Outcomes after surgery for acute type A aortic dissection in “non-Marfan syndrome” patients with long life expectancy: A 24-year follow-up

Objective: Valve-sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute Type-A Aortic Dissection (ATAAD). The Florida Sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the Florida Sleeve (FS) repair in patients with dilated roots in the setting of an ATAAD. Methods: We retrospectively reviewed 24 consecutive patients (2002-2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow-up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. Results: Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal-perfusion or shock. The FS was combined with hemi-arch replacement in 15 (62.5%) patients and a zone-2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow-up period was 46 months (range; 0.3-146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. Conclusion: FS is simplified and reproducible valve-sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type-A aortic dissection with excellent early and long-term results.

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Aortic Valve Function at Medium-term Follow-up after Resuspension During Repair of Acute Type A Aortic Dissection. Royal Brompton and Harefield Hospitals, Experience

Structural Heart ◽

10.1080/24748706.2019.1589263 ◽

2019 ◽

Vol 3 (sup1) ◽

pp. 66-66

Author(s):

Alessia Gambaro ◽

Marco Morosin ◽

Micheal Murphy ◽

John Pepper ◽

Jullien Gaer ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Medium Term ◽

Type A Aortic Dissection ◽

Valve Function

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Early Spontaneous Resolution of an Iatrogenic Acute Type A Aortic Dissection

Aorta ◽

10.12945/j.aorta.2016.16.067 ◽

2016 ◽

Vol 04 (06) ◽

pp. 235-239

Author(s):

Mohammad Zafar ◽

Philip Pang ◽

Glen Henry ◽

Bulat Ziganshin ◽

Maryann Tranquilli ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Type I ◽

Acute Type ◽

Computed Tomography Scan ◽

Descending Aorta ◽

Type A Aortic Dissection ◽

Tomography Scan

AbstractAcute aortic dissection is a rare but devastating complication during cardiac catheterization. We present the case of an elderly female who incurred a Stanford Type A/DeBakey Type I acute aortic dissection extending into the arch vessels and descending aorta likely occurring during right coronary artery engagement for angioplasty. The patient was treated successfully by immediately sealing the entrance of the dissection via the placement of a stent and anti-impulse therapy. Follow-up computed tomography scan showed complete resolution of the dissection within one month.

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Extended-arch repair for acute type-A aortic dissection: perioperative and mid-term results

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz071 ◽

2019 ◽

Vol 56 (4) ◽

pp. 714-721 ◽

Cited By ~ 4

Author(s):

Akash Fichadiya ◽

Alexander J Gregory ◽

Vamshi K Kotha ◽

Eric J Herget ◽

Holly N Smith ◽

...

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Type A ◽

Acute Type ◽

Cross Sectional ◽

Acute Setting ◽

Type A Aortic Dissection ◽

Surgical Complexity ◽

Permanent Neurological Deficit

Abstract OBJECTIVES: Extended-arch techniques offer the potential to comprehensively treat acute type-A aortic dissection (ATAAD), but add surgical complexity compared to the standard hemiarch technique. This study describes both perioperative and mid-term outcomes following the introduction of an extended-arch technique for ATAAD. METHODS: Ours is a retrospective single-centre observational study of 95 consecutive patients with ATAAD from 2011 to 2016. The decision to perform extended-arch or hemiarch repair was individualized based on clinical and radiological features. Extended-arch repair was defined as replacement of the ascending aorta and arch with reimplantation of head vessels with or without distal endovascular extension. Clinical follow-up was 100% complete. Cross-sectional double-oblique measurements were performed for aortic remodelling analysis. RESULTS: Extended-arch (n = 28) and hemiarch (n = 67) repair resulted in a in-hospital mortality of 10% (n = 3) and 10%, (n = 7), and permanent neurological deficit rate of 7% and 12%, respectively. At a mean imaging follow-up duration of 2.7 ± 1.5 years, false lumen thrombosis was achieved in 57% and 9% of patients undergoing extended-arch and hemiarch repair, respectively. Rate of growth in the proximal descending aorta was 0.7 ± 2.3 mm/year in the extended-arch group vs 2.7 ± 3.9 mm/year in the hemiarch group. At a mean clinical follow-up time of 3.0 ± 1.6 years, open surgical aortic reoperation was 0% in the extended-arch group and 22% in the hemiarch group. CONCLUSIONS: Extended-arch repair of ATAAD can be introduced in the acute setting without increase in perioperative mortality or morbidity. At mid-term follow-up, extended-arch for ATAAD improves aortic remodelling and reduces the need for open surgical reoperation.

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