Less invasive quick replacement of the proximal arch with aggressive rapid rewarming for type A acute aortic dissection

Hata, Mitsumasa; Suzuki, M; Sezai, Akira; Niino, Tetsuya; Yoshitake, Isamu; Unosawa, Satoshi; Minami, Kazutomo

doi:10.1007/s00595-008-3864-x

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…We previously reported the surgical technique. [2][3][4][5] Cardiopulmonary bypass was implemented after cannulation of the femoral artery. A 2-stage venous cannula was inserted into the right atrium.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Prognosis of patients undergoing emergency surgery for type A acute aortic dissection without exclusion of the intimal tear

Unosawa

Hata

Niino

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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Objectives: To investigate the prognosis after emergency surgery for acute type A aortic dissection with an unknown entry site and to identify the predictors of postoperative aortic dilatation.Methods: The subjects were 102 patients undergoing emergency surgery for acute type A dissection from July 2005 to October 2010. They were divided into group I (n ¼ 45) undergoing aortic surgery without tear resection and group II (n ¼ 57) undergoing resection that included the intimal tear.Results: The postoperative hospital mortality was similar, 13.3% (n ¼ 6) in group I and 12.3% (n ¼ 7) in group II. Of the 102 patients, 69 underwent follow-up computed tomography scanning after discharge, and the aortic diameter was significantly increased in group I compared with that in group II (P ¼ .035). Dilatation of the descending aorta occurred in 21 patients (30.4%). Multivariate logistic regression analysis revealed that a patent false lumen (P ¼ .027) and nonexclusion of the entry site (P ¼ .012) were independent risk factors for aortic dilatation. No difference was found in the freedom from aorta-related clinical events at 4 years, with a rate of 81.9% in group I and 74.4% in group II. Also, no difference was found in the 4-year actuarial survival rate between groups I and II (86.4% and 78.5%, respectively). Conclusions:The prognosis of patients without exclusion of the entry site was acceptable. Careful follow-up is needed for patients with a patent false lumen or nonexcluded entry because of the risk of aortic dilatation.

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Section: Surgical Proceduresmentioning

confidence: 99%

Prognosis of patients undergoing emergency surgery for type A acute aortic dissection without exclusion of the intimal tear

Unosawa

Hata

Niino

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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

光賢¹,

明²,

哲也³

et al. 2009

Nichidai Igaku Zasshi

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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.

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Current Surgical Treatment for Acute Type A Aortic Dissection: Clinical

Unosawa¹,

Kimura²,

Niino³

2012

Nichidai Igaku Zasshi

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We report the efficacy of BioGlue ® , (CryoLife Inc, Kennesaw, GA, USA) in emergency surgery for acute type A aortic dissection. Between August 2011 and April 2012, seven patients underwent ascending aorta replacement for type A aortic dissection in our institution. At the time of surgery, the aortic stumps were reinforced with BioGlue ® . The average durations of the operation, cardiopulmonary bypass, and circulatory arrest were 217 ± 32.7, 129 ± 17.5 and 25.4 ± 3.4 min, respectively. There were no incidents of operative death or postoperative complications. Postoperative enhanced computed tomography revealed that there was no patent false lumen in the aortic root or aortic pseudoaneurysm at the anastomotic site in any of the patients. Furthermore, thrombosed false lumen was found in the descending aorta in 5 patients. It was considered that BioGlue ® might be effective in providing very quick adhesion of the false lumen during emergency surgery for acute type A aortic dissection.

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Less invasive quick replacement of the proximal arch with aggressive rapid rewarming for type A acute aortic dissection

Cited by 3 publications

References 10 publications

Prognosis of patients undergoing emergency surgery for type A acute aortic dissection without exclusion of the intimal tear

Prognosis of patients undergoing emergency surgery for type A acute aortic dissection without exclusion of the intimal tear

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

Current Surgical Treatment for Acute Type A Aortic Dissection: Clinical

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