Italian multicentre study on type A acute aortic dissection: a 33-year follow-up

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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Surgical treatment of type A acute aortic dissection with cerebral malperfusion: a systematic review

10.22541/au.163700485.51035911/v1 ◽

2021 ◽

Author(s):

Changtian Wang ◽

LEI ZHANG ◽

tao li ◽

Zhilong Xi ◽

Haiwei Wu ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Surgical Repair ◽

Type A ◽

Mortality And Morbidity ◽

Medline Search ◽

Cerebral Malperfusion

Purpose: Type A acute aortic dissection (TAAAD) complicated with cerebral malperfusion (CM) is a life-threatening condition associated with high mortality, poor outcomes, and the optimal surgical management remains controversial. The aim of this review was to report the current results of surgical interventions of these patients. Methods: A systematic review was performed using PubMed and MEDLINE search for cases underwent surgical repair for TAAAD with CM. Demographics, neurological symptom, the time from onset of symptoms to operation, operation data, mortality, neurological outcome, and follow-up were reviewed. Results: A total of 363 patients with mean age of 65.7±13 years underwent surgical repair for TAAAD with CM were identified in 12 retrospective studies. In-hospital mortality was 20.1%. Mean duration of follow-up was 40.1 ± 37.6 months. The involved supra-aortic branch vessels were RCCA (n=99), LCCA (n=25) , B-CCA (n=52), CCA (n=131), IA (n=19), and LSA (n=8). Time from onset of neurological symptoms to surgery was 13.3 hours. Antegrade and/or retrograde cerebral perfusion was applied. Postoperatively, improved, unchanged and worsened neurological status was occurred in 54.3%, 27.1%, and 8.5%, respectively in 199 patients. Conclusion: The outcomes of surgical treatment of TAAAD complicated with CM indicate acceptable early mortality and morbidity. It is reasonable to perform lifesaving surgery on these patients. Early central surgical repair and reperfusion of brain may improve the outcomes.

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Abstract 19334: Management and Outcomes of Acute Retrograde Type A Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection

Circulation ◽

10.1161/circ.132.suppl_3.19334 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Foeke J Nauta ◽

Joon Bum Kim ◽

Himanshu J Patel ◽

Mark D Peterson ◽

Hans-Henning Eckstein ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Innominate Artery ◽

Type A ◽

Ascending Aorta ◽

Early Mortality ◽

Long Term Results ◽

Descending Aorta ◽

International Registry

Background: Presentations and outcomes of acute aortic dissection (AD) with an entry tear in the ascending aorta may differ from retrograde dissection with an entry tear in the descending aorta. However, guidelines recommend urgent surgical repair for both entities. Methods and Results: All patients with AD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2014 were analyzed. We identified 99 patients (67 men; 63.2±14.0 years) with an entry tear in the descending aorta and retrograde extension into the arch or ascending aorta. Overall, independent predictors of retrograde type A AD were increasing age(OR 1.0; 95% CI, 1.0 to 1.0; P=0.004), history of cocaine abuse (OR 4.9; 95% CI, 1.7 to 13.6; P=0.003), back pain at presentation (OR 2.1; 95% CI, 1.3 to 3.3; P=0.002), and non-white race (OR 0.4; 95% CI, 0.2 to 0.6; P<0.001). During initial hospitalization, 44 of these patients were managed medically (MED), 33 with open surgery(SURG) and 22with endovascular therapy (ENDO). Patients in the SURG group presented with larger ascending aortic diameters than MED and ENDO patients (P=0.04). The majority of the MED (72.7%) and ENDO (86.4%) patients had AD extension confined to zone 1 (proximal arch, P<0.001), whereas most of the SURG patients (71.8%) presented with AD extension into zone 0 (proximal to the innominate artery, P<0.001). Early (30-day or in-hospital) mortality rates of the MED, SURG and ENDO groups were 9.1%, 18.2%, and 13.6%, respectively (P=0.51), with 5-year survival of 86.7%, 80.0%, and 90.9%, respectively (mean follow-up, 3.3 years, log rank P=0.67). A trend of favorable early mortality was observed in patients with retrograde extension till zone 1 (8.6%) versus into zone 0 (18.6%, P=0.14).Early mortality of patients with retrograde type A AD (12.9%) was lower than those with type A AD (20.0%, P=0.001), while 5-year survival was similar (86.8% and 89.5%, respectively, mean follow-up, 3.0 years, log rank P=0.96). Conclusion: There is a subset of patients with acute retrograde type A AD who can be managed non-operatively with acceptable short and long-term results. This implies that a selective approach may be reasonable, particularly among those with proximal extension limited to the arch distal to the innominate artery.

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Faculty Opinions recommendation of Type A acute aortic dissection with ≥40-mm aortic root: results of conservative and replacement strategies at long-term follow-up.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.739273857.793581623 ◽

2021 ◽

Author(s):

John Augoustides

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Acute Aortic Dissection ◽

Type A ◽

Long Term Follow Up

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Persistent dissection of carotid artery in patients operated on for type A acute aortic dissection—carotid ultrasound follow-up

International Journal of Cardiology ◽

10.1016/s0167-5273(99)00072-8 ◽

1999 ◽

Vol 70 (2) ◽

pp. 133-139 ◽

Cited By ~ 23

Author(s):

Tomasz Zieliński ◽

Jolanta Wołkanin-Bartnik ◽

Hanna Janaszek-Sitkowska ◽

Andrzej Biederman ◽

Dariusz Rynkun ◽

...

Keyword(s):

Carotid Artery ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Carotid Ultrasound

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Successful surgical treatment of a type A acute aortic dissection during advanced pregnancy: A 10‐year follow‐up

Journal of Cardiac Surgery ◽

10.1111/jocs.15179 ◽

2020 ◽

Author(s):

Jiaqi Tong ◽

Ning Wang ◽

Yu Li ◽

Mu Jin

Keyword(s):

Surgical Treatment ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A

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Effects of psychiatric disorders on Type A acute aortic dissection pathogenesis and analysis of follow-up results

Archives of Clinical and Experimental Surgery (ACES) ◽

10.5455/aces.20150108115200 ◽

2015 ◽

Vol 4 (4) ◽

pp. 202

Author(s):

Paolo Nardi ◽

Antonio Pellegrino ◽

Francesco Bianchi ◽

Marco Russo ◽

Guglielmo Saitto ◽

...

Keyword(s):

Aortic Dissection ◽

Psychiatric Disorders ◽

Acute Aortic Dissection ◽

Type A

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Abstract 754: Ascending Aortic vs. Femoral Cannulation for Acute Aortic Dissection Type A

Circulation ◽

10.1161/circ.118.suppl_18.s_612-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Hiroyuki Kamiya ◽

Dominique Halmer ◽

Merve Oezsoez ◽

Kathrin Ilg ◽

Artur Lichtenberg ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Circulatory Arrest ◽

Operation Time ◽

Type A ◽

Patient Characteristics ◽

Study Cohort ◽

Aortic Cannulation ◽

Aortic Dissection Type A

Objectives: The site of cannulation for repair of ascending aortic dissection remains controversial. Here we present our experience with ascending aortic cannulation for acute aortic dissection type A (AADA). Methods: From 01/1988 to 09/2007, we operated on 242 patients for AADA. Medical records of 235 patients who received ascending aortic cannulation or femoral cannulation were retrospectively reviewed. Long term follow-up was complete in 97% of patients. Cannulation was accomplished in 82 patients through the ascending aorta and in 153 patients through the femoral artery. Results: There were no significant differences in preoperative characteristics between groups. Similarly, there were no differences in preoperative patient characteristics and intraoperative parameters including operation time (ascending 357±139 vs. peripheral 342±125 min.; p=0.40), bypass time (ascending 219±105 vs peripheral 206±96 min.; p=0.32), cross-clamp time (ascending 106±43 vs peripheral 106±51 min.; p=0.69), hypothermic circulatory arrest time (ascending 28±19 vs peripheral 27±23 min.; p=0.73), and percentage of total arch replacement (ascending 54.9% vs peripheral 55.7%; p=0.44). Hospital mortality was 12.2% in each group (p=0.98), and incidence of stroke was 4.9% in ascending group and 4.5% in peripheral group (p=0.86). During follow-up (mean 5.5 years), survival at 5 years and 10 years was 65% and 41% in ascending group and 64% and 46% in peripheral group, respectively (p=0.97). No persistent malperfusion by ECC was observed after aortic cannulation. Conclusions: Direct cannulation of the dissected aorta in patients with AADA was safe with acceptable results in our study cohort. The conventional femoral cannulation had no advantage on the direct cannulation strategy, and the avoidance of additional incision and possible peripheral vascular injury may favor the direct cannulation strategy.

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Type A acute aortic dissection with ≥40-mm aortic root: results of conservative and replacement strategies at long-term follow-up

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa456 ◽

2020 ◽

Author(s):

Igor Vendramin ◽

Andrea Lechiancole ◽

Daniela Piani ◽

Laura Deroma ◽

Annarita Tullio ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Acute Aortic Dissection ◽

Type A ◽

Aortic Insufficiency ◽

Acute Type ◽

Group A ◽

Group B

Abstract OBJECTIVES We evaluated the long-term results of aortic root (AR) preservation and replacement in patients operated on for acute type A aortic dissection. METHODS Out of 302 patients discharged after repair of acute aortic dissection (1977–2019), 124 patients had an AR ≥40 mm, which was preserved in 84 (68%, group A) patients and replaced in 40 (32%, group B) patients. Group B patients were younger (mean age 57 ± 12 vs 62 ± 11 years, P = 0.07), with a mean AR of 47 vs 43 mm and ≥moderate aortic insufficiency in 65% vs 30%. Survival, causes of death and reoperations were analysed at mean follow-up of 9 ± 8 years (6 months to 40 years). RESULTS Actuarial survival of discharged patients at 5, 10 and 15 years was 97% (0.89–0.99), 78% (0.67–0.90) and 75% (0.64–0.88) in group A, and 85% (0.71–0.95), 62% (0.44–0.78) and 57% (0.39–0.76) in group B (log-rank test P = 0.2). Nine patients in group A (7 patients for aortic insufficiency and dilatation of the root and 2 patients for pseudoaneurysm) and 1 patient of group B (pseudoaneurysm of the right coronary button) required proximal reoperation without deaths. At 5, 10 and 15 years, the cumulative incidence of proximal aortic reoperations was 5%, 9% and 25% in group A, and 0%, 3% and 3% in group B (P = 0.02). At multivariable analysis AR >45 mm [hazard ratio (HR) 6.8, P = 0.026] and age (HR 0.9, P = 0.016) were independently associated with proximal reoperation. CONCLUSIONS AR preservation in acute type A dissection showed acceptable long-term outcomes. Nevertheless, a more aggressive approach appears a valid option, especially in patients with AR diameter >45 mm.

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