Efficacy of limited proximal arch replacement for type A acute aortic dissection with critical complications

Hata, Mitsumasa; Orime, Yukihiko; Wakui, Shinji; Nakamura, Tetsuya; Hinoura, Rei; Akiyama, Kenji

doi:10.1007/s11748-016-0688-2

Cited by 4 publications

(3 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Considering the high complication rates and perioperative mortality of extended aortic arch repair, many surgeons are reluctant to perform a simple proximal repair alone, especially for acute type A AD with critical complications. 17 In the past, proximal permutation has been used extensively for type A AD, 5 In recent years, enlargement surgery has been used more frequently to completely eliminate lacerations. The meta-analysis suggested that the two methods had survival rate.…”

Section: Discussionmentioning

confidence: 99%

“…Considering the high complication rates and perioperative mortality of extended aortic arch repair, many surgeons are reluctant to perform a simple proximal repair alone, especially for acute type A AD with critical complications. 17 In the past, proximal permutation has been used extensively for type A AD, 5 In recent years, enlarge- survival rate. 7,18 Therefore, we believe that extensive surgery could improve distal vascular remodeling, reduce the reoperation rate significantly, and create conditions for TEVAR and thoracoabdominal aorta replacement.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Long‐term outcomes of treatment with different stent grafts in acute DeBakey type I aortic dissection

Xiao

Qiu

et al. 2020

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Background: We developed an integrated triple-branched stent to treat acute DeBakey type I aortic dissection (AD) and modified it to enhance its adaptability. However, whether the patients treated by the modified stent would achieve better long-term prognosis is unknown. Methods: This study enrolled 147 patients with acute DeBakey type I AD. The original integrated triple-branched stents were used in 57 patients (Group A) between July 2012 and August 2013, and the modified stents in 90 patients (Group B) between September 2013 and March 2015. Clinical characteristics, surgical data, postoperative complications, mortality, and follow-up data of the two groups were analyzed. Results: The two groups presented comparable early death rates (Group A = 7.0%, Group B = 5.9%; p = .719). The incidence of postoperative acute kidney injury (AKI) was lower in Group B (10.0%) versus Group A (24.6%) (p = .018). Compared with the original integrated triple-branched stent graft, the modified stent could reduce the risk of early postoperative AKI (OR [95% CI] = 0.36 [0.14, 0.94]). Early endoleak rates were significantly lower in Group B (1.0%) compared to Group A (9.4%) (p = .004). During follow-up, there were five deaths in Group A (9.4%) and six deaths in Group B (7.2%) (p = .646). Chronic kidney injury (7.5% vs. 3.6%; p = .311), delayed endoleak (11.3% vs. 4.8%; p = .157), and late reinterventions (7.5% vs. 2.4%; p = .155) in the two groups were similar. Conclusions: In patients with acute DeBakey type I AD, the modified stent showed feasible and safe treatment outcomes and reduced early endoleak rates. However, the long-term effects were similar to the original treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Considering the high complication rates and perioperative mortality of extended aortic arch repair, many surgeons are reluctant to perform a simple proximal repair alone, especially for acute type A AD with critical complications. 17 In the past, proximal permutation has been used extensively for type A AD, 5 In recent years, enlarge- survival rate. 7,18 Therefore, we believe that extensive surgery could improve distal vascular remodeling, reduce the reoperation rate significantly, and create conditions for TEVAR and thoracoabdominal aorta replacement.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of treatment with different stent grafts in acute DeBakey type I aortic dissection

Xiao

Qiu

et al. 2020

Journal of Cardiac Surgery

View full text Add to dashboard Cite

show abstract

“…Many surgeons are inclined to use only simple proximal repair, considering the high perioperative mortality and complication rates of extended arch repair. 14 A metaanalysis showed that although conservative proximal repair decreased early postoperative mortality, the reoperation rate on the distal vessels significantly increased, and the longterm survival rate was not improved. 15 Total arch replacement and FET could significantly improve distal vascular remodeling, decrease the reoperation rate, and create conditions for thoracoabdominal aorta replacement and thoracic endovascular aortic repair.…”

Section: Discussionmentioning

confidence: 99%

Untreated distal intimal tears may be associated with paraplegia after total arch replacement and frozen elephant trunk treatment of acute Stanford type A aortic dissection

Tan

Xiao

Zhou

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

Objective: To investigate the possible overlooked causes of early postoperative paraplegia, a severe complication of acute Stanford type A aortic dissection (ATAAD) after total arch replacement and frozen elephant trunk (FET). Methods:We reviewed the clinical data and perioperative aortic computed tomography angiography records of 110 consecutive patients with ATAAD who underwent total arch replacement and FET (12 cm) between December 2014 and September 2017 and investigated the possible risk factors related to early postoperative paraplegia.Results: Paraplegia occurred in 5 (4.5%) patients. No significant differences were found between patients with and without paraplegia in terms of sex, age, medical history, cardiopulmonary bypass time, antegrade cerebral perfusion time, rectal temperature during antegrade cerebral perfusion, postoperative hypotension, maximum first 24-hour vasoactive-inotropic score, upper-lower pressure gradient, or false lumen thrombosis. Postoperative aortic computed tomography angiography showed a ''cutoff'' phenomenon in the lower descending aorta in 4 of the 5 patients. Univariate logistical analysis showed that paraplegia was associated with the ''cutoff'' phenomenon (P <.05). The patients with a distance !30 mm from the distal end of the stent to the first untreated intimal tear had significantly greater rates of the ''cutoff'' phenomenon and paraplegia than those with the distance <30 mm (P <.05).Conclusions: Total arch replacement and FET is safe and feasible for ATAAD involving the descending aorta. Early postoperative paraplegia is associated with the ''cutoff'' phenomenon in the lower descending aorta. The position of the first untreated intimal tear may be related with the occurrence of the ''cutoff'' phenomenon and paraplegia.

show abstract

Efficacy of modified less invasive quick replacement using mild hypothermic arrest and partial retrograde cerebral perfusion for type A acute aortic dissection

Hata

Orime

Wakui

et al. 2017

Gen Thorac Cardiovasc Surg

View full text Add to dashboard Cite

show abstract

Efficacy of limited proximal arch replacement for type A acute aortic dissection with critical complications

Abstract: Limited proximal arch repair is suitable for high-risk patients with AAD, despite no excision of the intimal tear.

Cited by 4 publications

References 16 publications

Long‐term outcomes of treatment with different stent grafts in acute DeBakey type I aortic dissection

Long‐term outcomes of treatment with different stent grafts in acute DeBakey type I aortic dissection

Untreated distal intimal tears may be associated with paraplegia after total arch replacement and frozen elephant trunk treatment of acute Stanford type A aortic dissection

Efficacy of modified less invasive quick replacement using mild hypothermic arrest and partial retrograde cerebral perfusion for type A acute aortic dissection

Contact Info

Product

Resources

About