Surgical techniques in acute Type A aortic dissection: How we do it

2021 ◽  
pp. 021849232110597
Author(s):  
Bashi Velayudhan ◽  
Mohammed Ibrahim ◽  
Mohammed Idhrees
Keyword(s):  
Aortic Dissection ◽  
High Mortality ◽  
Surgical Techniques ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Mortality And Morbidity ◽  
Surgical Emergency

Acute Type A aortic dissection (ATAAD), a surgical emergency, has high mortality and morbidity. More than half of the patients dies within 2 weeks and the 30-day mortality is 90%. Here we describe our technique of ATAAD repair.

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

Aorta ◽  
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.

scholarly journals Type A Acute Aortic Dissection in Nonagenarian: Rare but Possible

2016 ◽  
Vol 68 (3) ◽  
Author(s):  
Rodolfo Citro ◽  
Marco Mariano Patella ◽  
Gennaro Provenza ◽  
Giovanni Gregorio ◽  
Eduardo Bossone
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Very Elderly ◽  
Type A Aortic Dissection ◽  
Mortality And Morbidity ◽  
Clinical Presentations ◽  
Age Range ◽  
Specific Symptoms ◽  
Symptoms And Signs

Acute type A aortic dissection (TA-AAD) is a highly lethal clinical entity that can occur within a wide age range, associated with multiple aetiologies and various clinical presentations. In the very elderly type A aortic dissection frequently presents with non-specific symptoms and signs and is associated with high mortality and morbidity. Thus the clinician must have a high index of clinical suspicion in order to prompt the most appropriate diagnostic-therapeutic strategy.We report a nonagenarian women with TA-AAD, treated successfully with medical therapy.

scholarly journals Techniques of Proximal Root Reconstruction and Outcomes Following Repair of Acute Type A Aortic Dissection

Aorta ◽  
2016 ◽  
Vol 04 (02) ◽  
pp. 33-41 ◽  
Author(s):  
Tyler Gunn ◽  
Sotiris Stamou ◽  
Nicholas Kouchoukos ◽  
Kevin Lobdell ◽  
Kamal Khabbaz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Operative Mortality ◽  
Survival Rates ◽  
Surgical Techniques ◽  
Type A ◽  
Acute Type ◽  
Actuarial Survival ◽  
Type A Aortic Dissection ◽  
Replacement Procedure

Background: The goal of this study was to compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute Type A aortic dissection, including aortic valve (AV) resuspension, aortic valve replacement (AVR), and a root replacement procedure. Methods: All patients who underwent acute Type A aortic dissection repair between January 2000 and October 2010 at four academic institutions were compiled from each institution’s Society of Thoracic Surgeons Database. This included 189 patients who underwent a concomitant aortic valve (AV) procedure; 111, 21, and 57 patients underwent AV resuspension, AVR, and the Bentall procedure, respectively. The median age of patients undergoing a root replacement procedure was significantly younger than the other two groups. Early clinical outcomes and 10-year actuarial survival rates were compared. Trends in outcomes and surgical techniques throughout the duration of the study were also analyzed. Results: The operative mortality rates were 17%, 29%, and 18%, for AV resuspension, AVR, and root replacement, respectively. Operative mortality (p = 0.459) was comparable between groups. Hemorrhage related re-exploration did not differ significantly between groups (p = 0.182); however, root replacement procedures tended to have decreased rates of bleeding when compared to AVR (p = 0.067). The 10-year actuarial survival rates for the AV resuspension, Bentall, and AVR groups were 72%, 56%, and 36%, respectively (log-rank p = 0.035). Conclusions: The 10-year actuarial survival was significantly lower in those receiving AVR compared to those receiving root replacement procedures or AV resuspension. Operative mortality was comparable between the three groups.

scholarly journals Repair of Acute Type-A Aortic Dissection in the Present Era: Outcomes and Controversies

Aorta ◽  
2019 ◽  
Vol 07 (06) ◽  
pp. 155-162 ◽  
Author(s):  
Ellie Moeller ◽  
Marcos Nores ◽  
Sotiris C. Stamou
Keyword(s):  
Aortic Dissection ◽  
Operative Mortality ◽  
Cochrane Review ◽  
False Lumen ◽  
Surgical Techniques ◽  
Type A ◽  
Acute Type ◽  
Close Monitoring ◽  
Type A Aortic Dissection ◽  
The Past

AbstractAcute Type-A aortic dissection (AAAD) remains a surgical emergency with a relatively high operative mortality despite advances in medical and surgical management over the past three decades. In spite of the severity of disease, there is a paucity of studies reviewing key controversies surrounding AAAD repair and management. A systematic literature search was performed using Cochrane review and PubMed bibliography review. Abstracts were first reviewed for general pertinence and then articles were reviewed in full. Literature review indicates that use of moderate hypothermia and antegrade cerebral perfusion is a safe alternative to deep hypothermia. In hemodynamically stable patients, axillary cannulation may be substituted for femoral cannulation. With regard to the technical aspects of repair, preserving the aortic root whenever possible and performing the distal anastomosis with the open distal technique rather than with the clamp on is the preferred approach. In patients with a patent false lumen, close monitoring is indicated. As demonstrated by the literature, significant improvement of early and late mortality over the past years has occurred in patients presenting with AAAD. Repair of acute Type-A aortic dissection remains a challenge with high operative mortality; however, improvement of surgical techniques and management have resulted in improvement of early and late clinical outcomes.

scholarly journals BioGlue cerebral embolism following acute type A aortic dissection repair

2021 ◽  
Author(s):  
Manabu Yamasaki ◽  
Kohei Abe ◽  
Ryota Nakamura ◽  
Rihito Tamaki ◽  
Hiroyasu Misumi
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Surgical Techniques ◽  
Type A ◽  
Cerebral Embolism ◽  
Total Arch Replacement ◽  
Acute Type ◽  
Type A Aortic Dissection

The outcomes of surgery for Acute Stanford type A aortic dissection (ATAAD) have significantly improved in recent decades due to advances in surgical techniques and, surgical adhesives such as BioGlue. However, this convenient material can sometimes cause complications such as thrombotic embolism and pseudoaneurysm. Here, we present the case of a 61-year-old male with ATAAD who successfully underwent total arch replacement. Five days after the surgery, he collapsed due to right hemiplegia. We immediately performed cerebral thrombectomy and removed the thrombotic embolus caused by BioGlue, which was used to obliterate the false lumen of the dissected aorta during ATAAD repair.

scholarly journals Plaster technique for filling up a future entry at the suture hole in type A aortic dissection

2021 ◽  
Author(s):  
Shinichi Ishida ◽  
Masato Mutsuga ◽  
Takashi Fujita ◽  
Kei Yagami
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Suture Line ◽  
Acute Type ◽  
The Novel ◽  
Perioperative Mortality ◽  
Type A Aortic Dissection ◽  
Mortality And Morbidity ◽  
Minimum Dose ◽  
Interrupted Suture

Although the surgical technique for acute type A aortic dissection markedly improved in the last decade, perioperative mortality and morbidity rates remain dramatically high. Therefore, we introduce the novel “plaster technique” using the single interrupted suture with a felt and plastering the minimum dose of BioGlue® (Cryolife Inc., Kennesaw, GA, USA) into the suture hole in this report. We found that the plaster technique using a felt pledget and minimum dose of BioGlue is effective for fragile aortic walls, as in patients undergoing acute aortic dissection and is a simple, safe, and durable technique to strengthen the suture line.

Is acute type A aortic dissection A true surgical emergency?

2002 ◽  
Vol 15 (2) ◽  
pp. 75-82 ◽  
Author(s):  
Anthony L. Estrera ◽  
Tam T.T. Huynh ◽  
Eyal E. Porat ◽  
Charles C. Miller ◽  
Jesse J. Smith ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Surgical Emergency
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