scholarly journals Hybrid Arch for Acute Type A Aortic Dissection: When to Deploy the Endograft? Debate: Frozen versus Staged?

Aorta ◽  
2018 ◽  
Vol 06 (05) ◽  
pp. 109-112
Author(s):  
Jehangir Appoo ◽  
Akash Fichadiya ◽  
Holly Smith ◽  
Vamshi Kotha ◽  
Eric Herget ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Endovascular Techniques ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Stent Grafting ◽  
Pros And Cons ◽  
Aortic Dissections ◽  
Open Arch

AbstractAdvances in open and endovascular techniques have resulted in novel approaches to repair of acute Type A aortic dissection. Hybrid arch procedures involve open arch resection and stent grafting of the descending aorta with stent graft insertion in one of two ways: Frozen or Staged. In this article, pros and cons of the two different paradigms of emerging hybrid arch techniques for acute Type A aortic dissections are discussed.

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

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
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.

Results of Immediate Surgical Treatment of All Acute Type A Dissections

Circulation ◽  
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.

scholarly journals Early Spontaneous Resolution of an Iatrogenic Acute Type A Aortic Dissection

Aorta ◽  
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.

scholarly journals Medical Management of Three Patients with an Acute Type A Aortic Dissection: Case Series and a Review of the Literature

Aorta ◽  
2018 ◽  
Vol 06 (04) ◽  
pp. 098-101
Author(s):  
Khaled Salhab ◽  
William Gioia ◽  
Andrew Rabenstein ◽  
George Gubernikoff ◽  
Scott Schubach
Keyword(s):  
Aortic Dissection ◽  
Medical Management ◽  
Case Series ◽  
Type A ◽  
Acute Type ◽  
Review Of The Literature ◽  
Type A Aortic Dissection ◽  
Surgery First ◽  
Aortic Dissections

AbstractThe model of surgery first and always for Type A aortic dissections has continued to evolve. During the last three decades, various studies have demonstrated that in select patients, surgery should be delayed or avoided. This case series examines three cases in which patients were medically treated. Furthermore, we review the literature and when surgery should be delayed for acute Type A aortic dissections.

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

VASA ◽  
2017 ◽  
Vol 46 (5) ◽  
pp. 377-382 ◽  
Author(s):  
Tamer Ghazy ◽  
Adrian Mahlmann ◽  
Zuzana Fajfrova ◽  
Ayham Darwish ◽  
Mohamed Eraqi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Redo Surgery ◽  
Anastomotic Leaks ◽  
Type A Aortic Dissection ◽  
Therapeutic Consequences ◽  
Independent Risk Factors ◽  
Aortic Dissections

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.

Acute type A aortic dissection with complete intimal intussusception into the descending aorta

2020 ◽  
Vol 35 (7) ◽  
pp. 1626-1627
Author(s):  
Edgar Aranda‐Michel ◽  
Valentino Bianco ◽  
Arman Kilic ◽  
Thomas G. Gleason ◽  
Ibrahim Sultan
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Intimal Intussusception
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