Aortic valve preservation and root reconstruction appear to be an appropriate surgical approach to AAAD.

Antiphospholipid antibodies (aPL)

Leaflet resection with sliding valvuloplasty or additional chordal replacement is a standard technique for very large posterior leaflet prolapse. Regular chordal replacement without resection is simpler than those techniques. However, it may not reduce the leaflet height enough to avoid systolic anterior motion. In our technique, two pairs of neochordae are placed on the middle portion of the prolapsing scallop, which fixes the prolapse, reduces the functional height of the posterior leaflet, and blocks the leaflet tip from moving forward. This simple nonresectional technique can be easily performed with minimally invasive approaches. Postoperative echocardiography shows excellent leaflet motion and deep coaptation.

No abstract

IntroductionStanford type A acute aortic dissection is one of the diseases requiring emergency surgery. In acute aortic dissection, a large number of thrombi are rapidly formed in the false lumen immediately after onset, which activates the fibrinolytic system. Moreover, the surgery is performed using extracorporeal circulation with haparin, under hypothermic conditions. Both use of extracorporeal circulation and hypothermia are known to activate the fibrinolytic system. Thus, perioperative bleeding is a major problem in surgery for acute aortic dissection, often necessitating blood transfusion in large amounts during surgery. Aprotinin, which had been used to reduce Purpose: We investigated the influence of intraoperative continuous tranexamic acid (TA) infusion on the amount of blood transfusion required in emergency surgery for type A acute aortic dissection. Methods: The study was based on the data of 55 consecutive patients who underwent surgery for type A acute aortic dissection. The patients were divided into 2 groups for comparison: Group T, consisting of 26 patients who received intraoperative continuous infusion of TA, and Group N, consisting of 29 patients who did not receive TA infusion during the surgery. Results: The mean amounts of blood transfusion required during and after surgery were compared between the 2 groups: they were 10.5 ± 8.7 and 16.2 ± 10.0 units of mannitoladenine-phosphate-added red cell concentrate, 9.3 ± 8.6 and 17.1 ± 10.0 units of fresh frozen plasma, and 20.4 ± 12.2 and 29.7 ± 14.9 units of platelet concentrate, respectively, in Groups T and N. Thus, the amount of each of these blood products required was significantly reduced in Group T. Conclusions: During emergency surgery for type A acute aortic dissection, continuous infusion of TA resulted in a significant reduction in the amount of blood transfusion required. Usefulness of Intraoperative Continuous Infusion of Tranexamic Acid during Emergency