15]

^e RIFLE criteria (Risk >1.5× increase in s-creatinine, Injury >2.0× increase in s-creatinine, Failure >3.0× increase in s-creatinine, Loss – renal replacement therapy.[16]

Figure 1. Annual number of operations performed for acute type A aortic dissection at each participating center from 2005 to 2014. Data was not available for Sahlgrenska University Hospital for the years 2005–2006.

Table 2. Current NORCAAD research projects.

Projects
Short-term outcome and predictors of surgical mortality
Long-term survival and predictors of long-term survival
Role of surgical techniques, perfusion techniques on outcomes
Effects of malperfusion of specific organ systems on outcome
Effects of postoperative acute kidney injury on outcomes
Bleeding complications after ATAAD repair, role of prior antiplatelet therapy
Duration of symptoms, time until surgery and it effects on outcome
Distal and proximal late reoperations
Neurological complications following ATAAD repair
Difference in outcome between male and females

ATAAD: acute type A aortic dissection.

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Available from: http://www.sts.org/sts-national-database/database-managers/adult-cardiac-surgery-database/data-collection

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