scholarly journals Surgical treatment of an aneurysm involving ascending aorta, aortic arch, and a rupture of a descending aortic aneurysm 26 years following acute type A aortic dissection

2006 ◽  
Vol 131 (1) ◽  
pp. 235-236.e1 ◽  
Author(s):  
Christian Kühn ◽  
Omke E. Teebken ◽  
Jürgen Weidemann ◽  
Matthias Karck ◽  
Maximillian Pichlmaier ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Descending Aortic Aneurysm

scholarly journals Hemiarch versus Arch Replacement in Acute Type A Aortic Dissection: Is the Occam’s Razor Principle Applicable?

2021 ◽  
Vol 11 (1) ◽  
pp. 114
Author(s):  
Igor Vendramin ◽  
Daniela Piani ◽  
Andrea Lechiancole ◽  
Sandro Sponga ◽  
Concetta Di Nora ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Ascending Aorta ◽  
Long Term Results ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Group 2 ◽  
Hemiarch Replacement ◽  
Group 1

Background and aim of the study: In patients with acute Type A aortic dissection (A-AAD) whether repair should be limited to ascending aorta/hemiarch replacement or extended to include the aortic arch is still debated. We have analyzed our experience to compare outcomes of patients with A-AAD treated with these 2 different surgical strategies. Methods: From 2006 to 2020, a total of 213 patients have undergone repair of A-AAD at our Center; in 163 of them ascending aorta/hemiarch replacement (Group 1) and in 75 ascending aorta and arch replacement (Group 2) were performed. The primary endpoint was early survival and secondary endpoints late survival, freedom from late complications and reoperations. Patients were compared according to era of operation: 2006 to 2013 (Era 1) and 2014 to 2020 (Era 2). Results: Overall hospital mortality was 12% and 5% in Group 1 and 2; mortality remained stable in Era 1 and 2 for Group 1 (15%), while it decreased from 8% to 1% in Group 2 patients (p = 0.24). Actuarial survival at 5 and 10 years is 72 ± 4% and 49 ± 5% in Group 1 and 77 ± 6% and 66 ± 9% in Group 2 (p = 0.073). Actuarial freedom from reoperation in the entire series is 94 ± 2% and 92 ± 3% at 5 and 10 years. Freedom from reoperation at 5 and 10 years is 92 ± 2% and 89 ± 3% in Group 1 and 98 ± 1% at all intervals in Group 2 (p = 0.068). Conclusions: An aggressive approach to A-AAD provides superior long-term results without increasing mortality. Furthermore, arch replacement during A-AAD repair represents a more stable solution with lower incidence of late aortic-related complications. Immediate aortic arch replacement should be considered in the treatment of A-AAD especially in experienced centers.

scholarly journals Anatomy of the retrograde type A aortic dissection after endovascular repair of type B aortic dissection: a case report

2021 ◽  
Vol 0 (Ahead of Print) ◽  
Author(s):  
Uliana Pidvalna ◽  
Marianna Mirchuk ◽  
Anna Voitovych ◽  
Dmytro Beshley
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Ascending Aorta ◽  
Medical Attention ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Type A Aortic Dissection ◽  
Aortic Replacement

Aortic dissection requires immediate medical attention. The optimal treatment approach of Type B aortic dissection is still a matter of debate. Possible options include open surgery, endovascular aortic repair (EVAR), and hybrid procedure. The indication for surgery is the dissection that involves the ascending aorta and the aortic arch (Type A Stanford, Types I and II DeBakey). Hybrid or endovascular procedures seem to be an attractive alternative treatment for patients with the complex aortic disease and a high risk of surgery. Endovascular treatment of acute Type B aortic dissections is designed to prevent the retrograde dissection of the ascending aorta and the aortic arch. The occurrence of retrograde Type A aortic dissection (RTAD) is rare, but the mortality rate is high. We report a case of a 55-year-old gentleman who had undergone thoracic EVAR. Thirty months after the given procedure he presented with RTAD and underwent supracoronary aortic replacement. The article is intended to remind the clinicians of the importance of early detection of the possible complications when performing EVAR, and the significance of a rapid response.

Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

2016 ◽  
Vol 24 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Tilo Kölbel ◽  
Christian Detter ◽  
Sebastian W. Carpenter ◽  
Fiona Rohlffs ◽  
Yskert von Kodolitsch ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Open Surgery ◽  
Type A ◽  
Ascending Aorta ◽  
Type I ◽  
Acute Type ◽  
Stent Grafts ◽  
Type A Aortic Dissection ◽  
Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

Extended and Total Aortic Resection in the Surgical Treatment of Acute Type A Aortic Dissection: Experience with 54 Patients

1988 ◽  
Vol 46 (4) ◽  
pp. 420-424 ◽  
Author(s):  
Carlo G. Massimo ◽  
Luigi F. Presenti ◽  
Piezluigi Marranci ◽  
Piero P. Favi ◽  
Alberto G. Poma ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

scholarly journals Surgical Treatment of Acute Type A Aortic Dissection with 18-Litre Bleeding

Aorta ◽  
2021 ◽  
Vol 09 (01) ◽  
pp. 030-032
Author(s):  
Sergey Y. Boldyrev ◽  
Kirill O. Barbukhatty ◽  
Vladimir A. Porhanov
Keyword(s):  
Surgical Treatment ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Type I ◽  
Acute Type ◽  
Drug Induced ◽  
Type A Aortic Dissection ◽  
Mortality And Morbidity ◽  
Perioperative Bleeding

AbstractSurgical treatment of Type-A acute aortic dissection is associated with high mortality and morbidity. One of the reasons is perioperative bleeding, which may lead to worse outcomes. We present a case of successful treatment of a patient with 18-litre perioperative blood loss in DeBakey Type-I acute aortic dissection with drug-induced hypocoagulation and malperfusion of a lower extremity.

Acute Type A Aortic Dissection After TAVR in an Octogenarian With Ascending Aorta Aneurysm

2021 ◽  
Author(s):  
Helen Hashemi ◽  
Sahil Khera ◽  
Malcolm Anastasius ◽  
Ismail El-Hamamsy ◽  
Gilbert H.L. Tang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aorta Aneurysm

scholarly journals Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

2020 ◽  
Vol 58 (5) ◽  
pp. 1027-1034 ◽  
Author(s):  
Raphaelle A Chemtob ◽  
Simon Fuglsang ◽  
Arnar Geirsson ◽  
Anders Ahlsson ◽  
Christian Olsson ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Pericardial Tamponade ◽  
Acute Type ◽  
Aortic Arch Replacement ◽  
Type A Aortic Dissection ◽  
Total Aortic Arch Replacement ◽  
Cerebral Malperfusion ◽  
Mortality Hazard Ratio

Abstract OBJECTIVES Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients. METHODS The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014. RESULTS Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34–3.05; P < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27–2.23; P < 0.001). CONCLUSIONS Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.

scholarly journals Influence of False Lumen Status on the Prognosis of Acute Type A Aortic Dissection without Urgent Surgical Treatment

2017 ◽  
Vol 24 (2) ◽  
pp. 169-175
Author(s):  
Akihito Tanaka ◽  
Hideki Ishii ◽  
Susumu Suzuki ◽  
Tomoyuki Ota ◽  
Hideki Oshima ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection
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