Acute DeBakey Type I aortic dissection without intimal tear in the arch: is total arch replacement the right choice?

Colli, Andrea; Carrozzini, Massimiliano; Francescato, Annalisa; Galuppo, Marco; Comisso, Marina; Toto, Francesca; Gregori, Darío; Gerosa, Gino

doi:10.1093/icvts/ivx229

Cited by 18 publications

(13 citation statements)

References 27 publications

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“…In 2018 Colli and colleagues performed surgical approaches on patients with Stanford A AAD without intimal tear in the aortic arch and found that patients with total aortic arch repair suffered from a higher 30-day mortality. 34 However longterm mortality in the total aortic arch repair group was similar to the ascending and hemiarch repair groups. These results corroborate our results focusing on less invasive or aggressive surgical procedures.…”

Section: Discussionmentioning

confidence: 75%

“…Latest studies published by Colli and colleagues in 2018 and 2016 34,35 and by Russo and colleagues 37 revealed that despite substantial progress in surgical techniques and perioperative management, the best surgical approach for patients suffering from Stanford A dissection is still controversial and outcomes highly dependent on perioperative risk factors.…”

Section: Discussionmentioning

confidence: 99%

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Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

Merkle

Sabashnikov

Deppe

et al. 2018

Therapeutic Advances in Cardiovascular Disease

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Background: Stanford A acute aortic dissection (AAD) is a life-threatening emergency associated with major morbidity and mortality. The aim of this study was to compare outcomes of three different surgical approaches in patients with Stanford A AAD. Methods: From January 2006 to March 2015 a total of 240 consecutive patients with diagnosed Stanford A AAD underwent elective, isolated surgical aortic repair in our centre. Patients were divided into three groups according to the extent of surgical repair: isolated replacement of the ascending aorta, hemiarch replacement and total arch replacement. Patients were followed up for up to 9 years. After univariate analysis multinomial logistic regression was performed for subgroup analysis. Baseline characteristics and endpoints as well as long-term survival were analysed. Results: There were no statistically significant differences among the three groups in terms of demographics and preoperative baseline and clinical characteristics. Incidence of in-hospital stroke (p = 0.034), need for reopening due to bleeding (p = 0.031) and in-hospital mortality (p = 0.017) increased significantly with the extent of the surgical approach. There was no statistical difference in terms of long-term survival (p = 0.166) among the three groups. Applying multinomial logistic regression for subgroup analysis significantly higher odds for stroke (p = 0.023), reopening for bleeding (p = 0.010) and in-hospital mortality (p = 0.009) for the arch surgery group in comparison to the ascending aorta surgery group as well as significantly higher odds for stroke (p = 0.029) for the total arch surgery group in comparison to the hemiarch surgery group were identified. Conclusions: With Stanford A AAD the incidence of perioperative complications increased significantly with the extent of the surgical approach. Subgroup analysis and long-term follow up in patients undergoing isolated ascending or hemiarch surgery showed a lower incidence of cerebrovascular events compared with surgery for total arch replacement.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

Merkle

Sabashnikov

Deppe

et al. 2018

Therapeutic Advances in Cardiovascular Disease

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“…Crack growth was also measured after the experiment. Aortic dissection is most commonly associated with an intimal tear or notch [53,[57][58][59], however it can and does occur (although less commonly) without a visible entry tear in certain cases [60][61][62][63]. This is reflected in the results of our study, all samples tested with a radial notch exhibited extensive mode II crack growth whereas only 3 out of 8 samples with a circumferential notch exhibited mode II crack growth.…”

Section: Appendix A: Artery Materials Modelmentioning

confidence: 49%

Development of a test method to investigate mode II fracture and dissection of arteries

FitzGibbon

McGarry

2021

Acta Biomaterialia

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The current study presents the development and implementation of a bespoke experimental technique to generate and characterise mode II crack initiation and propagation in arterial tissue. The current study begins with a demonstration that lap-shear testing of arterial tissue results in mixed mode fracture, rather than mode II. We perform a detailed computational design of a bespoke experimental method (which we refer to as a shear fracture ring test (SFRT)) to robustly and repeatably generate mode II crack initiation and propagation in arteries. This method is based on generating a localised region of high shear adjacent to a cylindrical loading bar. Placement of a radial notch in this region of high shear stress is predicted to result in a kinking of the crack during a mode II initiation and propagation of the crack over a long distance in the circumferential (c)-direction along the circumferential-axial (c-a) plane. Fabrication and experimental implementation of the SFRT on excised ovine aorta specimens confirms that the bespoke test method results in pure mode II initiation and propagation. We demonstrate that the mode II fracture strength along the c-a plane is eight times higher than the corresponding mode I strength determined from a standard peel test. We also calibrate the mode II fracture energy based on our measurement of crack propagation rates. The mechanisms of fracture uncovered in the current study, along with our quantification of mode II fracture properties have significant implications for current understanding of the biomechanical conditions underlying aortic dissection.

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“…Average crack length was 11.79mm+/− 4.1mm. Aortic dissection is most commonly associated with an intimal tear or notch [33,[37][38][39], however it can and does occur (although less commonly) without a visible entry tear in certain cases [40][41][42][43]. This is reflected in the results of our study, all samples tested with a radial notch exhibited extensive mode II crack growth whereas only 3 out of 8 samples with a circumferential notch exhibited mode II crack growth.…”

Section: Appendix A: Artery Materials Modelmentioning

confidence: 49%

Development of a test method to investigate mode II fracture and dissection of arteries

FitzGibbon¹,

McGarry²

2020

Preprint

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The current study presents the development and implementation of a novel experimental technique to generate and characterise mode II crack initiation and propagation in arterial tissue. The current study begins with a demonstration that lap-shear testing of arterial tissue results in mixed mode fracture, rather than mode II. We perform a detailed computational design of a novel experimental method (which we refer to as a shear fracture ring test (SFRT)) to robustly and repeatably generate mode II crack initiation and propagation in arteries. This method is based on generating a localised region of high shear adjacent to a cylindrical loading bar. Placement of a radial notch in this region of high shear stress is predicted to result in a kinking of the crack during a mode II initiation and propagation of the crack over a long distance in the c-direction along the c-a plane. Fabrication and experimental implementation of the SFRT on excised ovine aorta specimens confirms that the novel test method results in pure mode II initiation and propagation. We demonstrate that the mode II fracture strength along the c-a plane is eight times higher than the corresponding mode I strength determined from a standard peel test. We also calibrate the mode II fracture energy based on our measurement of crack propagation rates. The mechanisms of fracture uncovered in the current study, along with our quantification of mode II fracture properties have significant implications for current understanding of the biomechanical conditions underlying aortic dissection.

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Acute DeBakey Type I aortic dissection without intimal tear in the arch: is total arch replacement the right choice?

Abstract: TAR was associated with higher 30-day mortality compared with the less extensive hemiarch replacement. In the long term, TAR showed a trend of improved survival and higher reintervention rate.

Cited by 18 publications

References 27 publications

Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

Development of a test method to investigate mode II fracture and dissection of arteries

Development of a test method to investigate mode II fracture and dissection of arteries

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