Anastomotic leak after surgical repair of type A aortic dissection                     – prevalence and consequences in midterm follow-up

Abstract. Background: This study reports the mid-term prevalence and therapeutic consequences of anastomotic leaks after surgery for Stanford type A aortic dissections. Patients and methods: From July 2007 to July 2013, 93 patients survived surgery for acute type A dissections at our center and underwent a standardized follow-up. The pre-, peri-, and postoperative as well as the midterm results were collected prospectively. Follow-up computed tomography (CT) imaging was performed 7 days, 3, and 12 months after surgery, and yearly thereafter, to assess the presence or progression of anastomotic leaks at the aorto-prosthesis anastomotic sites. Results: The mean follow-up was 4 years (1534 ± 724 days). Follow-up CT revealed anastomotic leaks in 4 patients (4.3 %). All leaks developed during midterm follow-up and half of them did not increase with time. Two patients required redo surgery for an increase in periaortic extravasation and compression of neighboring structures. Further analysis was not able to reveal independent risk factors for development or deterioration of leaks. Conclusions: Anastomotic leaks after surgery for Stanford Type A aortic dissection can develop in midterm follow-up, even after initially excellent results. Meticulous follow-up is mandatory to detect possible deterioration and a need for redo surgery.

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Influence of Luminal Communication on Aortic Enlargement after Hemiarch Replacement for Acute Type A Aortic Dissection

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1677886 ◽

2019 ◽

Vol 68 (04) ◽

pp. 294-300

Author(s):

Gaku Uchino ◽

Takeshi Yoshida ◽

Bunpachi Kakii ◽

Masato Furui

Keyword(s):

Risk Factors ◽

Growth Rate ◽

Aortic Dissection ◽

Univariate Analysis ◽

Type A ◽

Aortic Diameter ◽

Acute Type ◽

Type A Aortic Dissection ◽

Independent Risk Factors ◽

Hemiarch Replacement

Background Aortic enlargement after hemiarch replacement (HAR) for acute type A aortic dissection (AAAD) is a serious problem. We reviewed our experience and analyzed the risk factors for aortic enlargement. Methods During April 2005 to December 2017, 364 patients underwent HAR for AAAD. Seventy-three patients fulfilled the inclusion criteria. We analyzed the change in aortic diameter, aortic growth rate, and major adverse aortic events (MAAEs) and their association with luminal communication of the aortic arch. Results Anastomotic communication, supra-aortic communication (SAC), and distal aortic communication were found in 34 (46.6%), 28 (38.4%), and 20 (27.4%) patients, respectively. The aortic growth rate was high because of the presence of SAC, distal aortic communication, and the number of coexisting aortic communication. Univariate analysis showed that the presence of SAC and an initial aortic diameter > 35 mm at 20 mm distal to the left subclavian artery and at the pulmonary artery bifurcation (PAB) were risk factors for MAAEs. Multivariate analysis showed that SAC and an initial aortic diameter > 35 mm at the PAB were independent risk factors for MAAEs. Conclusion SAC, distal aortic communication, and the number of coexisting aortic communication are significant risk factors for aortic enlargement after HAR for AAAD. SAC and an initial aortic diameter > 35 mm at the PAB are independent risk factors for MAAEs after this procedure.

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Acute Type A Aortic Dissection in a 36-Week Pregnant Patient

Case Reports in Emergency Medicine ◽

10.1155/2013/390670 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Erol Kohli ◽

Sharhabeel Jwayyed ◽

Gary Giorgio ◽

Mary Colleen Bhalla

Keyword(s):

Aortic Dissection ◽

Early Recognition ◽

Type A ◽

Pregnant Patient ◽

Acute Type ◽

Third Trimester ◽

Type A Aortic Dissection ◽

Increased Risk ◽

History Of ◽

Aortic Dissections

Aortic dissection is a relatively rare yet often fatal condition. Early recognition and treatment are crucial for survival. While the majority of patients who present with aortic dissection are older than 50 years of age and have a history of hypertension, younger patients with connective tissue disease, bicuspid aortic valves, and a family history of aortic dissection are also at an increased risk for developing this condition. A review of the literature revealed a paucity of published cases describing the successful, emergent repair of acute type A aortic dissections in third- trimester gravid patients. We present the case of the successful diagnosis and surgical repair of a 41-year-old female who presented to the emergency department with an acute type A aortic dissection at 36 weeks of gestation.

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Fate of the preserved aortic root after treatment of acute type A aortic dissection: 23-year follow-up

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2012.09.049 ◽

2013 ◽

Vol 146 (6) ◽

pp. 1456-1460 ◽

Cited By ~ 19

Author(s):

Angelo M. Dell'Aquila ◽

Giovanni Concistrè ◽

Alina Gallo ◽

Stefano Pansini ◽

Alessandro Piccardo ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection

Annals of Palliative Medicine ◽

10.21037/apm-21-1428 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Jing Zhou ◽

Jieyi Pan ◽

Yuheng Yu ◽

Weixiang Huang ◽

Yan Lai ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Independent Risk Factors

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Florida Sleeve is a Safe and Effective Technique for Valve Salvage in Acute Stanford Type A Aortic Dissection

10.22541/au.163256960.06606439/v1 ◽

2021 ◽

Author(s):

Mahmoud Alhussaini ◽

Eric Jeng ◽

Tomas Martin ◽

Amber Filion ◽

Thomas Beaver ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Long Term Results ◽

Acute Type ◽

Type A Aortic Dissection ◽

Valve Sparing

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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