Here, we review our experience in acute type A aortic dissection analyzing the role of antegrade brain protection. A total of 105 patients underwent surgery for acute type A aortic dissection between March 1990 and October 2008. An open technique with deep hypothermia was used in 81 patients. Deep hypothermia alone was induced in 32 patients; in combination with retrograde cerebral perfusion in 26 patients and in combination with antegrade cerebral perfusion (ACP) in the final 23 patients. The overall hospital mortality rate was 15%. Hospital mortality risk factors were age >or=70 years and preoperative shock (P<0.05). Hospital mortality was reduced to 9% in the last 23 consecutive patients in whom ACP was accomplished (P=0.05). Survival rate after 1, 5, 10 and 15 years of follow-up was 97.6+/-1.7%, 84.3+/-4.4%, 60.7+/-7.5% and 57.1+/-7.8%, respectively. The only late death risk predictor was the non-use of ACP (P<0.05). Surgery for acute aortic dissection provides excellent results. ACP via the axillary artery improves the prognosis for these patients and should be the brain protection method of choice.
Acute type A aortic dissection is an uncommon complication after orthotopic heart transplantation and usually affects the native aorta. Seven cases reported in the literature describe an aortic dissection confined to the donor aorta and only in two of them were they detected during the early postoperative period. We describe the case of a 58-year-old man, the recipient of a cardiac allograft for ischemic cardiomyopathy 20 days earlier, who presented an acute type A aortic dissection limited to the donor aorta. Transesophageal echocardiography revealed severe aortic regurgitation and an intimal tear 2 cm above commissures. The patient was successfully treated with a composite valve graft. This case is the first successful repair in a cardiac allograft with acute aortic dissection of the donor aorta during the early postoperative period using a Bentall procedure.
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