Surgical outcome of acute type A aortic dissection: analysis of risk factors

Kazui, Teruhisa; Washiyama, Naoki; Bashar, Abul Hasan Muhammad; Terada, Hitoshi; Suzuki, Takahiro; Ohkura, Kazuhiro; Yamashita, Katsushi

doi:10.1016/s0003-4975(02)03603-2

Cited by 137 publications

(97 citation statements)

References 18 publications

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“…Kazui, in a series of 130 patients, investigated the in-hospital mortality of three groups of patients having different extents of distal aortic replacement. The study reported an overall in-hospital mortality of 19.2% without significant difference in the three groups: 26% in the ascending aorta replacement group, 14% in the hemiarch replacement group, and 17% in the total arch replacement group (20). Similar results are also reported by other well experienced 'aortic' surgeons (21).…”

Section: Indications For Aortic Arch Replacementsupporting

confidence: 78%

When and how to replace the aortic arch for type A dissection

Bartolomeo

Leone

Marco

et al. 2016

Ann. Cardiothorac. Surg.

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Acute type A aortic dissection (AAAD) remains one of the most challenging diseases in cardiothoracic surgery and despite numerous innovations in medical and surgical management, early mortality remains high.The standard treatment of AAAD requires emergency surgery of the proximal aorta, preventing rupture and consequent cardiac tamponade. Resection of the primary intimal tear and repair of the aortic root and aortic valve are well-established surgical principles. However, the dissection in the aortic arch and descending untreated aorta remains. This injury is associated with the risk of subsequent false lumen dilatation potentially progressing to rupture, true lumen compression and distal malperfusion. Additionally, the dilatation of the aortic arch, the presence of a tear and retrograde dissection can all be considered indication for a total arch replacement in AAAD. In such cases a more aggressive strategy may be used, from the classic aortic arch operation to a single stage frozen elephant trunk (FET) technique or a two-stage approach such as the classical elephant trunk (ET) or the recent Lupiae technique. Although these are all feasible solutions, they are also complex and time demanding techniques requiring experience and expertise, with an in the length of cardiopulmonary bypass and both myocardial and visceral ischemia. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. Moreover, a correct assessment of the anatomy of the dissection, through the preoperative angio CT scan, in addition to the clinical condition of the patients, remain the decision points for the best arch repair strategy to use in AAAD.

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Section: Indications For Aortic Arch Replacementsupporting

confidence: 78%

When and how to replace the aortic arch for type A dissection

Bartolomeo

Leone

Marco

et al. 2016

Ann. Cardiothorac. Surg.

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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: 62%

“…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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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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“…Complete resection of the primary intimal tear is mandatory for obtaining satisfactory early and long-term results in patients with acute aortic dissection (27)(28)(29). In patients with severe aortic arch compromise by the dissecting process, TAR seems to be more effective than a conservative approach in avoiding bleeding, anastomotic leak, progression of aneurysmal dilatation, aortic rupture, reoperation and brain injury (11,27,28).…”

Section: Distal Arch Tears and Extensive Arch Diseasementioning

confidence: 99%

“…In patients with severe aortic arch compromise by the dissecting process, TAR seems to be more effective than a conservative approach in avoiding bleeding, anastomotic leak, progression of aneurysmal dilatation, aortic rupture, reoperation and brain injury (11,27,28). In this setting, the FET technique is a valuable adjunct to TAR in patients with complex primary and re-entry tears involving the distal arch and proximal DTA, distal arch and DTA rupture, an aneurysmal arch and proximal DTA, and a severely damaged aortic arch hampering safe distal aortic arch anastomosis.…”

Section: Distal Arch Tears and Extensive Arch Diseasementioning

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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Surgical outcome of acute type A aortic dissection: analysis of risk factors

Cited by 137 publications

References 18 publications

When and how to replace the aortic arch for type A dissection

When and how to replace the aortic arch for type A dissection

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

Descending endograft for DeBakey type 1 aortic dissection: pro

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