Conservative treatment of the aortic root in acute type a dissection1

Niederhäuser, U; Künzli, Andreas; Seifert, Burkhardt; Schmidli, Jürg; Lachat, Mario; Zünd, Gregor; Vogt, Paul; Turina, Marko

doi:10.1016/s1010-7940(99)00079-2

Cited by 33 publications

(28 citation statements)

References 21 publications

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“…The rate of reoperation for redissection was higher in this series than in others, [5][6][7][8]15,16 which suggests that the development of redissection was more closely related to the technique of anastomosis with GRF glue. The possible factors associated with the technique of anastomosis include the method of compressing the layers of the dissected aortic wall, the duration of compression for polymerization, the temperature of the tissue where glue is applied, and the performance of Teflon-felt reinforcement.…”

Section: Discussioncontrasting

confidence: 47%

Influence of Gelatin-Resorcin-Formalin Glue on Mid-Term Redissection After Aortic Repair

et al. 2005

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Section: Discussioncontrasting

confidence: 47%

Influence of Gelatin-Resorcin-Formalin Glue on Mid-Term Redissection After Aortic Repair

et al. 2005

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“…Conservative root repair has been recommended to reduce the complexity of the surgery, with the goal of improving the initial operative outcome rather than long-term sequelae (1,3,(7)(8)10,25,26). Aortic valve re-suspension has been utilized to repair the AR with good results, as long as the root is not excessively dilated or the intimal tear does not extend below the sino-tubular junction (1,7,26).…”

Section: Root Management and Extent Of Distal Repairmentioning

confidence: 99%

“…Despite diminishing reliance on the femoral artery, there has been no consensus on the best arterial cannulation technique with the lowest complication rate that could shorten operative times (9). Proponents of a more conservative root management and extent of distal repair claimed that early survival is improved by reducing the complexity of the surgery, a gain that is offset by the higher risk of reoperation when diseased aortic tissue is left in situ (1,7,8,10).…”

Section: Introductionmentioning

confidence: 99%

Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Cabasa¹,

Pochettino²

2016

Ann. Cardiothorac. Surg.

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Background: Type A aortic dissection (TAAD) is a complex cardiovascular disease that is associated with high perioperative morbidity and mortality. The most effective approach is still being debated-such as the best cannulation technique, and conservative versus extensive initial surgery. We reviewed our experience over the last 20 years and examined for variables that correlated with observed outcomes.Methods: All patients who underwent TAAD repair were reviewed. Chi-Square tests, Fisher Exact tests and Wilcoxon tests were performed where appropriate. Survival and freedom from reoperations were analyzed with the Kaplan-Meier actuarial method.Results: Acute TAAD was associated with a higher incidence of permanent stroke (P=0.010), renal failure (P=0.025), prolonged mechanical ventilator support (P=0.004), higher operative mortality (P=0.039) and higher 30-day mortality (P=0.003) compared to chronic TAAD. There was a trend towards higher risk for transient neurologic events among patients who were reoperated on (P=0.057). Extensive proximal repair led to longer perfusion and cross clamp times (P<0.001) and the need for temporary mechanical support postoperatively (P=0.011). More patients that had extensive distal repair underwent circulatory arrest (P=0.009) with no significant differences in the incidence of peri-operative complications, early, middle and long-term survival compared to the conservative management group. Overall survival in our series was 66.73% and 46.30% at 5 and 10 years respectively (median survival time: 9.38 years). There was a significant improvement in operative mortality (P=0.002) and 30-day mortality (P=0.033) in the second decade of our study.Conclusion: TAAD is a complex disease with several options for its surgical management. Each technique has its own advantages and complications and surgical management should be individualized depending on the clinical presentation. We propose our present approach to maximize benefits in both the short and long term.

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“…Initial modeling used elements marginally suggestive of an unadjusted association to in-hospital death (defined as PϽ0. 20). Variables were reviewed for clinical significance before testing.…”

Section: Predictive Modelingmentioning

confidence: 99%

Predicting Death in Patients With Acute Type A Aortic Dissection

et al. 2002

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Background-Given the high mortality rates in patients with type A aortic dissection, predictive tools to identify patients at increased risk of death are needed to assist clinicians for optimal treatment. Methods and Results-Accordingly, we evaluated 547 patients with this diagnosis enrolled in the International Registry of Acute Aortic Dissection (IRAD) between January 1996 and December 1999. Univariate testing followed by multivariate logistic regression analysis was performed to identify independent predictors of death. In-hospital mortality rate was 32.5% in type A dissection patients.

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Conservative treatment of the aortic root in acute type a dissection1

Cited by 33 publications

References 21 publications

Influence of Gelatin-Resorcin-Formalin Glue on Mid-Term Redissection After Aortic Repair

Influence of Gelatin-Resorcin-Formalin Glue on Mid-Term Redissection After Aortic Repair

Surgical management and outcomes of type A dissection—the Mayo Clinic experience

Predicting Death in Patients With Acute Type A Aortic Dissection

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