Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection

Kimura, Naoyuki; Tanaka, Masashi; Kawahito, Koji; Yamaguchi, Atsushi; Ichihara, T.; Adachi, Hideo

doi:10.1016/j.jtcvs.2008.05.052

Cited by 123 publications

(90 citation statements)

References 25 publications

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“…Our relatively conservative surgical approach seems to be reasonable for patients experiencing at least one of various preoperative complications, or elderly, from previous reports showing that elderly patients tended to have a thrombosed false lumen after initial surgery for AAAD. 8) Ten-year survival rates ranged from 37% to 71% in previously reported cases, 11,[15][16][17][18] 77% survival rate at 10 years in our institution seems acceptable. DeBakey et al reported that rupture of the distal aorta was the most common cause of death among patients with AAAD, accounting for 29.3% of 205 late deaths.…”

Section: Discussionmentioning

confidence: 65%

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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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Section: Discussionmentioning

confidence: 65%

“…3,[6][7] It is possible that the low percentage of aortic arch replacements in the present series (12%, 28/243) led to the relatively high rate of residual, false lumen patency. 8) Crawford et al recommended replacement of the aortic arch, only when it is aneurysmic and there is a risk for impending or actual rupture of the false lumen.…”

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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“…Surgery for ATAAD was as reported previously 25, 26, 27. Briefly, aortic repair was performed via median sternotomy.…”

Section: Methodsmentioning

confidence: 99%

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

Itagaki

Kimura

Mieno

et al. 2018

JAHA

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BackgroundClinical characteristics and treatment outcomes of acute type A aortic dissection with D‐dimer elevation have not been clarified.Methods and ResultsD‐dimer was measured preoperatively within 24 hours of symptom onset in 262 patients with acute type A aortic dissection. The median (and interquartile range) admission D‐dimer concentration in our total patient group was 26.7 (8.3–85.9) μg/mL. Median (interquartile range) D‐dimer concentrations were 5.0 (2.6–18.0) μg/mL for complete false lumen thrombosis (n=33), 60.9 (19.4–160.4) μg/mL for partial thrombosis (n=81), 26.5 (10.0–70.6) μg/mL for a patent false lumen (n=131), and 8.7 (3.2–26.9) μg/mL for ulcerlike projection (n=17) (P<0.01). With a D‐dimer concentration of ≤8.3 μg/mL representing the lower quartile, we then investigated predictors of a low D‐dimer level. Multivariate analysis showed dissection limited to the ascending aorta (P<0.01; odds ratio, 9.81) or descending aorta (P<0.01; odds ratio, 7.68), a completely thrombosed false lumen (P<0.01; odds ratio, 4.02), and absence of brain ischemia (P=0.013; odds ratio, 4.74) to be predictors of the lower D‐dimer concentration. Compared with patients with a low D‐dimer concentration (≤8.3 μg/mL, n=66), patients with a D‐dimer concentration >8.3 μg/mL (n=196) had a reduced preoperative platelet count and increased operation time and transfusion volume. In‐hospital mortality was elevated in this group (1.5% versus 11.2%; P=0.031), although 7‐year survival did not differ for hospital survivors (lower versus higher, 93.1% versus 79.1%; P=0.21).ConclusionsD‐dimer concentrations are strongly influenced by the extent of dissection and false lumen status. Operative risks are increased in patients with a relatively high D‐dimer concentration.

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“…However, it has been demonstrated that the distal false lumen remains patent in about 70% to 80% of patients undergoing surgery for DBT1-AAD dissection (5)(6)(7)(8), and a wide and patent false lumen worsens the prognosis (6,(9)(10)(11)(12)(13)(14)(15)(16) by increasing the risk of late death, re-intervention and aneurysmal dilatation of the remaining dissected aorta (6,(17)(18)(19)(20)(21). The regions with the highest risk of developing an aneurysm are the distal arch and proximal descending thoracic aorta (DTA) (17,(22)(23)(24). In patients undergoing DBT1-AAD repair, freedom from aortic reoperation at 10 years ranges from 61% to 74% (10,20,25).…”

Section: Perspectivementioning

confidence: 99%

Descending endograft for DeBakey type 1 aortic dissection: pro

Berretta¹,

Eusanio²

2016

Ann. Cardiothorac. Surg.

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The surgical management of patients with DeBakey type 1 acute aortic dissection (DBT1-AAD) represents a major challenge for aortic surgeons. It has been demonstrated that the distal false lumen remains patent in about 70% to 80% of patients undergoing DBT1-AAD surgery and that a patent false lumen worsens the prognosis. In order to improve long term outcomes and reduce the frequency of late aneurysm formation and reoperation, a more aggressive primary operation involving total arch replacement (TAR) and concomitant antegrade stenting of the descending thoracic aorta (DTA) with a frozen elephant trunk (FET) has been introduced. Such extensive operations, however, remain controversial due to their increased technical complexity and perceived higher operative mortality and morbidity. This perspective article will overview the rationale behind, and the potential advantages and current evidence for, FET surgery in acute aortic dissection.

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Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection

Abstract: The patent false lumen influences postoperative aortic enlargement. However, with careful follow-up, a favorable prognosis is expected even for patients with a residual patent false lumen.

Cited by 123 publications

References 25 publications

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

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

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

Descending endograft for DeBakey type 1 aortic dissection: pro

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