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Omura A, Miyahara S, Yamanaka K, Sakamoto T, Matsumori M, Okada K, Okita Y. Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement. J Thorac Cardiovasc Surg 2016; 151:341-8. [DOI: 10.1016/j.jtcvs.2015.03.068] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/08/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
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Hsu HL, Chen YY, Huang CY, Huang JH, Chen JS. The Provisional Extension To Induce Complete Attachment (PETTICOAT) technique to promote distal aortic remodelling in repair of acute DeBakey type I aortic dissection: preliminary results. Eur J Cardiothorac Surg 2016; 50:146-52. [PMID: 26792928 DOI: 10.1093/ejcts/ezv466] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 12/04/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To report our preliminary results of an aggressive technique, the Provisional Extension To Induce Complete Attachment (PETTICOAT), in repair of acute DeBakey type I aortic dissection. METHODS From April 2014 to November 2014, 18 patients with acute DeBakey type I aortic dissection were reviewed retrospectively. Nine patients underwent open repair combined with proximal stent grafting and distal bare stenting (PETTICOAT group). For comparison, another 9 patients underwent open repair combined with proximal stent grafting (NON-PETTICOAT group) were included. Open repair entailed ascending aorta plus total arch replacement under circulatory arrest, with variable aortic root work. Mortality and morbidity were recorded, and computed tomography was performed to evaluate the aortic remodelling at 6 months postoperatively. RESULTS Preoperative parameters were similar. In the PETTICOAT group, one early mortality was noted. One complication of cardiac tamponade and sternal wound infection led to reopen surgeries. In the NON-PETTICOAT group, one case of transient ischaemic attack took place. Compared with the NON-PETTICOAT group, a significant increase in diameter of true lumen (median, 0.6 vs 0.1 mm, P < 0.01) and a decrease in diameter of false lumen (FL; median, -0.9 vs 0.0 mm, P < 0.01) at the level of lowest renal artery were noted in the PETTICOAT group. Moreover, significant FL volume regression (median, -102.0 vs -42.2 mm(3), P = 0.03) was observed in the PETTICOAT group. More cases of total thrombosis or regression of FL down to the level of renal artery were also noted in the PETTICOAT group (5/8 vs 0/9, P < 0.01). Two patients of the NON-PETTICOAT group received endovascular distal aortic reintervention at 6 months. CONCLUSIONS The PETTICOAT technique in the management of acute DeBakey type I dissection is a feasible and promising method to promote distal aortic remodelling. However, outcomes are preliminary and further follow-up is required.
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Affiliation(s)
- Hung-Lung Hsu
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Division of Cardiovascular Surgery, Department of Surgery, Mennonite Christian Hospital, Hualien, Taiwan
| | - Yin-Yin Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Yang Huang
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jih-Hsin Huang
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jer-Shen Chen
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Nishida H, Tabata M, Fukui T, Takanashi S. Surgical Strategy and Outcome for Aortic Root in Patients Undergoing Repair of Acute Type A Aortic Dissection. Ann Thorac Surg 2015; 101:1464-9. [PMID: 26627176 DOI: 10.1016/j.athoracsur.2015.10.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/13/2015] [Accepted: 10/01/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study evaluated the relevance of our indication of aortic root operations for acute type A aortic dissection and compared early and long-term outcomes of emergency type A aortic dissection operations between patients who underwent aortic root operations and those who did not. METHODS We retrospectively reviewed 316 consecutive patients who underwent emergency aortic operations for acute type A aortic dissection between January 2009 and September 2013. We performed simultaneous aortic root operations when the aortic root diameter was greater than 45 mm or an intimal tear was present in the aortic root, or both. After this indication, we performed aortic repair involving the aortic root in 40 patients (aortic root replacement [ARR] group, 12.7%) and not involving the aortic root in 276 patients (non-ARR group, 87.3%). We analyzed early and long-term outcomes, including late aortic root events. RESULTS In-hospital mortality was 12.5% (5 of 40) in the ARR group and 4.7% (13 of 276) in non-ARR group (p = 0.05). Overall survival at 3 and 5 years was 84.8% and 84.8%, respectively in ARR group and was 91.9% and 91.9%, respectively, in the non-ARR group (p = 0.078). Late aortic root events, defined as aortic root dilatation (≥ 3 mm/y), reoperation of the aortic root, aortic regurgitation (moderate or higher), and pseudoaneurysm, were observed in no patients in the ARR group and in 32 patients (11.6%) in the non-ARR group (p = 0.029). In the non-AAR group, dissection of 2 or more aortic sinuses was the only independent predictor of a late aortic root event (hazard ratio, 2.20; 95% confidence interval, 1.08 to 4.61; p = 0.03). CONCLUSIONS Simultaneous aortic root operations significantly reduced the incidence of late aortic root events. The dissection of 2 or more sinuses of Valsalva was associated with a late aortic root event in patients who did not undergo aortic root operations.
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Affiliation(s)
- Hidefumi Nishida
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
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Fukui T, Tabata M, Morita S, Takanashi S. Gender differences in patients undergoing surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg 2015; 150:581-7.e1. [DOI: 10.1016/j.jtcvs.2015.06.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 05/25/2015] [Accepted: 06/05/2015] [Indexed: 11/27/2022]
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Late reoperations after acute aortic dissection repair: Single-center experience. Asian Cardiovasc Thorac Ann 2015; 23:787-94. [DOI: 10.1177/0218492315584523] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background After repair of acute type A aortic dissection, aortic complications can develop, and reoperations might be necessary. In our retrospective study, we wanted to assess early and late outcomes in this cohort of patients. Methods From September 2005 to July 2012, 21 consecutive patients previously operated on for acute type A aortic dissection underwent 27 redo aortic surgical procedures. Indications for redo procedures were: enlargement of the false lumen in the residual aorta (18 events), severe aortic regurgitation with or without aortic root dilatation (8 events), suture dehiscence and pseudoaneurysm at the proximal or distal aortic graft anastomosis (5 events) or at the coronary button anastomosis in patients who previously underwent a Bentall procedure (1 patient). In all cases, total or partial cardiopulmonary bypass was used. Hypothermic cardiocirculatory arrest was needed in 22 (81%) procedures. Results Hospital mortality was 3.7% (1/27), reexploration for bleeding and paraplegia rates were 7.4% and 7.4%, respectively. Marfan patients received 3.2 procedures per patient vs. 1.5 in non-Marfan patients ( p < 0.01). At a mean follow-up of 6.5 years, 2 aortic events occurred: 1 aortic death, and 1 additional aortic redo surgery. Conclusions When procedures are carried out on elective basis, redo aortic surgery can be performed in all segments of the aorta with good early and late outcomes. Close lifelong clinical and radiological follow-up is mandatory. After repair of acute type A aortic dissection, Marfan patients are more prone to develop late complications, with a more rapid evolution.
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Bajona P, Quintana E, Schaff HV, Daly RC, Dearani JA, Greason KL, Pochettino A. Aortic arch surgery after previous type A dissection repair: results up to 5 years. Interact Cardiovasc Thorac Surg 2015; 21:81-5; discussion 85-6. [DOI: 10.1093/icvts/ivv036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/23/2015] [Indexed: 11/14/2022] Open
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Marfan syndrome is associated with recurrent dissection of the dissected aorta. Ann Thorac Surg 2015; 99:1616-23. [PMID: 25818572 DOI: 10.1016/j.athoracsur.2014.12.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/16/2014] [Accepted: 12/23/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recurrent dissection of a previously dissected aortic segment has been reported as a rare, late complication in single case reports. The infrequency of this event makes informed risk assessment in an individual patient challenging. METHODS To investigate this issue we examined the database of the Massachusetts General Hospital Thoracic Aortic Center between January 1, 2003 and December 31, 2012. A retrospective review was performed to identify patients with both (1) an acute aortic dissection after a prior aortic dissection and (2) evidence of a new dissection within a previously dissected aortic segment creating a triple lumen aorta. Data were reviewed to identify factors predisposing to dissection of a previously dissected aortic segment. RESULTS Over a 10-year period we identified 5 cases of aortic dissection within a previously dissected aortic segment presenting as a new acute aortic syndrome. On average, the recurrent dissection occurred 1 decade after the first aortic dissection (mean = 9.8 ± 1.9 years). Patients identified in this series were significantly younger at first dissection and more likely to carry the diagnosis of Marfan syndrome. Aortic aneurysm diameter was quantified before and after the new dissection event and demonstrated a marked increase in aneurysmal size (mean increase = 1.6 ± 0.3 cm). CONCLUSIONS We conclude that medial degeneration, as seen in the Marfan aorta, represents a predisposing factor for recurrent dissection of the dissected aorta. Our data indicate that double aortic dissections cause significant arterial destabilization and a low threshold for surgical intervention is appropriate.
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Leshnower BG, Myung RJ, McPherson L, Chen EP. Midterm Results of David V Valve-Sparing Aortic Root Replacement in Acute Type A Aortic Dissection. Ann Thorac Surg 2015; 99:795-800; discussion 800-1. [DOI: 10.1016/j.athoracsur.2014.08.079] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 08/18/2014] [Accepted: 08/25/2014] [Indexed: 11/24/2022]
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Weiss G, Santer D, Dumfarth J, Pisarik H, Harrer ML, Folkmann S, Mach M, Moidl R, Grabenwoger M. Evaluation of the downstream aorta after frozen elephant trunk repair for aortic dissections in terms of diameter and false lumen status. Eur J Cardiothorac Surg 2015; 49:118-24. [DOI: 10.1093/ejcts/ezv044] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/12/2015] [Indexed: 11/13/2022] Open
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Di Bartolomeo R, Pantaleo A, Berretta P, Murana G, Castrovinci S, Cefarelli M, Folesani G, Di Eusanio M. Frozen elephant trunk surgery in acute aortic dissection. J Thorac Cardiovasc Surg 2015; 149:S105-9. [DOI: 10.1016/j.jtcvs.2014.07.098] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/26/2014] [Accepted: 07/24/2014] [Indexed: 10/24/2022]
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Rylski B, Milewski RK, Bavaria JE, Branchetti E, Vallabhajosyula P, Szeto WY, Desai ND. Outcomes of Surgery for Chronic Type A Aortic Dissection. Ann Thorac Surg 2015; 99:88-93. [DOI: 10.1016/j.athoracsur.2014.07.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/10/2014] [Accepted: 07/14/2014] [Indexed: 11/25/2022]
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113
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Di Eusanio M, Trimarchi S, Peterson MD, Myrmel T, Hughes GC, Korach A, Sundt TM, Di Bartolomeo R, Greason K, Khoynezhad A, Appoo JJ, Folesani G, De Vincentiis C, Montgomery DG, Isselbacher EM, Eagle KA, Nienaber CA, Patel HJ. Root Replacement Surgery Versus More Conservative Management During Type A Acute Aortic Dissection Repair. Ann Thorac Surg 2014; 98:2078-84. [DOI: 10.1016/j.athoracsur.2014.06.070] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/23/2014] [Accepted: 06/27/2014] [Indexed: 10/24/2022]
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Mody PS, Wang Y, Geirsson A, Kim N, Desai MM, Gupta A, Dodson JA, Krumholz HM. Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000-2011. Circ Cardiovasc Qual Outcomes 2014; 7:920-8. [PMID: 25336626 PMCID: PMC4380171 DOI: 10.1161/circoutcomes.114.001140] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 08/27/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The epidemiology of aortic dissection (AD) has not been well described among older persons in the United States. It is not known whether advancements in AD care over the last decade have been accompanied by changes in outcomes. METHODS AND RESULTS The Inpatient Medicare data from 2000 to 2011 were used to determine trends in hospitalization rates for AD. Mortality rates were ascertained through corresponding vital status files. A total of 32 057 initial AD hospitalizations were identified. The overall hospitalization rate for AD remained unchanged at 10 per 100 000 person-years. For 30-day and 1-year mortality associated with AD, the observed rate decreased from 31.8% to 25.4% (difference, 6.4%; 95% confidence interval [CI], 6.2-6.5; adjusted, 6.4%; 95% CI, 5.7-6.9) and from 42.6% to 37.4% (difference, 5.2%; 95% CI, 5.1-5.2; adjusted, 6.2%; 95% CI, 5.3-6.7), respectively. For patients undergoing surgical repair for type A dissections, the observed 30-day mortality decreased from 30.7% to 21.4% (difference, 9.3%; 95% CI, 8.3-10.2; adjusted, 7.3%; 95% CI, 5.8-7.8) and the observed 1-year mortality decreased from 39.9% to 31.6% (difference, 8.3%; 95% CI, 7.5-9.1%; adjusted, 8.2%; 95% CI, 6.7-9.1). The 30-day mortality decreased from 24.9% to 21% (difference, 3.9%; 95% CI, 3.5-4.2; adjusted, 2.9%; 95% CI, 0.7-4.4) and 1-year decreased from 36.4% to 32.5% (difference, 3.9%; 95% CI, 3.3-4.3; adjusted, 3.9%; 95% CI, 2.5-6.3) for surgical repair of type B dissection. CONCLUSIONS Although AD hospitalization rates remained stable, improvement in mortality was noted, particularly in patients undergoing surgical repair.
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Affiliation(s)
- Purav S Mody
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Yun Wang
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Arnar Geirsson
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Nancy Kim
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Mayur M Desai
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Aakriti Gupta
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - John A Dodson
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Harlan M Krumholz
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.).
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Wang Z, Greason KL, Pochettino A, Schaff HV, Suri RM, Stulak JM, Dearani JA. Long-term outcomes of survival and freedom from reoperation on the aortic root or valve after surgery for acute ascending aorta dissection. J Thorac Cardiovasc Surg 2014; 148:2117-22. [DOI: 10.1016/j.jtcvs.2013.12.059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/25/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
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Ariyaratnam P, Loubani M, Griffin SC, Cowen ME, Vijayan A, Jarvis MA, Cale AR. Complex aortic surgery in a regional center in the United Kingdom. Should the United Kingdom now adopt a United States–style supercenter model? J Thorac Cardiovasc Surg 2014; 148:1428-1434.e1. [DOI: 10.1016/j.jtcvs.2014.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/14/2013] [Accepted: 01/10/2014] [Indexed: 11/16/2022]
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Rylski B, Beyersdorf F, Kari FA, Schlosser J, Blanke P, Siepe M. Acute type A aortic dissection extending beyond ascending aorta: Limited or extensive distal repair. J Thorac Cardiovasc Surg 2014; 148:949-54; discussion 954. [DOI: 10.1016/j.jtcvs.2014.05.051] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/12/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
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Rylski B, Bavaria JE, Milewski RK, Vallabhajosyula P, Moser W, Kremens E, Pochettino A, Szeto WY, Desai ND. Long-Term Results of Neomedia Sinus Valsalva Repair in 489 Patients With Type A Aortic Dissection. Ann Thorac Surg 2014; 98:582-8; discussion 588-9. [DOI: 10.1016/j.athoracsur.2014.04.050] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 03/20/2014] [Accepted: 04/01/2014] [Indexed: 11/27/2022]
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Preventza O, Cervera R, Cooley DA, Bakaeen FG, Mohamed AS, Cheong BY, Cornwell L, Simpson KH, Coselli JS. Acute type I aortic dissection: Traditional versus hybrid repair with antegrade stent delivery to the descending thoracic aorta. J Thorac Cardiovasc Surg 2014; 148:119-25. [DOI: 10.1016/j.jtcvs.2013.07.055] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/21/2013] [Accepted: 07/26/2013] [Indexed: 11/15/2022]
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Hsu RB, Chen JW. Low Incidence of Late Pseudoaneurysm and Reoperation After Conventional Repair of Acute Type A Aortic Dissection. J Card Surg 2014; 29:641-6. [DOI: 10.1111/jocs.12359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ron-Bin Hsu
- Department of Surgery, National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan ROC
| | - Jeng-Wei Chen
- Department of Surgery, National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan ROC
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121
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Rylski B, Desai ND, Bavaria JE, Vallabhajosyula P, Moser W, Pochettino A, Szeto WY, Milewski RK. Aortic Valve Morphology Determines the Presentation and Surgical Approach to Acute Type A Aortic Dissection. Ann Thorac Surg 2014; 97:1991-6; discussion 1996-7. [DOI: 10.1016/j.athoracsur.2013.12.090] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/10/2013] [Accepted: 12/18/2013] [Indexed: 11/15/2022]
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122
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Katayama A, Uchida N, Katayama K, Arakawa M, Sueda T. The frozen elephant trunk technique for acute type A aortic dissection: results from 15 years of experience†. Eur J Cardiothorac Surg 2014; 47:355-60; discussion 360. [DOI: 10.1093/ejcts/ezu173] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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123
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Type A Aortic Dissection After Previous Cardiac Surgery: Results of an Integrated Surgical Approach. Ann Thorac Surg 2014; 97:1582-8; discussion 1588-9. [DOI: 10.1016/j.athoracsur.2013.12.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/02/2013] [Accepted: 12/17/2013] [Indexed: 11/21/2022]
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124
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Saczkowski R, Malas T, Mesana T, de Kerchove L, El Khoury G, Boodhwani M. Aortic valve preservation and repair in acute Type A aortic dissection. Eur J Cardiothorac Surg 2014; 45:e220-6. [PMID: 24648432 DOI: 10.1093/ejcts/ezu099] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Repair and preservation of the aortic valve in Type A aortic dissection (AAD) remains controversial. We performed a meta-analysis of outcomes for aortic valve (AV) repair and preservation in AAD focusing on long-term valve-related events. METHODS Structured searches were performed in Embase (1980-2013) and PubMed (1966-2013) for studies reporting AV repair or preservation in AAD. Early mortality and linearized rates for late mortality and valve-related events were derived. Outcome data were pooled with an inverse-variance-weighted random-effects model. RESULTS Of 5325 screened articles, 19 observational studies met the eligibility criteria consisting of 2402 patients with a median follow-up of 4.1 [range: 3.1-12.6 years, total 13 733 patient-years (pt-yr)]. The cohort was principally male (median = 68.1%, range: 39-89) with a median age of 59 (range: 55-68) years and Marfan's syndrome was present in 2.5%. AV resuspension was performed in 95% of the patients and the remainder underwent valve-sparing root replacement (reimplantation = 2.5% and remodelling = 2.5%). Pooled early mortality rate was 18.7% [95% confidence interval (95% CI): 12.2-26.2%], and linearized late mortality rate was 4.7%/pt-yr (95% CI: 3.4-6.3). Linearized rate for AV reintervention was 2.1%/pt-yr (95% CI: 1.0-3.6), recurrent aortic insufficiency (>2+) was 0.9%/pt-yr (95% CI: 0.3-2.2) and endocarditis was 0.2%/pt-yr (95% CI: 0.1-0.5). The composite rate of thromboembolism and bleeding was 1.4%/pt-yr (95% CI: 0.7-2.2). CONCLUSIONS Patients surviving an AAD have a limited long-term survival. Preservation and repair of the aortic valve is associated with a moderate risk of reoperation, but a low risk of thromboembolism, bleeding and endocarditis.
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Affiliation(s)
- Richard Saczkowski
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Tarek Malas
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Thierry Mesana
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Laurent de Kerchove
- Department of Thoracic and Cardiovascular Surgery, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Gebrine El Khoury
- Department of Thoracic and Cardiovascular Surgery, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
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125
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Vallabhajosyula P, Szeto WY, Pulsipher A, Desai N, Menon R, Moeller P, Musthaq S, Pochettino A, Bavaria JE. Antegrade thoracic stent grafting during repair of acute Debakey type I dissection promotes distal aortic remodeling and reduces late open distal reoperation rate. J Thorac Cardiovasc Surg 2014; 147:942-8. [DOI: 10.1016/j.jtcvs.2013.10.047] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 10/31/2013] [Indexed: 11/16/2022]
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126
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Dell'Aquila AM, Concistrè G, Gallo A, Pansini S, Piccardo A, Passerone G, Regesta T. Fate of the preserved aortic root after treatment of acute type A aortic dissection: 23-year follow-up. J Thorac Cardiovasc Surg 2013; 146:1456-60. [DOI: 10.1016/j.jtcvs.2012.09.049] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/18/2012] [Accepted: 09/20/2012] [Indexed: 10/27/2022]
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127
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Kallenbach K, Sundt TM, Marwick TH. Aortic Surgery for Ascending Aortic Aneurysms Under 5.0 cm in Diameter in the Presence of Bicuspid Aortic Valve. JACC Cardiovasc Imaging 2013; 6:1321-6. [DOI: 10.1016/j.jcmg.2013.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 08/27/2013] [Indexed: 11/15/2022]
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128
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The use of surgical glue in acute type A aortic dissection. Gen Thorac Cardiovasc Surg 2013; 62:207-13. [DOI: 10.1007/s11748-013-0343-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Indexed: 11/26/2022]
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129
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Kouchoukos NT, Kulik A, Castner CF. Clinical outcomes and fate of the distal aorta following 1-stage repair of extensive chronic thoracic aortic dissection. J Thorac Cardiovasc Surg 2013; 146:1086-91. [DOI: 10.1016/j.jtcvs.2013.07.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
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130
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Di Eusanio M, Castrovinci S, Tian DH, Folesani G, Cefarelli M, Pantaleo A, Murana G, Berretta P, Yan TD, Bartolomeo RD. Antegrade stenting of the descending thoracic aorta during DeBakey type 1 acute aortic dissection repair. Eur J Cardiothorac Surg 2013; 45:967-75. [DOI: 10.1093/ejcts/ezt493] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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131
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Di Eusanio M, Pantaleo A, Murana G, Pellicciari G, Castrovinci S, Berretta P, Folesani G, Di Bartolomeo R. Frozen elephant trunk surgery-the Bologna's experience. Ann Cardiothorac Surg 2013; 2:597-605. [PMID: 24109567 DOI: 10.3978/j.issn.2225-319x.2013.08.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 08/08/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Different approaches are available to treat patients with complex and extensive diseases of the thoracic aorta. This study aims to report and comment on our experience with the frozen elephant trunk (FET) technique. METHODS Between January 2007 and July 2012, 122 patients (male: 86.9%; mean age: 61 years) underwent extensive thoracic aorta surgery using the FET approach with an E-vita open prosthesis. The most frequent indications for surgery included residual type A chronic dissection (45.9%), extensive degenerative aneurysm of the thoracic aorta (27%), and type A acute aortic dissection (7.4%). Sixty-nine patients had already undergone cardiac/aortic interventions through a median sternotomy. A total of 60 associated procedures were performed, with 76.6% on the aortic root. Selective antegrade cerebral perfusion and moderate hypothermia were used in all cases. RESULTS Overall, hospital mortality was 15.2%. Post-operatively, 7.4% and 9.0% of patients were complicated by permanent neurologic dysfunction and spinal cord injury, respectively. For the surviving patients, 1- and 3-year freedom from all-cause mortality was (91.7±2.8)% and (79.1±6.1)%, respectively. 1- and 3-year freedom from re-intervention was (83.1±3.5)% and (74.1±4.3)%, respectively. CONCLUSIONS In our experience, FET surgery allowed treatment of complex patients with extensive thoracic aortic diseases with satisfactory short- and mid-term results. Acute and chronic dissections represent interesting subsets for FET application. While further larger and longer-term studies are required to show the survival benefits of the FET technique versus other types of management, new strategies for spinal cord injury (paraplegia/paraparesis) reduction should also be researched.
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Affiliation(s)
- Marco Di Eusanio
- Department of Cardiac Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Italy
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132
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Jakob H. Frozen elephant trunk in acute type I dissection-a personal view. Ann Cardiothorac Surg 2013; 2:640-1. [PMID: 24109574 DOI: 10.3978/j.issn.2225-319x.2013.09.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 09/23/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University Hospital Essen, Germany
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133
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Brechtel K, Kalender G, Stock UA, Wildhirt SM. Hybrid debranching and TEVAR of the aortic arch off-pump, in re-do patients with complicated chronic type-A aortic dissections: a critical report. J Cardiothorac Surg 2013; 8:188. [PMID: 24007462 PMCID: PMC3846913 DOI: 10.1186/1749-8090-8-188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/27/2013] [Indexed: 11/16/2022] Open
Abstract
Background Patients suffering from acute type A aortic dissection undergo replacement of the ascending aorta, the proximal hemiarch or complete aortic arch, depending on the extent of the individual pathology. In a subset of these treated patients, secondary pathologies of the distal anastomosis or the remaining distal part of the aorta occur. The treatment of these pathologies is challenging, requiring major surgical re-do procedures with aortic arch replacement under extracorporeal circulation and hypothermic circulatory arrest. Methods We report our experience of five patients with complex aortic pathologies after previous aortic surgery treated with a single stage re-do hybrid procedure, consisting of bypass grafting of the supraaortic branches off-pump, stent graft placement for endovascular aortic repair (TEVAR) and surgical debranching of the aortic arch. Results In all patients the surgical vascular grafts and stent grafts were deployed successfully, there were no intraoperative deaths. Four out of five patients were discharged from hospital in good clinical condition. One patient died postoperatively due to cardiac tamponade. In one patient a type I endoleak persisted leading to occlusion of a bypass branch requiring surgical revision at one year after debranching. Conclusion We discuss the prerequisites, all steps and potential pitfalls of this hybrid aortic arch replacement. The current procedure avoids cardiopulmonary bypass and circulatory arrest, which may benefit early patient outcome; however, patient and device selection plays a key role for immediate success and midterm outcomes. In addition, precise procedural planning and development of customized stents may help to develop this procedure into a true alternative for conventional aortic arch replacement.
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134
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Appoo JJ, Pozeg Z. Strategies in the surgical treatment of type A aortic arch dissection. Ann Cardiothorac Surg 2013; 2:205-11. [PMID: 23977584 DOI: 10.3978/j.issn.2225-319x.2013.01.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/23/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Jehangir J Appoo
- Libin Cardiovascular Institute of Alberta, Division of Cardiac Surgery, Department of Cardiac Sciences and Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Easo J, Weigang E, Hölzl PPF, Horst M, Hoffmann I, Blettner M, Dapunt OE. Influence of operative strategy for the aortic arch in DeBakey type I aortic dissection - analysis of the German Registry for Acute Aortic Dissection type A (GERAADA). Ann Cardiothorac Surg 2013; 2:175-80. [PMID: 23977579 DOI: 10.3978/j.issn.2225-319x.2013.01.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 01/14/2013] [Indexed: 12/28/2022]
Affiliation(s)
- Jerry Easo
- Department of Cardiothoracic and Vascular Surgery, Klinikum Oldenburg, Germany
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136
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Mestres CA, Tsagakis K, Pacini D, Di Bartolomeo R, Grabenwöger M, Borger M, Bonser RS, Jakob H. One-stage repair in complex multisegmental thoracic aneurysmal disease: results of a multicentre study†. Eur J Cardiothorac Surg 2013; 44:e325-31. [PMID: 23918768 DOI: 10.1093/ejcts/ezt374] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Carlos-A. Mestres
- Department of Cardiovascular Surgery, Hospital Clínico, University of Barcelona, Barcelona, Spain
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, Essen, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Roberto Di Bartolomeo
- Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria
| | - Michael Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Robert S. Bonser
- Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, Essen, Germany
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137
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Affiliation(s)
- Joseph E. Bavaria
- From the Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA (J.E.B., W.Y.S.)
| | - Wilson Y. Szeto
- From the Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA (J.E.B., W.Y.S.)
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138
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Rylski B, Beyersdorf F, Blanke P, Boos A, Hoffmann I, Dashkevich A, Siepe M. Supracoronary ascending aortic replacement in patients with acute aortic dissection type A: What happens to the aortic root in the long run? J Thorac Cardiovasc Surg 2013; 146:285-90. [DOI: 10.1016/j.jtcvs.2012.07.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 06/11/2012] [Accepted: 07/10/2012] [Indexed: 11/16/2022]
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139
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Olsson C, Hillebrant CG, Liska J, Lockowandt U, Eriksson P, Franco-Cereceda A. Mortality and reoperations in survivors operated on for acute type A aortic dissection and implications for catheter-based or hybrid interventions. J Vasc Surg 2013; 58:333-339.e1. [DOI: 10.1016/j.jvs.2012.12.078] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/21/2012] [Accepted: 12/26/2012] [Indexed: 11/29/2022]
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140
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Spear R, Kaladji A, Roeder B, Haulon S. Endovascular Repair of a Chronic Arch Dissecting Aneurysm With a Branched Endograft. Ann Thorac Surg 2013; 96:e39-41. [DOI: 10.1016/j.athoracsur.2013.01.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 12/22/2012] [Accepted: 01/28/2013] [Indexed: 11/26/2022]
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141
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Zhang H, Lang X, Lu F, Song Z, Wang J, Han L, Xu Z. Acute type A dissection without intimal tear in arch: proximal or extensive repair? J Thorac Cardiovasc Surg 2013; 147:1251-5. [PMID: 23778086 DOI: 10.1016/j.jtcvs.2013.04.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/11/2013] [Accepted: 04/19/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE For acute type A dissection without an intimal tear in the arch, the optimal surgical strategy is unknown. The present study was designed to clarify the issue by comparing the early and late outcomes of proximal (PR) and extensive repair (ER). METHODS From January 2002 to June 2010, 331 patients with acute type A dissection were treated surgically at our institute. Of these 331 patients, 197 were identified without an arch tear on the preoperative imaging examination and by intraoperative inspection. Of these 197 patients, 74 underwent proximal repair, including the aortic root, ascending aortic, or hemiarch repair, and 88 underwent extensive repair, including proximal repair, total arch replacement and a stented elephant trunk technique. The perioperative variables and late results were statistically analyzed. RESULTS No significant difference was found in the rates of early mortality and morbidity between the 2 groups, despite the shorter duration of circulatory arrest in the PR group. During long-term follow-up (mean, 55.7 ± 33.1 months; maximum, 129), the overall survival rate in the whole cohort was 100%, 90.8%, and 71.1% at 1, 5, and 8 years, respectively. No difference was found in survival between the 2 groups (P > .05). However, complete thrombosis of the false lumen in the proximal descending aorta was achieved in 100% of the ER group and 24.6% of the PR group (P < .001). For patients with a patent false lumen in the PR group, distal anastomosis leakage and unclosed small intimal tears were identified in 53.3% and 35.6% patients, respectively. The reintervention rate was also lower in the ER group than in the PR group (4.9% vs 15.9%, P < .05) during follow-up. Moreover, the reintervention rate for patients with Marfan syndrome was 9.5% in the ER group and 38.5% in the PR group (P < .05). CONCLUSIONS For patients with acute type A dissection without an intimal tear in the arch, extensive repair could promote the occlusion of distal false lumen and decrease the reintervention rate without increasing the operative risk.
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Affiliation(s)
- Hao Zhang
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xilong Lang
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fanglin Lu
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhigang Song
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jun Wang
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lin Han
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiyun Xu
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
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Levack MM, Bavaria JE, Gorman RC, Gorman JH, Ryan LP. Rapid Aortic Arch Debranching Using the Gore Hybrid Vascular Graft. Ann Thorac Surg 2013; 95:e163-5. [DOI: 10.1016/j.athoracsur.2013.01.078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 12/13/2012] [Accepted: 01/07/2013] [Indexed: 10/26/2022]
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143
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Dissected axillary artery cannulation in redo-total arch replacement surgery. J Thorac Cardiovasc Surg 2013; 145:e57-9. [PMID: 23490244 DOI: 10.1016/j.jtcvs.2013.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/18/2013] [Accepted: 02/12/2013] [Indexed: 11/22/2022]
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144
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Malvindi PG, van Putte BP, Sonker U, Heijmen RH, Schepens MA, Morshuis WJ. Reoperation After Acute Type A Aortic Dissection Repair: A Series of 104 Patients. Ann Thorac Surg 2013; 95:922-7. [DOI: 10.1016/j.athoracsur.2012.11.029] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/09/2012] [Accepted: 11/13/2012] [Indexed: 11/30/2022]
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145
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Gionis MN, Kaimasidis G, Tavlas E, Kontopodis N, Plataki M, Kafetzakis A, Ioannou CV. Medical management of acute type a aortic dissection in association with early open repair of acute limb ischemia may prevent aortic surgery. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:52-7. [PMID: 23569563 PMCID: PMC3614383 DOI: 10.12659/ajcr.883793] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 01/10/2013] [Indexed: 11/16/2022]
Abstract
Background: Acute type A aortic dissection (AAAD) is a cardiovascular emergency with a high potential for death. Rapid surgical treatment is indicated to prevent fatal complications. Aggressive appropriate medical management starts at first suspicion and is essential to prevent exacerbation or rupture of the dissection. Despite improved surgical techniques, perioperative care and the development of specialized cardiovascular centers, mortality remains high. Organ ischemia is a catastrophic manifestation of aortic dissection, demanding acute surgical intervention in specialized cardiovascular centers. Case Report: We present the case of a 62-year-old man with isolated acute limb ischemia due to an acute type A aortic dissection treated in a regional general hospital, without a specialized cardiovascular service, with immediate open malperfusion repair and aggressive medical management. The patient did not undergo further surgical aortic repair, and after a 30-month follow-up he remains symptom free and in good clinical condition, suggesting that although aortic surgery remains the gold standard for treatment of acute Type A dissection, appropriate medical management and early malperfusion repair may offer an initial limb- or life-saving procedure. Conclusions: This staged approach gives clinicians more time to properly evaluate and transfer the patient to a specialized cardiovascular center, and in some cases may even offer a definite treatment.
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Affiliation(s)
- Michalis N Gionis
- Vascular Surgery Department, University of Crete Medical School, Heraklion, Greece ; Department of Thoracic Surgery, Regional General Hospital of Chania, Greece
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146
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Ikenaga S, Mikamo A, Kudo T, Kurazumi H, Suzuki R, Hamano K. Arch translocation and the intra-arch elephant-trunk technique with collared graft for extended chronic dissecting aortic aneurysm. J Cardiothorac Surg 2013; 8:23. [PMID: 23363661 PMCID: PMC3563508 DOI: 10.1186/1749-8090-8-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/22/2013] [Indexed: 11/18/2022] Open
Abstract
Management of extensive, chronic, dissecting aortic aneurysms after prior repair of the ascending aorta presents a technical challenge for surgeons. A symptomatic 64-year-old patient was admitted for elective surgical repair of an aortic annular dilatation, causing severe aortic regurgitation, and a Crawford type II extended thoracoabdominal aneurysm, 4 years after he underwent primary repair of an acute aortic dissection. The aorta was diffusely dilated, and there were no sites beyond the distal aortic arch where anastomosis could be performed. We successfully performed total aortic replacement with a 2-stage strategy, using an arch translocation technique and an intra-arch elephant-trunk technique.
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Affiliation(s)
- Shigeru Ikenaga
- Department of Surgery and Clinical Science, Yamagchi University School of Medicine, Minami-Kogushi1-1-1, Ube, Yamaguchi 755-8505, Japan
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147
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Hofferberth SC, Newcomb AE, Yii MY, Yap KK, Boston RC, Nixon IK, Mossop PJ. Hybrid proximal surgery plus adjunctive retrograde endovascular repair in acute DeBakey type I dissection: superior outcomes to conventional surgical repair. J Thorac Cardiovasc Surg 2012; 145:349-54; discussion 354-5. [PMID: 23142120 DOI: 10.1016/j.jtcvs.2012.07.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 06/22/2012] [Accepted: 07/25/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The present study compared the outcomes between conventional surgery and the hybrid approach of proximal surgery with adjunctive retrograde descending aortic endografting plus distal bare metal stenting in acute DeBakey type I dissection. METHODS From 2003 to 2011, 61 patients underwent surgical management for acute type A aortic dissection at our institution. Of these, 37 were DeBakey type I dissections: 18 patients (group 1) received conventional surgical repair alone, and 19 (group 2) underwent conventional hybrid surgery with adjunctive retrograde descending aortic stent grafting plus distal bare metal stenting. RESULTS The patients' baseline characteristics were comparable, including the incidence of preoperative malperfusion syndromes (P = .23). The intraoperative and postoperative characteristics were similar, except 4 (22%) patients in group 1 (vs 0 in group 2) had ongoing malperfusion postoperatively (P = .04). Overall, hospital mortality was 11% (n = 2) for group 1 versus 5% (n = 1) for group 2. At a mean follow-up of 50 months, 4 (25%) subjects in group 1 required secondary thoracoabdominal aortic reintervention versus none in group 2 (P = .03). CONCLUSIONS The use of adjunctive retrograde descending aortic endografting plus distal bare metal stenting during acute DeBakey type 1 dissection repair is a feasible method to enhance thoracoabdominal remodeling. This hybrid strategy improves perioperative outcomes and decreases late distal aortic complications compared with conventional surgical repair for acute DeBakey type I dissection. A prospective, multicenter study is warranted to definitively assess this promising new treatment paradigm.
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Affiliation(s)
- Sophie C Hofferberth
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Fitzroy, Victoria, Australia.
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148
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Subramanian S, Leontyev S, Borger MA, Trommer C, Misfeld M, Mohr FW. Valve-Sparing Root Reconstruction Does Not Compromise Survival in Acute Type A Aortic Dissection. Ann Thorac Surg 2012; 94:1230-4. [DOI: 10.1016/j.athoracsur.2012.04.094] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/25/2012] [Accepted: 04/26/2012] [Indexed: 10/28/2022]
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149
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Uchida N. Open stent grafting for complex diseases of the thoracic aorta: clinical utility. Gen Thorac Cardiovasc Surg 2012; 61:118-26. [PMID: 23054614 PMCID: PMC3589658 DOI: 10.1007/s11748-012-0151-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Indexed: 11/02/2022]
Abstract
Open stent grafting is an alternative treatment for extensive thoracic aortic replacement. However, this procedure is associated with a high incidence of spinal cord injury, which has limited its application. Multiple factors have been suggested to explain the risk of spinal cord injury, including deep delivery of the stent graft, history of operation of the downstream aorta, and postoperative low blood pressure. Cerebrospinal fluid drainage or a hybrid operation in combination with trans-femoral thoracic stent grafting is useful for preventing spinal cord injury. Open stent grafting remains an alternative treatment for atherosclerotic aneurysms with dilatation of the ascending aorta. Open stent grafting for acute aortic dissection is effective for remodeling of the false lumen. The graft diameter for aortic dissection should be 90 % of the total diameter of the aorta, and the distal landing zone should be limited to the T7 vertebral level to prevent new intimal tears or spinal cord injury. Open stent grafting seems a feasible bailout strategy for the treatment of retrograde aortic dissection after TEVAR for type B aortic dissection. Newly designed devices for open stent grafts include the Matsui-Kitamura stent graft or branched open stent graft, which is produced in Japan. The effectiveness of open stent grafting in the treatment of Marfan syndrome remains unclear. A commercially available device for open stent grafting would be desired in Japan. In conclusion, an open stent graft remains an alternative treatment for complex thoracic aortic pathologies.
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Affiliation(s)
- Naomichi Uchida
- Division of Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
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150
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Krüger T, Conzelmann LO, Bonser RS, Borger MA, Czerny M, Wildhirt S, Carrel T, Mohr FW, Schlensak C, Weigang E. Acute aortic dissection type A. Br J Surg 2012; 99:1331-44. [DOI: 10.1002/bjs.8840] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Acute aortic dissection type A (AADA) is a life-threatening vascular emergency. Clinical presentation ranges from pain related to the acute event, collapse due to aortic rupture or pericardial tamponade, or manifestations of organ or limb ischaemia. The purpose of this review was to clarify important clinical issues of AADA management, with a focus on diagnostic and therapeutic challenges.
Methods
Based on a MEDLINE search the latest literature on this topic was reviewed. Results from the German Registry for Acute Aortic Dissection Type A (GERAADA) are also described.
Results
Currently, the perioperative mortality rate of AADA is below 20 per cent, the rate of definitive postoperative neurological impairment approaches 12 per cent and the long-term prognosis after surviving the acute phase of the disease is good. Many pathology- and therapy-associated factors influence the outcome of AADA, including prompt diagnosis with computed tomography and better cerebral protection strategies during aortic arch reconstruction. Endovascular technologies are emerging that may lead to less invasive treatment options.
Conclusion
AADA is an emergency that can present with a wide variety of clinical scenarios. Advances in the surgical management of this complex disease are improving outcomes.
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Affiliation(s)
- T Krüger
- Department of Cardiothoracic and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - L O Conzelmann
- Department of Cardiothoracic and Vascular Surgery, Medical Centre of Johannes Gutenberg University Mainz, Mainz, Germany
| | - R S Bonser
- Department of Cardiac Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust and University of Birmingham, Birmingham, UK
| | - M A Borger
- Department of Cardiac Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany
| | - M Czerny
- Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland
| | - S Wildhirt
- Department of Cardiothoracic and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - T Carrel
- Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland
| | - F W Mohr
- Department of Cardiac Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany
| | - C Schlensak
- Department of Cardiothoracic and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - E Weigang
- Department of Cardiothoracic and Vascular Surgery, Medical Centre of Johannes Gutenberg University Mainz, Mainz, Germany
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