Aortic Root Remodeling in Acute Aortic Dissection

2020 ◽  
Author(s):  
Tristan Ehrlich ◽  
Irem Karliova ◽  
Lennart Froede ◽  
Christian Giebels ◽  
Takashi Kunihara ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Acute Aortic Dissection ◽  
Group Versus ◽  
Long Term Results ◽  
Control Group ◽  
Actuarial Survival ◽  
Aortic Replacement ◽  
Aortic Root Remodeling

Abstract Objectives To evaluate the long-term results of remodeling in acute aortic dissection type A (AADA) to define operative risk and root and valve stability. Methods Between October 1995 and December 2018, a total of 352 patients were treated surgically for AADA. Of these, 90 patients with AADA (<2 weeks from onset; age: 57 ± 15 years; 70 males) with a root diameter of >43 to 45 mm (depending on patient size) (48 ± 4.1 mm) underwent aortic root remodeling and were analyzed further. As the control group, we chose the patients with normally sized aortic roots who had been treated by tubular replacement only (n = 227). Other procedures were performed in 35 cases. Results Early mortality was 9% in the remodeling group versus 15% in the tubular ascending aortic replacement (TAR). Actuarial survival at 10 and 15 years was 68 ± 5% and 58.3 ± 6.4%, respectively, in the root remodeling group versus 68 ± 4% and 66 ± 4% in the TAR group (p = 0.99). Freedom from reoperation on the aortic valve or root was 95 ± 3% at 10 years and at 89 ± 6% at 15 years. Freedom from proximal reoperation after TAR at 10 and 15 years was 93 ± 3% and 91 ± 3% (n = 31 patients at risk), respectively, not statistically different from that after remodeling (p = 0.75). Conclusions The long-term stability of aortic root remodeling for enlarged roots with AADA was comparable to TAR preserving a normal aortic root.

scholarly journals Long-Term Outcome of Aortic Root Remodeling for Patients With and Without Acute Aortic Dissection

2017 ◽  
Vol 81 (12) ◽  
pp. 1824-1831 ◽  
Author(s):  
Takashi Kunihara ◽  
Niklas Neumann ◽  
Steffen Daniel Kriechbaum ◽  
Ryota Nomura ◽  
Hans-Joachim Schäfers
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Acute Aortic Dissection ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Aortic Root Remodeling

Bentall–de Bono procedure for acute aortic dissection

2021 ◽  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Acute Aortic Dissection ◽  
Aortic Surgery ◽  
Acute Type ◽  
Aortic Diseases ◽  
Type A Aortic Dissection ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Valve Sparing

We present a patient with an acute type A aortic dissection that involves the aortic root. The high mortality of patients with this condition is often associated with operations performed by surgeons with minimal experience dealing with aortic diseases. Therefore, less-experienced surgeons often opt for less complicated techniques like supracoronary ascending aortic replacement. However, according to the latest guidelines for the management of aortic diseases, the aortic root should be replaced when it is compromised by the dissection. The Bentall–de Bono technique treats the aortic root and demands less experience than valve-sparing aortic surgery.

scholarly journals Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?

2020 ◽  
Author(s):  
Wei Qin ◽  
Cunhua Su ◽  
Liangpeng Li ◽  
Michael Carmichael ◽  
Fuahua Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Elderly Patients ◽  
Acute Aortic Dissection ◽  
Group Versus ◽  
Type A ◽  
Surgical Approaches ◽  
Elephant Trunk ◽  
Aortic Repair ◽  
Aortic Replacement ◽  
Significant Difference

Abstract Objective This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes. Methods From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n = 41) and total arch replacement + stent elephant trunk implantation (TAR + SET, n = 62). Results There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR + SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality (P = 0.04). The overall survival rates at 5-year follow-up were 82.5 ± 6.0% in LAR group and 75.2 ± 5.6% in TAR + SET group, but with no difference (p = 0.151). The freedom from adverse aortic events at 5-year was 84.3 ± 6.5% in LAR group versus 97.9 ± 2.1% in TAR + SET group, with a statistical difference (p = 0.03). Conclusion These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.

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

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.

scholarly journals Aortic root remodeling in bicuspid and tricuspid aortic valves—long-term results

2019 ◽  
Vol 36 (S1) ◽  
pp. 81-87
Author(s):  
Shunsuke Miyahara ◽  
Irem Karliova ◽  
Christian Giebels ◽  
Ulrich Schneider ◽  
Shunsuke Matsushima ◽  
...  
Keyword(s):  
Aortic Root ◽  
Long Term Results ◽  
Aortic Valves ◽  
Aortic Root Remodeling

LONG-TERM RESULTS OF BRONCHOPLASTIC SURGICAL INTERVENTIONS IN COMPARISON WITH PNEUMONECTOMIES IN LUNG CANCER

2017 ◽  
Vol 63 (2) ◽  
pp. 234-239
Author(s):  
Yevgeniy Levchenko ◽  
Aleksandr Mikhnin ◽  
Stepan Yergnyan ◽  
Aleksey Barchuk ◽  
Leonid Gorokhov ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Survival Rates ◽  
Group Versus ◽  
Disease Free Survival ◽  
Long Term Results ◽  
Control Group ◽  
Free Survival ◽  
Surgical Interventions ◽  
Disease Free

The analysis of long-term results of surgical treatment of 198 patients with non-small cell lung cancer (NSCLC) I -III stages. Bronchoplasty (BP) interventions were performed in 99 cases, the control group comprised 99 patients after pneumonectomies (PE) corresponding to the main prognostic criteria for patients after BP interventions. A 1-year, 3-year and 5-year observed survival rates of patients were 87.7%, 56.2% and 44.6% after BP versus 82.8%, 54.6% and 35.9% after PE, respectively. A 1-year, 3-year and 5-year disease-free survival in the BP group was 87.9%, 64.2% and 52.3% versus 88.1%, 61.6% and 37.9% in the PE group. The median of overall and disease-free survival was 51.4 and 55.2 months in the BP group versus 46.2 and 41.0 months in the PE group, respectively.

scholarly journals Natural courses and long-term results of type A acute aortic intramural haematoma and retrograde thrombosed type A acute aortic dissection: a single-centre experience

2019 ◽  
Vol 30 (1) ◽  
pp. 113-120 ◽  
Author(s):  
Yen-Yu Chen ◽  
Hsu-Ting Yen ◽  
Chien-Ming Lo ◽  
Chia-Chen Wu ◽  
David Kwan-Ru Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Medical Therapy ◽  
Acute Aortic Dissection ◽  
Survival Rates ◽  
Type A ◽  
Long Term Results ◽  
Urgent Surgery ◽  
Life Threatening ◽  
Thrombosed Type

Abstract OBJECTIVES Few reports on the outcomes of patients treated for Stanford type A acute aortic intramural haematoma (TAAIMH) and retrograde thrombosed type A acute aortic dissection exist. This study aimed to evaluate their long-term results and predictors of adverse outcomes. METHODS We retrospectively analysed 40 patients with TAAIMH and retrograde thrombosed type A acute aortic dissection. All patients underwent urgent surgery on presentation of life-threatening complications. Before discharge, 18 patients underwent open aortic surgery, and 22 were treated with medical therapy alone. Clinical features of these patients and image appearances were reviewed, and the relationship with overall survival, aortic events, and aortic death was investigated. RESULTS The in-hospital mortality rate was 4.5% (1 patient) with medical therapy alone and 11.1% (2 patients) with surgical intervention. No patient with initial medical therapy required urgent surgery for life-threatening complications beyond 3 days of admission. The overall survival and aortic death-free survival rates at 1, 5 and 10 years were 85.0%, 72.5% and 59.8% and 90.0%, 81.6% and 77.1%, respectively. TAAIMH associated with penetrating aortic ulcer (PAU) was a risk factor of aortic events (P = 0.020) and significantly influenced aortic death-free survival (P = 0.003). CONCLUSIONS Urgent surgery for complicated TAAIMH and retrograde thrombosed type A acute aortic dissection patients and initial medical therapy for uncomplicated patients show favourable long-term survival rates. TAAIMH is frequently associated with PAU; PAU enlargement is common. Although PAU can remain stable for years, it is a strong predictor of poor prognosis. For optimal long-term results, surgical repair is recommended for TAAIMH associated with PAU.

Long-Term Results After Repair of Type A Acute Aortic Dissection According to False Lumen Patency

2009 ◽  
Vol 88 (4) ◽  
pp. 1244-1250 ◽  
Author(s):  
Khalil Fattouch ◽  
Roberta Sampognaro ◽  
Emiliano Navarra ◽  
Marco Caruso ◽  
Calogera Pisano ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Long Term Results
Sign in / Sign up

Export Citation Format

Share Document