Extended total arch replacement for acute type a aortic dissection: Experience with seventy patients

Kazui, Teruhisa; Washiyama, Naoki; Bashar, Abul Hasan Muhammad; Terada, Hitoshi; Yamashita, Katsushi; Takinami, Makoto; Tamiya, Yukihiko

doi:10.1016/s0022-5223(00)70136-x

Cited by 186 publications

(128 citation statements)

References 27 publications

(40 reference statements)

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“…In an effort to maximize the resection of entry tears and to decrease the incidence of residual patent false lumina, several groups [4][5][6][7]11,12 have advocated a more aggressive approach to aortic arch repair: routine replacement of the total aortic arch regardless of the site of the entry tear, although distal manipulation has been associated with an increased operative mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…Because the residual dissection flap in the aortic arch and descending aorta carries risks of progressive aortic dilation and rupture and the need for secondary intervention, several groups have suggested immediate extensive surgery that involves the aortic arch, although concomitant distal aortic manipulation has been associated with an increased risk of morbidity and death. [4][5][6][7][8][9][10][11][12][13] In this situation, 2 different surgical strategies have been proposed: total arch replacement or hemiarch replacement (a more conservative repair limited to the ascending aorta and proximal arch). 4,[9][10][11][12] We evaluated the early and intermediate outcomes of aortic arch surgery in patients with type A AAD, investigating the effect, upon postoperative results, of aortic arch extension.…”

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confidence: 99%

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Total Arch versus Hemiarch Replacement for Type A Acute Aortic Dissection: A Single-Center Experience

Lio¹,

Nicolò²,

Bovio³

et al. 2016

Texas Heart Institute Journal

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T he surgical mortality rate for type A acute aortic dissection (AAD) still remains high (8%-34%), despite improvements in perioperative and postoperative management during the last decade.1-3 Complete resection of the intimal tear and prosthetic replacement of the ascending aorta are still considered the standard of care for type A dissection surgery. Because the residual dissection flap in the aortic arch and descending aorta carries risks of progressive aortic dilation and rupture and the need for secondary intervention, several groups have suggested immediate extensive surgery that involves the aortic arch, although concomitant distal aortic manipulation has been associated with an increased risk of morbidity and death. [4][5][6][7][8][9][10][11][12][13] In this situation, 2 different surgical strategies have been proposed: total arch replacement or hemiarch replacement (a more conservative repair limited to the ascending aorta and proximal arch). 4,[9][10][11][12] We evaluated the early and intermediate outcomes of aortic arch surgery in patients with type A AAD, investigating the effect, upon postoperative results, of aortic arch extension. Patients and MethodsWe undertook a retrospective, observational study of prospectively collected data on consecutive patients who had presented with type A AAD at our institution. This cohort study was approved by our local ethics committee, and individual consent was obtained by each patient's physician. From January 2006 through July 2013, 201 patients with type A AAD underwent urgent surgery at our institution. For the purposes of this study, we did not consider 109 AAD patients who underwent isolated replacement of the ascending aorta. We included only the 92 patients who underwent

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Total Arch versus Hemiarch Replacement for Type A Acute Aortic Dissection: A Single-Center Experience

Lio¹,

Nicolò²,

Bovio³

et al. 2016

Texas Heart Institute Journal

View full text Add to dashboard Cite

show abstract

“…3,[5][6][7] The main benefit of this approach is the complete resection of a small, invisible entry site located in the aortic arch. 6) We have recently reported that the patent false lumen of the distal aorta were associated with late, distal aortic enlargement.…”

Section: Discussionmentioning

confidence: 99%

In-hospital and Long-Term Results of Surgery for Acute Type A Aortic Dissection: 243 Consecutive Patients

Tanaka

Kimura

Yamaguchi

et al. 2012

ATCS

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Background: Our surgical strategies for acute type A aortic dissection (AAAD) are prompt establishment of cardiopulmonary bypass and primary entry resection. We investigated our experience with surgery for AAAD. Methods: Between January 1997 and December 2006, 243 consecutive patients with AAAD underwent emergency surgery. Clinical and diagnostic data of these patients were analyzed retrospectively. Results: Surgical procedures included ascending aorta or hemiarch replacement (n = 212) and total or partial arch replacement (n = 31), and those for proximal reconstruction included modified Bentall procedure (n = 8), and aortic valve replacement (n = 3). Hospital mortality was 6.9%, and entry resection was performed in 74% of patients. Actuarial survival rate at 5 and 10 years was 86% ± 14% and 77% ± 23%, respectively. A total of 13 patients required re-operation: 5, an aortic root; 3, an aortic arch; and 5, a descending aorta. Actuarial freedom from re-operation at 5 and 10 years was 95% ± 5%, and 81% ± 18%, respectively. Conclusions: Our surgical strategy for AAAD seems to be pertinent with acceptable shortand long-term results. Since we lost 8 patients due to rupture of false lumen postoperatively, careful follow-up for a residual false lumen may improve the patients' prognosis.Keywords: aortic dissection, aortic operation, outcomes, aortic reoperation Ann Thorac Cardiovasc Surg 2012; 18: 18-23 doi: 10.5761/atcs.oa.11.01704 have shown that a more aggressive technique, such as the routine replacement of a total arch, have resulted in better long-term outcomes by the elimination of the residual, patent false lumen. 3,5-7)However, we believe that priority of the patient with AAAD is immediate survival, which may be accomplished by simple and less invasive operative procedures, rather than risking further aggression for already risky patient through extended surgery. Simple and less invasive operative procedures that we recommend include prompt establishment of cardiopulmonary bypass to prevent malperfusion, preservation of the aortic valve whenever possible, and aortic arch replacement in patients with an entry site located in or extending into the aortic arch. This study investigated our early and late surgical results of AAAD to validate our surgical strategy for AAAD.

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“…In 1983, Borst introduced the elephant trunk procedure [3], followed by a variety of modifications [4][5][6], with improved clinical outcomes over the years [7][8][9]. Recently, endovascular placement of stent grafts and hybrid repair have also emerged as new treatment options [10,11].…”

Section: Introductionmentioning

confidence: 99%

Dr. Sun's Procedure for Type A Aortic Dissection: Total Arch Replacement Using Tetrafurcate Graft With Stented Elephant Trunk Implantation

Zheng

Liu

et al. 2013

aorta

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Sun's procedure is a modified elephant trunk technique that integrates the advantages of open surgical and endovascular repairs as a treatment of type A aortic dissection. It is named after Dr. Li-Zhong Sun and refers to total arch replacement using a four-branched graft with implantation of a special stented endovascular graft. Since its introduction, it has produced excellent early and late clinical outcomes. We present a video of this procedure and make an overview regarding the technical aspects, surgical indications, and clinical outcomes of Sun's procedure.

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Extended total arch replacement for acute type a aortic dissection: Experience with seventy patients

Abstract: Extended total arch replacement for acute type A aortic dissection could be justified in properly selected patients.

Cited by 186 publications

References 27 publications

Total Arch versus Hemiarch Replacement for Type A Acute Aortic Dissection: A Single-Center Experience

Total Arch versus Hemiarch Replacement for Type A Acute Aortic Dissection: A Single-Center Experience

In-hospital and Long-Term Results of Surgery for Acute Type A Aortic Dissection: 243 Consecutive Patients

Dr. Sun's Procedure for Type A Aortic Dissection: Total Arch Replacement Using Tetrafurcate Graft With Stented Elephant Trunk Implantation

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