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

Circulation ◽  
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.

ARCH Replacement in Acute Aortic Dissection Type a in Normothermia

2001 ◽  
Vol 71 (3) ◽  
pp. 282-286
Author(s):  
Ovidiu Stiru ◽  
Roxana Carmen Geana ◽  
Adrian Tulin ◽  
Raluca Gabriela Ioan ◽  
Victor Pavel ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Ct Scan ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Ascending Aorta ◽  
Descending Aorta ◽  
The Right ◽  
Aortic Dissection Type A

The purpose of this case presentation is to present a simplified surgical technique when in a patient with acute aortic dissection type A (AAD), aortic arch, and ascending aorta is completely replaced without circulatory arrest. A 67-year old male was presented in our institution with severe chest and back pain at 12 h after the onset of the symptoms. Imaging studies by 3D contrast-enhanced thoracic computed tomography (CT-scan) and transesophageal echocardiography (TEE) revealed ascending aortic dissection towards the aortic arch, which was extending in the proximal descending aorta. We practiced emergency median sternotomy and established cardiopulmonary bypass (CBP) between the right atrium and the right femoral artery with successive cross-clamping of the ascending and descending aorta below the origin of the left subclavian artery (LSA). In normothermic condition without circulatory arrest and with antegrade cerebral perfusion, we replaced the ascending aorta and aortic arch with a four branched Dacron graft. Patient evolution was uneventful, and he was discharged, after fourteen days from the hospital. At a one-year follow-up, 3D CT-scan showed no residual dissection with a well-circulated lumen of the supra-aortic arteries. Using the described surgical approach, CPB was not interrupted, the brain was protected, and hypothermia was no used. This approach made these surgical procedures shorter, and known complications of hypothermia and circulatory arrest are avoided.Acute aortic dissection aortic type A, total arch replacement, normothermia

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 Insights from the International Registry of Acute Aortic Dissection

2016 ◽  
Vol 2016 (1) ◽  
Author(s):  
Arturo Evangelista ◽  
Giuliana Maldonado ◽  
Doménico Gruosso ◽  
Gisela Teixido ◽  
Jose Rodríguez-Palomares ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
University Of Michigan ◽  
Type B ◽  
Clinical Observations ◽  
International Registry ◽  
Diagnostic Management ◽  
The University

The International Registry of Acute Aortic Dissection (IRAD) was established in 1996 for the purpose of enrolling patients at large referral centres to assess the presentation, management and outcomes of acute aortic dissection (AAD). Data on presentation, diagnostic, management and outcomes were initially collected by 12 centres and then extended to 28 referral centres. All data of more than 5,000 cases were reviewed and analysed by the IRAD Coordinating Center at the University of Michigan. Since the first publication in 2000, IRAD investigators have reported a number of clinical observations, in more than 70 publications. This article will cover most of these points highlighting the findings of IRAD in patients with type A (with ascending aorta involvement) and type B (without ascending aorta involvement) AAD. 

Cannulating a Dissecting Aorta Using Ultrasound-Epiaortic and Transesophageal Guidance

2011 ◽  
Vol 14 (6) ◽  
pp. 373 ◽  
Author(s):  
Saina Attaran ◽  
Maria Safar ◽  
Hesham Zayed Saleh ◽  
Mark Field ◽  
Manoj Kuduvalli ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Type A Aortic Dissection ◽  
Complete Rupture

<p>Management of acute Stanford type A aortic dissection remains a major surgical challenge. Directly cannulating the ascending aorta provides a rapid establishment of cardiopulmonary bypass but consists of risks such as complete rupture of the aorta, false lumen cannulation, subsequent malperfusion and propagation of the dissection.</p><p>We describe a technique of cannulating the ascending aorta in patients with acute aortic dissection that can be performed rapidly in hemodynamically unstable patients under ultrasound-epiaortic and transesophageal (TEE) guidance.</p>

Epiaortic Ultrasound-Guided True Lumen Cannulation of Ascending Aorta in Acute Aortic Dissection Type A

2021 ◽  
Vol 104 (4) ◽  
pp. 604-609
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Axillary Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Ultrasound Guided ◽  
True Lumen ◽  
Artery Cannulation ◽  
Aortic Cannulation ◽  
Aortic Dissection Type A

Background: The choice of arterial inflow for acute Stanford type A aortic dissection repair remains controversial. The axillary artery should be considered as first choice for cannulation, but this technique is time-consuming. The ascending aortic cannulation provides antegrade perfusion and can be performed rapidly but there are several concerns such as aortic rupture, extension of dissection, and false lumen cannulation. Objective: To compare the establishment time of cardiopulmonary bypass (CPB) and postoperative outcomes of the two cannulation techniques that provide antegrade perfusion, which was direct true lumen cannulation on the dissected ascending aorta using epiaortic ultrasound-guided and axillary artery cannulation in Siriraj Hospital. Materials and Methods: The authors retrospectively reviewed all the 30 cases of acute aortic dissection type A using two different cannulation methods performed between February 2011 and May 2017. Direct true lumen ascending aortic cannulation was performed using the epiaortic ultrasound-guide with Seldinger technique in 12 patients, and axillary artery cannulation was performed in 18 patients. Results: The direct true lumen ascending aortic cannulation was safely performed in all patients. None of them had aortic rupture. Skin incision to CPB time was significantly faster in the epiaortic ultrasound-guided ascending aortic cannulation group at 29±8 versus 49±14 minutes (p<0.001). The 30-day mortality and postoperative adverse events, such as ischemic stroke, acute kidney injury, visceral organ and limb malperfusion showed no statistically significant difference from the axillary artery cannulation method. Conclusion: Epiaortic ultrasound-guided true lumen cannulation of ascending aorta in the treatment of acute aortic dissection type A is safe and feasible. Skin incision to CPB time can be performed faster and provided good outcome compared to the axillary artery cannulation technique. Keywords: Acute aortic dissection, Ascending cannulation, Epiaortic ultrasound

scholarly journals Aorto-Cutaneous Fistula and False Aneurysm of the Ascending Aorta Five Years after its Prosthetic Replacement for Stanford Type A Acute Aortic Dissection

Aorta ◽  
2017 ◽  
Vol 05 (02) ◽  
pp. 57-60
Author(s):  
Pierre Demondion ◽  
Dorian Verscheure ◽  
Pascal Leprince
Keyword(s):  
Aortic Dissection ◽  
Carotid Arteries ◽  
Acute Aortic Dissection ◽  
False Aneurysm ◽  
Type A ◽  
Aneurysm Rupture ◽  
Ascending Aorta ◽  
Cutaneous Fistula ◽  
The Right ◽  
Selective Cannulation

AbstractAorto-cutaneous fistula and false aneurysm of the ascending aorta in patients who previously underwent Stanford Type A acute aortic dissection are rare and severe complications. Surgical correction remains a demanding challenge. In a case of false aneurysm rupture during redo sternotomy, selective cannulation of the right axillary and left carotid arteries allowed an efficient method of cerebral perfusion.

scholarly journals Early misdiagnosis of acute aortic dissection: A case report and analysis of the causes

2016 ◽  
Vol 4 (1) ◽  
pp. 15
Author(s):  
Xiao-yan Chen ◽  
Fan-liang Kong ◽  
Tong-guo Wu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Case Report ◽  
Aortic Dissection ◽  
Emergency Room ◽  
Male Patient ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Type A Aortic Dissection

Type A aortic dissection is a catastrophic clinical entity involving the ascending aorta. In this case report, a patient was admitted to the emergency room with a presentation resembling acute myocardial infarction (AMI) that led to the inappropriate administration of anticoagulant agents or platelet. This is a case report of a 69-year-old male patient with early misdiagnosis and analysis of type A aortic dissection with discussion on the causes of misdiagnosis in light of the literature.

scholarly journals Efficacy of entry exclusion strategy for DeBakey type III retrograde Stanford type A acute aortic dissection

2020 ◽  
Author(s):  
Yosuke Inoue ◽  
Hitoshi Matsuda ◽  
Jiro Matsuo ◽  
Takayuki Shijo ◽  
Atsushi Omura ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Type Iii ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract OBJECTIVES Resection of a primary entry tear is essential for the treatment of Stanford type A acute aortic dissection (AAAD). In DeBakey type III retrograde AAAD (DBIII-RAAAD), resection of the primary entry tear in the descending aorta is sometimes difficult. The frozen elephant trunk technique and thoracic endovascular aortic repair (TEVAR) enable the closure of the primary entry in the descending aorta. The aim of this study was to investigate the efficacy of resection or closure of primary entry, i.e. entry exclusion, in patients with DeBakey type III retrograde-AAAD. METHODS The medical records of 654 patients with AAAD who underwent emergency surgery between January 2000 and March 2019 were retrospectively reviewed, and 80 eligible patients with DeBakey type III retrograde-AAAD were divided into the excluded (n = 50; age, 62 ± 12 years) and residual (n = 30; age, 66 ± 14 years) groups according to postoperative computed tomography angiographic data of the false lumen around the primary entry. The excluded group was defined as having a postoperative false lumen at the level of the elephant trunk or thrombosis of the endograft including primary entry. Patients with early false lumen enhancement around the elephant trunk or an unresected primary entry tear after isolated hemiarch replacement were included in the residual group. The early and long-term surgical outcomes were compared between the groups. RESULTS The in-hospital mortality rate was 8% (6/80), with no significant difference observed between the excluded and the residual groups (10% and 7%, respectively; P &gt; 0.99). Ninety-five percentage of the patients (20/21) achieved entry exclusion with stent grafts including the frozen elephant trunk procedure and TEVAR. Spinal cord ischaemia was not observed in either group. The cumulative overall survival at 5 years was comparable between the 2 groups (76% and 81% in the excluded and residual groups, respectively; P = 0.93). The 5-year freedom from distal aortic reoperation rate was significantly higher in the excluded group (97%) than in the residual group (97% vs 66%; P = 0.008). CONCLUSIONS Not only resection but also closure using the entry exclusion approach for DeBakey type III retrograde-AAAD utilizing new technologies including the frozen elephant trunk technique and TEVAR might mitigate dissection-related reoperations.

scholarly journals The use of innominate artery cannulation for antegrade cerebral perfusion in aortic dissection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Eden C. Payabyab ◽  
Jonathan M. Hemli ◽  
Allan Mattia ◽  
Alex Kremers ◽  
Sohrab K. Vatsia ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Cerebral Perfusion ◽  
Innominate Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Artery Cannulation ◽  
Selective Antegrade Cerebral Perfusion ◽  
Antegrade Cerebral Perfusion

Abstract Background Direct cannulation of the innominate artery for selective antegrade cerebral perfusion has been shown to be safe in elective proximal aortic reconstructions. We sought to evaluate the safety of this technique in acute aortic dissection. Methods A multi-institutional retrospective review was undertaken of patients who underwent proximal aortic reconstruction for Stanford type A dissection between 2006 and 2016. Those patients who had direct innominate artery cannulation for selective antegrade cerebral perfusion were selected for analysis. Results Seventy-five patients underwent innominate artery cannulation for ACP for Stanford Type A Dissections. Isolated replacement of the ascending aorta was performed in 36 patients (48.0%), concomitant aortic root replacement was required in 35 patients (46.7%), of whom 7 had a valve-sparing aortic root replacement, ascending aorta and arch replacement was required in 4 patients (5%). Other procedures included frozen elephant trunk (n = 11 (14.7%)), coronary artery bypass grafting (n = 20 (26.7%)), and peripheral arterial bypass (n = 4 (5.3%)). Mean hypothermic circulatory arrest time was 19 ± 13 min. Thirty-day mortality was 14.7% (n = 11). Perioperative stroke occurred in 7 patients (9.3%). Conclusions This study is the first comprehensive review of direct innominate artery cannulation through median sternotomy for selective antegrade cerebral perfusion in aortic dissection. Our experience suggests that this strategy is a safe and effective technique compared to other reported methods of cannulation and cerebral protection for delivering selective antegrade cerebral perfusion in these cases.

Sign in / Sign up

Export Citation Format

Share Document