Abstract 751: Retrograde Acute Type A Aortic Dissection: Are Outcomes Worse Than Classic Acute Aortic Dissection?

Introduction: Recent reports of retrograde acute type A aortic dissection (RTAAD) following thoracic aortic endovascular repair have been associated with poor outcomes. This raises concerns about outcomes with RTAAD in general. We report and compare outcomes of retrograde acute Type A aortic dissection repair with classic acute aortic dissection (CAAD). Methods: Between 8/1991 and 5/2008, we repaired 322 patients with acute type A dissection. This cohort was divided into two groups: RTAAD Group (52 cases), and CAAD Group (270 cases). RTAAD was defined as the presence of a dissection tear originating distal to the arch as identified intra-operatively. Tears in the ascending aorta denoted dissection as classic. Repairs using circulatory arrest were similar between groups, p>0.33. Preoperative, operative, and post-operative variables were analyzed retrospectively. Results: Retrograde type A aortic dissection occurred in 16.1% (52/322) of patients. RTAAD differed from CAAD in the median time from initial symptoms to operation (75+−87 hours vs. 47+−61 hours) and specific presenting conditions. (See Table 1 ) Outcomes (stroke: RTAAD, 2.1% vs. CAAD, 3.6%, bleeding: 4% vs. 9%, myocardial infarction: 6% vs. 6%, and mortality: 11% vs. 18%) did not differ significantly between the groups, p>0.05. Conclusions: RTAAD presented later for repair and less frequently with redo-sternotomy and aortic valvular insufficiency. Despite these differences, outcomes from surgical repair did not differ significantly. Acceptable outcomes may be achieved with timely intervention. Table 1: Preoperative Variables

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JOHN RITTER SYNDROME – ACUTE TYPE A DISSECTION CAUSING ACUTE MYOCARDIAL INFARCTION: INSIGHTS FROM THE INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION (IRAD)

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(12)61902-0 ◽

2012 ◽

Vol 59 (13) ◽

pp. E1901

Author(s):

Lindsay Hagan ◽

Kevin Greason ◽

Artur Evangelista Masip ◽

Daniel Montgomery ◽

Patrick O'Gara ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Acute Type ◽

Acute Type A Dissection ◽

International Registry ◽

Type A Dissection

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High Failure Rate After Valve-sparing Aortic Root Replacement Using the “Remodeling Technique” in Acute Type A Aortic Dissection

Circulation ◽

10.1161/01.cir.0000032850.20885.9b ◽

2002 ◽

Vol 106 (12_suppl_1) ◽

Author(s):

Rainer G. Leyh ◽

Stefan Fischer ◽

Klaus Kallenbach ◽

Theo Kofidis ◽

Klaus Pethig ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Aortic Root Replacement ◽

Acute Type ◽

Type A Aortic Dissection ◽

Acute Type A Dissection ◽

Type A Dissection ◽

Valve Sparing

Background Valve-sparing surgery including the replacement of the sinus of valsalvae were initially meant to be promising approaches in the treatment of acute type A aortic dissection. However, the long-term outcome after valve-sparing aortic root replacement in acute type A dissection is currently the subject of intense debate, and the evidence reported in the literature is sparse. Here we report on our experience on valve sparing aortic root replacement inpatients with acute type A dissection. Methods From August 1995 to November 2000, 30 patients with acute type A dissection received valve-sparing aortic root replacement. Two different techniques were performed: the “remodeling” technique, first described by Yacoub in 1983 (8 patients) and the “reimplantation” technique, initially described by David and Feindel, in 1992 (22 patients). Endpoints of the study were early and late mortality, as well as aortic valve-related complications and reoperations. Results The mean follow-up time was 22.6±15.4 months. The overall 30 day mortality was 17% (5/29) and the late mortality 4% (1/24). During the observation period, 4 patients had to be reoperated (n=3) for acute aortic valve regurgitation after aortic root remodeling and for acute aortic valve endocarditis (n=1) after aortic root reimplantation. In the 3 patients with acute aortic valve regurgitation, symptoms occurred 44, 24, and 17 months after the initial operation in these patients. Intraoperatively prolapsing aortic leaflets because of commissural detachment was found in all 3 cases. In all other patients the latest echocardiographic follow-up examination revealed freedom from aortic regugitation higher than grade 1. Conclusions The high failure rate of aortic root remodeling inpatients with acute type A aortic dissection is discouraging. Whether this technique should be applied in acute type A aortic dissection is questionable. In contrast, aortic root reimplantation lead to favorable midterm outcome. Thus, we recommend consideration of this technique for surgical treatment of patients with acute type A aortic dissection.

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Acute Aortic Dissection in Pregnancy: Cesarean Section Prior to Repair of Acute Type A Dissection

Journal of Anesthesia & Clinical Research ◽

10.4172/2155-6148.1000154 ◽

2011 ◽

Vol 02 (08) ◽

Cited By ~ 1

Author(s):

Adam D. Lichtman

Keyword(s):

Aortic Dissection ◽

Cesarean Section ◽

Acute Aortic Dissection ◽

Type A ◽

Acute Type ◽

Acute Type A Dissection ◽

Type A Dissection ◽

In Pregnancy

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Repair of acute type A dissection with distal malperfusion using a novel hybrid arch device

10.1510/mmcts.2020.062 ◽

2020 ◽

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Circulatory Arrest ◽

Spinal Cord Ischemia ◽

False Lumen ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Acute Type A Dissection ◽

Feasible Option

Acute type A aortic dissection remains a high-risk surgical condition, and mortality among those presenting with malperfusion is up to 3-fold higher. Despite the added technical challenge of distal aortic arch interventions in the acute setting, it may be necessary to resolve distal malperfusion in patients with this disorder. The ideal arch intervention to address acute type A aortic dissection complicated by malperfusion should address the following objectives: (1) to relieve distal malperfusion by expanding the distal true lumen and depressurizing the false lumen; (2) to avoid compromising arch branches without requiring additional arch branch interventions; (3) to minimize the risk of spinal cord ischemia; and (4) to minimize the operative duration and circulatory arrest time. The use of an uncovered aortic arch stent that is delivered in an antegrade manner during circulatory arrest, concomitantly with hemiarch replacement, therefore represents an attractive solution in the management of acute type A aortic dissection complicated by malperfusion. This strategy does not require complex arch reconstruction and may thus be a feasible option among cardiac and vascular surgeons in lower volume aortic centers. Here we present a step-by-step approach to acute type A aortic dissection repair with hemiarch repair and delivery of an uncovered arch stent for a patient presenting with malperfusion.

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The Circulatory Arrest Time in Patients with Acute Type A Aortic Dissection: Does It Influence the Outcome?

10.1055/s-0040-1705505 ◽

2020 ◽

Author(s):

J. Kapahnke ◽

K. Huenges ◽

M. Salem ◽

P. Kolat ◽

J. Schoettler ◽

...

Keyword(s):

Aortic Dissection ◽

Circulatory Arrest ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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101 Total Aortic Arch Repair Without Circulatory Arrest Using Hybrid Techniques - A Novel Treatment For Acute Type A Dissection

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2012.07.110 ◽

2012 ◽

Vol 28 (5) ◽

pp. S125-S126

Author(s):

J.J. Appoo ◽

E.J. Herget ◽

W.D. Kent ◽

S.K. Smith ◽

J.K. Wong

Keyword(s):

Aortic Arch ◽

Circulatory Arrest ◽

Type A ◽

Acute Type ◽

Hybrid Techniques ◽

Acute Type A Dissection ◽

Novel Treatment ◽

Type A Dissection ◽

Aortic Arch Repair

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Preoperative hematological parameters are inadequate for predicting mortality in Stanford Type A aortic dissection repair

Clinical surgery research communications ◽

10.31491/csrc.2021.06.075 ◽

2021 ◽

Vol 5 (2) ◽

pp. 01-06

Author(s):

Selim Durmaz ◽

◽

Ömer Faruk Rahman ◽

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Roc Analysis ◽

Circulatory Arrest ◽

Hematological Parameters ◽

Demographic Data ◽

Type A ◽

Hospital Death ◽

Acute Type ◽

Type A Aortic Dissection

Background: Mortality in acute Type A aortic dissection is still high and unpredictable. We aimed to investigate the validity of preoperative hematological markers and possible risk factors in predicting in-hospital mortality in patients operated with deep hypothermic circulatory arrest method. Methods: 78 consecutive patients who were admitted to the emergency service and operated on were retrospectively analyzed. Risk factors for in-hospital death were investigated to develop a predictive model. Results: There was no difference between patients in terms of the were demographic data of the patients. In the mortality group, only preoperative creatinine levels were found to be higher (p < 0.05). Factors affecting mortality were found as total circulatory arrest (TCA) and cross-clamp (X-clamp) times when intraoperative data were examined (p < 0.05). ROC analysis was performed to determine the power to predict mortality and to determine the cut-off point. In ROC analysis to predict mortality, X-Clamp time > 71 minutes, 68.2% sensitivity and 66.1% specificity, TCA > 44.5 minutes, 72.7% sensitivity and 73.2% specificity were found. In the mortality group, these values were found to be significantly higher than those who were discharged. Conclusion: In the surgical treatment of Type A aortic dissection under deep hypothermia, hematologic biomarkers may be insufficient in estimating the risk for mortality. Keywords: Acute; aortic dissection; biomarker; mortality

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

Aorta ◽

10.1055/s-0041-1722897 ◽

2021 ◽

Vol 09 (01) ◽

pp. 030-032

Author(s):

Sergey Y. Boldyrev ◽

Kirill O. Barbukhatty ◽

Vladimir A. Porhanov

Keyword(s):

Surgical Treatment ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Type I ◽

Acute Type ◽

Drug Induced ◽

Type A Aortic Dissection ◽

Mortality And Morbidity ◽

Perioperative 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.

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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.

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