Long-term effectiveness of operations for ascending aortic dissections

Sabik, Joseph F.; Lytle, Bruce W.; Blackstone, Eugene H.; McCarthy, Patrick M.; Loop, Floyd D.; Cosgrove, Delos M.

doi:10.1016/s0022-5223(00)70090-0

Cited by 195 publications

(132 citation statements)

References 27 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: 66%

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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: 66%

“…11,[15][16][17][18][19] Larger numbers of patients with a longer follow-up period may be recommended for further studies.…”

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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“…[1][2][3][4][5][6][7][8][9][10] Far fewer studies have been published on results of examination of the operatively resected portion of the ascending aorta. [11][12][13][14][15][16][17][18][19][20][21] The present report focuses on aortic medial elastic-fiber structure in 69 patients having portions of the ascending aorta operatively resected because of acute dissection involving the ascending aorta with or without involvement of other portions of the aorta.…”

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confidence: 99%

Aortic Medial Elastic Fiber Loss in Acute Ascending Aortic Dissection

Roberts

Vowels

Kitchens

et al. 2011

The American Journal of Cardiology

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The cause of acute aortic dissection continues to be debated. One school of thought suggests that underlying aortic medial cystic necrosis is the common denominator. The purpose of the present study was to determine if there was loss and, if so, how much loss of medial elastic fibers in the ascending aorta in patients with acute aortic dissection with the entrance tear in the ascending aorta. We examined operatively excised ascending aortas in 69 patients having acute dissection with tears in the ascending aorta. Patients with previous aortotomy, healed dissection, and connective tissue disorders were excluded. The 69 patients' ages ranged from 31 to 88 years (mean 56); 49 were men and 20 were women. Loss of aortic medial elastic fibers was graded as 0 (no loss), 1؉ (trace), 2؉ (mild), 3؉ (moderate), and 4؉ (full thickness loss). Of these 69 patients, 56 (82%) had 0 or 1؉ elastic fiber loss; 13 patients (18%), 2؉ to 4؉ loss including 4 with 2؉, 6 with 3؉, and 2 with 4؉. Nearly all patients (97%) had a history of systemic hypertension and/or had received antihypertensive drug therapy. In conclusion, most patients (82% in this study) having acute aortic dissection with entrance tears in the ascending aorta have normal numbers or only trace loss of aortic medial elastic fibers. Thus, underlying abnormal ascending aortic structure uncommonly precedes acute dissection.

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“…23 25 In the surgical management of the acute type A dissection, although valve-sparing techniques are widely used by many surgeons, the standard procedure, namely, supracoronary replacement of the dissected ascending aorta with Teflon felt or glue reconstruction of the dissected aortic root is still attractive because of its simplicity, short operation time and reduced mortality rates. [25][26][27][28] This technique has been proven by several authors inasmuch as the freedom from reoperation for aortic valve dysfunction was 91% to 82% after 10 years. 8,28 The major drawback of this technique is the need of reoperation due to sinus of Valsalva aneurysm.…”

Section: Discussionmentioning

confidence: 98%

“…The technical approach to acute type A aortic dissection that we follow in our institution is supported by many other authors. 12,[24][25][26][27][28][29][30] We recommend the use of a simple tube graft replacement in most cases except for Marfan syndrome, other known connective tissue disorders, or frank annuloaortic ectasia. The vast majority of patients with acute type A aortic dissection can be treated appropriately with a simple supracommissural tube graft.…”

Section: Discussionmentioning

confidence: 99%

Supracommissural Aortic Replacement: A Reliable Option for Acute and Chronic Aortic Type A Dissection

Güler¹,

Toker²,

Eren³

et al. 2010

Turkiye Klinikleri J Med Sci

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A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: : To re vi ew early and la te re sults of sup ra com mis su ral aor tic rep la ce ment in pa ti ents with acu te and chro nic type A dis sec ti on. M Ma a t te e r ri i a al l a an nd d M Me et t h ho od ds s: : From Feb ru ary 1985 to Oc to ber 2005, 162 pa ti ents with acu te and chro nic aor tic dis sec ti on un der went sup ra com mis su ral aor tic graft rep la ce ment. A ret ros pec ti ve cli ni cal re vi ew was un der ta ken using hos pi tal re cords, clini cal and ec ho car di og rap hic da ta, and te lep ho ne in ter vi ews with pa ti ents. R Re e s su ul lt ts s: : The re we re 23 (14.1 %) ope ra ti ve and eight (6.4 %) la te de aths. The most com mon ca u ses of hos pi tal de ath we re in tra o pe ra ti ve comp li ca ti ons re la ted to he morr ha ge (n= 9), and res pi ra tory fa i lu re (n = 6), and the ot her ca u se was mul ti or gan fa i lu re (n= 5). The hos pi tal mor ta lity ra te for pa ti ents with chro nic type A dis sec ti on was 6.25% (3/48). The ca u ses of de ath we re res pi ra tory fa i lu re (n= 2) and mul ti or gan fa i lu re (n= 1). The mo des of hos pi tal de aths we re not re la ted to re si du al aor tic in suf fi ci ency (AR) in any ca se sin ce early pos to pe ra ti ve trans tho ra cic ec ho car di og raphy did not show gra ter than grade II in the se pa ti ents in early pos to pe ra ti ve or fol low-up pe ri od, trans tho ra cic ec ho car di og raphy did not show aor tic re gur gi ta ti on gra ter than gra de II in any ca se. All sur vi vors we re in New York He art As so ci a ti on class I or II at the last vi sit. C Co on nc c l lu u s si i o on n: : Sup ra com mis su ral aor tic graft rep la cement pro vi des sa tis fac tory re sults for many pa ti ents with as cen ding aor tic dis sec ti on. The func ti on of the pre ser ved aor tic val ves re ma i ned unc han ged in the ma jo rity of the pa ti ents du ring the first fi ve ye ars of fol low-up. K Ke ey y W Wo or rd ds s: : Aor ta; aor tic val ve in suf fi ci ency; aor tic val ve Ö ÖZ ZE ET T A Am ma aç ç: : Sup ra ko mis su ral aort rep las ma nı uy gu la nan akut ve kro nik Tip A aort dis sek si yon lu ol gu la rın er ken ve geç dö nem so nuç la rı nın göz den ge çi ril me si. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: : Şubat 1985 ile Ekim 2005 ta rih le ri ara sın da akut ve kro nik dis sek si yo nu olan 162 ol gu ya sup ra kom mis su ral aort gretf rep las ma nı uy gu lan dı. Kli nik bul gu lar ret ros pek tif ola rak has ta ka yıt la rı, kli nik ve eko kar diyog ra fik bul gu lar ve has ta lar la te le fon gö rüş me le ri ile sağ lan dı. B Bu ul l g gu u l la ar r: : Yir mi üç (%14.1) ope ratif, se kiz (%5.8) geç dö nem mor ta li te si mev cut tu. En sık ölüm ne den le ri, in tra o pe ra tif komp li kasyon la ra bağ lı ola rak, ka na ma (n=9), so lu num yet mez li ği (n= 6) ve di ğer se bep ola rak da mul ti or gan yet mez li ği (n= 5) idi. Kro nik tip A dis sek si yon ol gu la rın da has ta ne mor ta li te si 6.25% (3/48) idi. Ölüm se bep le ri; so...

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Long-term effectiveness of operations for ascending aortic dissections

Cited by 195 publications

References 27 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

Aortic Medial Elastic Fiber Loss in Acute Ascending Aortic Dissection

Supracommissural Aortic Replacement: A Reliable Option for Acute and Chronic Aortic Type A Dissection

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