![]() As the remaining two patients, who did not undergo pericardiocentesis, survived, they speculated that pericardiocentesis induced intensified bleeding and extension of the dissection of the aorta. In 1994, Isselbacher et al reported the following catastrophic results: in six patients presenting with cardiac tamponade in the context of AADA on arrival at hospital or during emergency room evaluation, four underwent pericardiocentesis, three of whom died after pericardiocentesis. In this situation, percutaneous pericardiocentesis has usually been contraindicated, given the possibility that rapid and aggressive drainage of pericardial blood may precipitate a worsening leak from the aorta into the pericardium. However, in the case of cardiac tamponade in the context of AADA, the indications for pericardiocentesis are still a matter of controversy. Pericardiocentesis has been proven to be a safe and effective procedure in the treatment of cardiac tamponade caused by various underlying diseases. Therefore, the presence of cardiac tamponade should prompt urgent aortic repair. In-hospital mortality from AADA with cardiac tamponade was 54%, which was more than twice the mortality rate without cardiac tamponade (24.6%, p<0.0001). Prolonged hypotension from admission to the operating room is associated with fatal outcomes in more than 40% of patients. However, cardiac tamponade is one of the important risk factors in poor outcomes. Recent studies have shown that surgical repair of an acute type A aortic dissection (AADA) has been markedly improved. Prognosis of cardiac tamponade due to aortic dissection In addition, when cardiac tamponade occurs in patients with AADA, many die before reaching hospital and before a diagnosis is made. The incidence of cardiac tamponade has been reported as being between 8% and 31% in patients with AADA. Most commonly, the transudation of fluid across the thin wall of an adjacent false lumen into the pericardial space leads to a haemodynamically insignificant pericardial effusion, which is present in one third of patients. Pericardial fluid collection is a frequent complication of AADA. However, controversy surrounds the treatment of patients with haemopericardium and cardiac tamponade who will not survive until surgery. The presence of cardiac tamponade should prompt urgent aortic repair. Tamponade-induced hypotension associated with aortic rupture has been identified as a major risk factor for perioperative mortality in patients with AADA. Cardiac tamponade is the most common cause of death in patients with acute type A aortic dissection (AADA) before they present for medical care.
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