Subtypes of Acute Aortic Dissection

Abstract

The technique of open distal anastomosis using deep hypothermic circulatory arrest was used in 69 cases of acute type A aortic dissection. These cases were subcategorized by site of intimal tear, which was found in the ascending aorta in 41 patients (60%), in the arch in 22 patients (32%), and in the descending aorta in 5 patients (7%). Clinical characteristics and complications are described for these subtypes. Hospital mortality, which was 14.5% overall for acute type A dissections, was 14.6% for ascending tears, 18.2% for arch tears, and 0% for descending aortic tears. Six-year survival was 69% +/- 15% for ascending tears, 69% +/- 22% for arch tears, and 80% +/- 25% for descending tears (mean +/- SEM, p = NS). A classification system for aortic dissection is proposed, based on both site of origin and propagation.

A case–control study found that low albumin and smoking were associated with aortic dissection

“…Blood urea nitrogen (BUN) level of cases was higher (P Ͻ .05) than that of controls, and current smoking rate of cases was significantly higher (P Ͻ .001) than that of controls. We further divided cases into two categories, Stanford type A and type B ( Table 2) [19]. There were 104 cases for Stanford type A and 115 for Stanford type B.…”

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

“…4) (212). However, a closed technique disregards secondary tears within the aortic arch present in 20% to 30% of DeBakey type I ATAAD (13,14,276), and the friable dissected AscAo might be injured by the clamp instrument, generating further intimal tearing. A closed technique results in nearuniform PFL persistence in DeBakey I dissections (257,272).…”

“…In ATAAD a primary intimal tear is usually present within the AscAo, sometimes accompanied by secondary, more distal tears (13). In others, involvement of the AscAo is due to retrograde propagation of a dissection with a primary tear originating within the arch or DescAo (14). On occasion, no intimal tear is identifiable.…”

“…A closed technique results in nearuniform PFL persistence in DeBakey I dissections (257,272). Because it facilitated more complete repair and hypothetically reduced PFL risk, ODA became both popular (277) and the accepted surgical norm (14,278). An ODA allows a more accurate approximation of the dissected layers and a direct visual inspection for further arch tears (279).…”

Complex aortic disease: Changes in perception, evaluation and management

“…The location of the primary fenestration may have an effect on outcome. 28 Other disease variants such as intramural hematoma and nonperfused false lumen have been observed to have better outcome, 29 whereas periaortic hematoma, 30 concurrent acute coronary symptoms, 31 and cocaine use 32 are predictive of poor outcome.…”