Septuagenarians with acute type A aortic dissection: outcome of direct true lumen cannulation in the surgical treatment

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.

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

Journal of Atherosclerosis and Thrombosis ◽

10.5551/jat.35675 ◽

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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Surgical treatment for acute type A aortic dissection during pregnancy (16 weeks) with Loeys-Dietz syndrome

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-012-0073-8 ◽

2012 ◽

Vol 60 (11) ◽

pp. 764-767 ◽

Cited By ~ 14

Author(s):

Hideyuki Kunishige ◽

Yoshimitsu Ishibashi ◽

Masakazu Kawasaki ◽

Tomoji Yamakawa ◽

Kiyotaka Morimoto ◽

...

Keyword(s):

Surgical Treatment ◽

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Late aortic root redissection following surgical treatment for acute type A aortic dissection using Gelatin-Resorcin-Formalin glue

The Japanese Journal of Thoracic and Cardiovascular Surgery ◽

10.1007/bf03032285 ◽

2002 ◽

Vol 50 (5) ◽

pp. 195-200 ◽

Cited By ~ 15

Author(s):

Kotaro Suehiro ◽

Takato Hata ◽

Hidenori Yoshitaka ◽

Yoshimasa Tsushima ◽

Mitsuaki Matsumoto ◽

...

Keyword(s):

Surgical Treatment ◽

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Open direct cannulation of the true lumen under visual control of the ascending aorta in acute type A aortic dissection: a fast and safe alternative

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2008-1037843 ◽

2008 ◽

Vol 56 (S 1) ◽

Author(s):

U Herold ◽

K Tsagakis ◽

M Kamler ◽

P Massoudy ◽

M Thielmann ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Ascending Aorta ◽

Visual Control ◽

Acute Type ◽

True Lumen ◽

Safe Alternative ◽

Type A Aortic Dissection

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Common carotid artery true lumen flow impairment in patients with type A aortic dissection

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa322 ◽

2020 ◽

Author(s):

Maximilian Kreibich ◽

Nimesh D Desai ◽

Joseph E Bavaria ◽

Wilson Y Szeto ◽

Prashanth Vallabhajosyula ◽

...

Keyword(s):

Carotid Artery ◽

Aortic Dissection ◽

Hospital Mortality ◽

Common Carotid Artery ◽

Type A ◽

Acute Type ◽

Imaging Data ◽

True Lumen ◽

Type A Aortic Dissection ◽

Logistic Regression Models

Abstract OBJECTIVES Our aim was to evaluate clinical and neurological effects of common carotid artery (CCA) true lumen flow impairment or occlusion in patients with type A aortic dissection. METHODS Characteristics and imaging data of patients with dissected CCA secondary to acute type A aortic dissection from 3 institutions were analysed. We defined true lumen blood flow as unimpaired when the maximum true lumen diameter exceeded 50% of the complete CCA diameter, as impaired when the true lumen was compressed to ˃50% of the complete lumen, or as occluded. RESULTS Out of 440 patients, 207 presented unimpaired CCA flow, 172 impaired CCA flow and CCA occlusion was present in 61 patients. Preoperative shock (P = 0.045) or a neurological deficit (P < 0.001) were least common in patients with unimpaired CCA flow and most common in those with CCA occlusion. Non-cerebral, other-organ malperfusion was common in 37% of all patients, but the incidence was similar (P = 0.69). In patients with CCA occlusion, postoperative stroke (P < 0.001) and in-hospital mortality (0.011) were significantly higher, while the incidences were similar between patients with unimpaired and impaired CCA flow. Mixed-effects logistic regression models showed that CCA flow impairment (P = 0.23) or occlusion (P = 0.55) was not predictive for in-hospital mortality, but CCA occlusion was predictive for in-hospital stroke (odds ratio 2.166, P = 0.023) CONCLUSIONS Shock and non-cerebral, other-organ malperfusion are common in patients with CCA dissection. While there is a high risk for stroke in patients with CCA occlusion, CCA flow impairment and occlusion were not predictive for in-hospital mortality. Surgery should not be denied to patients with CCA flow impairment or occlusion.

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Results of Immediate Surgical Treatment of All Acute Type A Dissections

Circulation ◽

10.1161/circ.102.suppl_3.iii-248 ◽

2000 ◽

Vol 102 (suppl_3) ◽

Author(s):

Marek P. Ehrlich ◽

M. Arisan Ergin ◽

Jock N. McCullough ◽

Steven L. Lansman ◽

Jan D. Galla ◽

...

Keyword(s):

Surgical Treatment ◽

Mortality Rate ◽

Aortic Dissection ◽

Type A ◽

Distal Anastomosis ◽

Hospital Death ◽

Acute Type ◽

Descending Aorta ◽

Type A Aortic Dissection ◽

Intimal Tear

Background —Surgery for acute type A aortic dissection is associated with a high mortality rate and incidence of postoperative complications. This study was designed to explore perioperative risk factors for death in patients with acute type A aortic dissection. Methods and Results —One hundred twenty-four consecutive patients with acute type A aortic dissection between 1984 and 1998 were reviewed. All underwent operation with resection of the intimal tear and open distal anastomosis: 107 patients had surgery within 24 hours and 17 patients had surgery within 72 hours of symptom onset. Median age was 62 years (23 to 89); 89 were men. Forty-three patients had ascending aortic replacement only, 72 had hemiarch repair, in 2 the entire arch was replaced, and in 7 replacement included the proximal descending aorta. The aortic valve was replaced in 54 patients, resuspended in 52, and untouched in 18. Hospital mortality rate was 15.3% (19 of 124): of these, 3 patients died during surgery, 4 had fatal rupture of the distal aorta before discharge, and 2 died of malperfusion-related complications. Multivariate analysis revealed age >60, hemodynamic compromise, and absence of hypertension as preoperative indicators of hospital death ( P <0.05); the presence of new neurological symptoms was a significant preoperative risk factor in univariate analysis. Ominous intraoperative factors included contained hematoma and a comparatively low esophageal temperature but not cerebral ischemic time (mean 32 minutes). The site of the intimal tear did not influence outcome, but mortality rate was higher with more extensive resection: 43% with resection including the descending aorta died versus 14% with only ascending aorta or hemiarch replacement. Overall 5- and 10-year survival was 71% and 54%, respectively; among discharged patients (median follow-up 41 months) survival was 84% and 64% versus expected US survival of 92% and 79%. Conclusions —Immediate surgical treatment of all acute type A dissections with resection of the intimal tear and use of hypothermic circulatory arrest for distal anastomosis results in acceptable early mortality rates and excellent long-term survival.

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