Surgical Treatment of Acute Type A Aortic Dissection with 18-Litre 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.

Download Full-text

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.

Download Full-text

Surgical treatment of acute type A aortic dissection

Medicina ◽

10.3390/medicina45030025 ◽

2009 ◽

Vol 45 (3) ◽

pp. 192

Author(s):

Juozas Sakalauskas ◽

Šarūnas Kinduris ◽

Rimas Benetis ◽

Saulius Giedraitis ◽

Povilas Jakuška ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Cardiopulmonary Bypass ◽

Surgical Treatment ◽

Aortic Dissection ◽

Cardiogenic Shock ◽

Acute Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

The objective of this study was to evaluate the short-term results of surgical treatment in patients with acute aortic dissection. Patients and methods. A retrospective analysis of 38 patients with acute type A aortic dissection who were surgically treated at the Clinic of Cardiac, Thoracic, and Vascular Surgery, Hospital of Kaunas University of Medicine, from January 2004 to December 2007 was conducted. The diagnosis of aortic dissection was confirmed by employing special techniques. Two-dimensional transthoracic echocardiography was performed in 34 (89.5%) patients; transesophageal echocardiography, in 24 (63.1%); computed tomography, in 29 (76.3%); coronagraphy and angiography, in 20 (52.6%). Preoperative shock was reported in 3 (7.9%) and cardiac tamponade in 18 (47.4%) cases. More than half (57.9%) of patients were operated on within the first 24 hours after admission. In the majority of cases (73.7%), the diameter of the aorta exceeded 4 cm. In the presence of type A aortic dissection, all patients underwent surgery on cardiopulmonary bypass; its duration varied from 20 to 485 min, with a mean of 214.6±102.9 min. The mean aortic cross-clamp time was 114.5±62.7 min. Complete circulatory arrest was needed in the majority of cases (86.8%), and it lasted 2 to 97 min (mean, 27.4±18.6 min). During cardiopulmonary bypass, body temperature was decreased to 17–28°C (mean, 18.9±1.95°C). The duration of surgery ranged from 1 to 14 hours, with a mean of 6.1±2.49 hours. During the early postoperative period, 12 (31.6%) patients died. Postoperative bleeding was seen in 16 (42.1%) patients, and 6 of them died later. Due to prolonged bleeding, 4 (10.5%) patients were left with an open sternum after surgery. Resternotomy was performed in 9 patients; 3 of them died due to multiorgan injury. During postoperative period, cardiogenic shock of various degrees was seen in 7 (18.4%) patients. Central nervous system injury occurred in 9 (23.7%) patients. Conclusion. The main risk factor for acute aortic dissection is the diameter of the aorta exceeding 4 cm (diagnosed in 73.7% of cases). The main postoperative complications are bleeding (42.1%), injuries of central nervous system (23.7%), and cardiogenic shock (18.4%).

Download Full-text

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

Journal of Endovascular Therapy ◽

10.1177/1526602816680089 ◽

2016 ◽

Vol 24 (1) ◽

pp. 75-80 ◽

Cited By ~ 17

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.

Download Full-text

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

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(10)64656-5 ◽

1988 ◽

Vol 46 (4) ◽

pp. 420-424 ◽

Cited By ~ 65

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

Download Full-text

Impact of GERAADA Score in Patients With Acute Type A Aortic Dissection

10.21203/rs.3.rs-1113329/v1 ◽

2021 ◽

Author(s):

Kayo Sugiyama ◽

Hirotaka Watanuki ◽

Masato Tochii ◽

Yasuhiro Futamura ◽

Yuka Kitagawa ◽

...

Keyword(s):

Mortality Rate ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Acute Type ◽

Postoperative Results ◽

Entire Study ◽

Type A Aortic Dissection ◽

Actual Mortality ◽

Aortic Dissection Type A

Abstract Background Despite continuous developments and advances in the perioperative management of patients suffering from acute aortic dissection type A (AADA), the associated postoperative morbidity and mortality remain high and strongly depend on the preoperative clinical status. The associated postoperative mortality is still hard to predict prior to the surgical procedure. The so-called German Registry of Acute Aortic Dissection Type A (GERAADA) score uses very basic and easily retrievable parameters and was specifically designed for predicting the 30-day mortality rate in patients undergoing surgery for AADA. This study evaluated impact of the GERAADA score in the authors’ institutional results. MethodsAmong 101 acute type A aortic dissection patients treated at our hospital during August 2015–March 2021, the GERAADA was calculated individually and retrospectively. Predicted and actual mortalities were assessed, and independent predicted factors were searched. The primary endpoint was defined as comparison of GERAADA scores and early mortality, and the secondary endpoints were defined as comparison of GERAADA scores and other postoperative results, and comparison of preoperative factors and postoperative results regardless to GERAADA scores.ResultsWhile the overall 30-day mortality for the entire study cohort calculated by the GERAADA score was 14.3 (8.1-77.6) %, the actual mortality rate was 6%. However, the GERAADA score was significantly high in some postoperative complications and showed significant correlation with some peri- and post-operative factors. In addition, factors not belonging to GERAADA score such as time from onset to arrival at the hospital, time from onset to arrival at the operation room, spouse presence, and hemodialysis were significantly associated with 30-day mortality.ConclusionsAlthough the actual mortality was lower than predicted, GERAADA score may impact on the postoperative course. In addition, it would be desirable to add parameters such as the time from onset to arrival, family background, and hemodialysis for further accuracy.

Download Full-text

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

Download Full-text

Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2004.09.005 ◽

2005 ◽

Vol 129 (1) ◽

pp. 112-122 ◽

Cited By ~ 328

Author(s):

Santi Trimarchi ◽

Christoph A. Nienaber ◽

Vincenzo Rampoldi ◽

Truls Myrmel ◽

Toru Suzuki ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

International Registry ◽

Results Of Surgery

Download Full-text

Successful treatment of an acute type A aortic dissection presented with ST segment elevation on ECG and pericardial tamponade. Case report

Orvosi Hetilap ◽

10.1556/oh.2014.30028 ◽

2014 ◽

Vol 155 (44) ◽

pp. 1763-1767

Author(s):

Miklós Pólos ◽

Zoltán Szabolcs ◽

Astrid Apor ◽

István Édes ◽

Erzsébet Paulovich ◽

...

Keyword(s):

Aortic Dissection ◽

Successful Treatment ◽

Acute Aortic Dissection ◽

Type A ◽

Pericardial Tamponade ◽

Left Ventricular ◽

Acute Type ◽

Type A Aortic Dissection ◽

St Segment Elevation ◽

St Segment

Successful treatment of type A acute aortic dissection depends on the promptness of diagnostic evaluation and therapy. Fast diagnosis can be challenged by numerous complications such as myocardial ischemia, acute aortic insufficiency, and disturbances in organ perfusion and pericardial tamponade. The authors report the case history of a 72-year-old woman, who was admitted after resuscitation with ST segment elevation. Echocardiography revealed acute type A aortic dissection with signs of pericardial tamponade. An emergency operation consisting of the resection of the ascending aorta and the reconstruction of the aortic root was performed, which took six hours from admission until the end of the operation. Follow-up examinations demonstrated good left ventricular function and competent aortic valve. The authors propose that with the development of diagnostic and therapeutic options, faster and less invasive interventions will be introduced in near future for the treatment of acute aortic dissection, which may reduce the morbidity and mortality rates of this lethal illness. Orv. Hetil., 2014, 155(44), 1763–1767.

Download Full-text