Clinical Trend of Optimal Treatment Strategy for type A Acute Aortic Dissection

Abstract

The mortality of emergency surgical intervention for type A acute aortic dissection (AAD) has been variously reported as 15-30%. These findings are often derived from series spanning 10-20 years. Recent advances in surgical techniques, anesthesia, and perioperative medical management are likely to have lowered the mortality of emergency operations over the last few years. In fact, many factors, such as surgical techniques, use of sealed prosthesis, access of cardiopulmonary bypass, cerebral protection techniques, and postoperative surveillance have markedly changed during this long time interval, influencing the recently-improved surgical outcomes. For example, open distal anastomosis to avoid aortic cross clamping and antegrade systemic recirculation after distal anastomosis have dramatically improved the early and late outcomes of surgery for AAD. On the other hand, in recent aging society, the number of octogenarians undergoing emergency surgery for AAD has been steadily increasing and this may negate the impact of the beneficial advances. We reviewed clinical trend of the optimal treatment strategy for type A acute aortic dissection and presented our newly modified technique, namely, less invasive quick replacement (LIQR) with rapid re-warming for octogenarians undergoing emergency surgery for type A acute aortic dissection.

Early and midterm outcomes of quick proximal arch replacement with mild hypothermia and rapid rewarming for type A acute aortic dissection

“…These symptoms were frequently overlapped in many patients, resulting in 18 patients (19.8%) having predictors for surgical mortality, such as vital organ malperfusion or preoperative cardiopulmonary arrest. 6 Surgical Procedure CPB was implemented via femoral arterial cannulation. The ascending aorta was clamped and opened longitudinally.…”

“…4 This high mortality rate is associated with various complications, such as uncontrollable bleeding, renal and respiratory failure, brain damage, infection, or becoming bedridden because of the extensive surgical stress caused by deep hypothermia and longer durations of cardiopulmonary bypass (CPB) and overall surgery. 5,6 Therefore, if surgical stress can be minimized by shortening the duration of brain ischemic stress, CPB, and operative procedures, the surgical outcome for AAD could be further improved.…”

Acute aortic dissection: An update

“…By contrast, the best treatment for the octogenarian patient is still unclear and needs further research. However, a minimally invasive approach, such as the less-invasive quick replacement with moderate hypothermic circulatory arrest followed by aggressive rapid rewarming, appears to be an option when treating this group of patients [56].…”

“…Deciding which aortic segment will be replaced is based on the location of the intimal tear. Furthermore, the following techniques have improved both early and late surgical outcomes in recent years: (1) open distal anastomosis to avoid aortic cross clamping; (2) antegrade systemic recirculation after distal anastomosis; (3) biological glue to preserve the native aortic valve when indicated; (4) cerebral protection with selective antegrade cerebral perfusion (SACP) or retrograde cerebral perfusion; and (5) postoperatively receiving a false lumen examination with periodical imaging studies [56]. When repairing an AAD, brain preservation is still one of the major challenges during surgery, and failure to do so is the best predictor of hospital mortality [57].…”

Successful treatment of an acute type A aortic dissection presented with ST segment elevation on ECG and pericardial tamponade. Case report

“…Hazánkban az akut coronariaszindróma kezelésére megszervezett országos katéterlaboratóriumi hálózat nagy segítséget jelent a mellkasi fájdalommal vagy EKGeltéréssel jelentkező akut dissectiós betegek helyes terá-piás irányba való terelésénél. Az akut aortadissectio mű-tétjének 30 napos mortalitása ennek ellenére is 9-30% a nemzetközi adatok alapján, az ötéves túlélés 50-80% kö-zött változik [10,11].…”