Treatment of a pseudoaneurysm of the ascending aorta in association with aortopulmonary fistula following acute Type A dissection

This report describes a rare case of aortic pseudoaneurysm with an aortopulmonary fistula in a 69-year-old woman two years following repair of a Type A aortic dissection. The patient presented with NYHA Class IV symptoms having deteriorated rapidly over a course of six weeks. We describe our successful surgical repair following a failed attempt of percutaneous closure with an atrial septal occlusion device.

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Cause of Death Following Surgery for Acute Type A Dissection

Aorta ◽

10.12945/j.aorta.2017.16.034 ◽

2017 ◽

Vol 05 (02) ◽

pp. 33-41 ◽

Cited By ~ 10

Author(s):

R. Scott McClure ◽

Maral Ouzounian ◽

Munir Boodhwani ◽

Ismail El-Hamamsy ◽

Michael Chu ◽

...

Keyword(s):

Cause Of Death ◽

Surgical Repair ◽

Multiorgan Failure ◽

Type A ◽

Acute Type ◽

Neurologic Injury ◽

Perioperative Mortality ◽

Acute Type A Dissection ◽

Modifiable Factors ◽

Type A Dissection

Background: Surgery confers the best chance of survival following acute Type A dissection (ATAD), yet perioperative mortality remains high. Although perioperative risk factors for mortality have been described, information on the actual causes of death is sparse. In this study, we aimed to characterize the inciting events causing death during surgical repair of ATAD. Methods: Nine centers participated in the study. We included all patients who died following surgical repair for ATAD between January 2007 and December 2013. An aortic surgeon at each site determined the primary cause of death from seven predetermined categories: cardiac, stroke, hemorrhage, other organ ischemia (peripheral, renal, or visceral), multiorgan failure, sepsis, or other causes. Additional characteristics and variables were analyzed to delineate potential modifiable factors for mortality. Results: Of the 692 surgeries for ATAD, there were 123 deaths (17.8% mortality rate). Mean age at death was 66 years. Events contributing to death were: cardiac (25%), stroke (22%), hemorrhage (21%), multiorgan failure (12%), other organ ischemia (11%), sepsis (4%), and other causes (5%). Neurologic injury at presentation was a predictor of stroke as the inciting cause of death (p = 0.04). Peripheral, renal, or visceral ischemia at presentation was highly predictive of death due to these presenting ischemic conditions (p = 0.004). We found no associations between cardiogenic shock, tamponade, or cardiopulmonary bypass duration and cardiac death. Conclusion: Operative mortality for ATAD remains high in Canada. Nearly 70% of deaths arise from cardiac failure, stroke, or hemorrhage. Therefore, novel surgical, hybrid, and endovascular strategies should target these three areas.

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Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2007.04.012 ◽

2007 ◽

Vol 32 (2) ◽

pp. 255-262 ◽

Cited By ~ 139

Author(s):

Arnar Geirsson ◽

Wilson Y. Szeto ◽

Alberto Pochettino ◽

Michael L. McGarvey ◽

Martin G. Keane ◽

...

Keyword(s):

Surgical Repair ◽

Type A ◽

Acute Type ◽

Acute Type A Dissection ◽

Type A Dissection

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A Successful Surgical Repair for Mesenteric Ischemia Associated with Acute Type A Dissection

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.38.56 ◽

2009 ◽

Vol 38 (1) ◽

pp. 56-59

Author(s):

Keiji Iwata ◽

Yasuhisa Shimazaki ◽

Tomohiko Sakamoto

Keyword(s):

Mesenteric Ischemia ◽

Surgical Repair ◽

Type A ◽

Acute Type ◽

Acute Type A Dissection ◽

Type A Dissection

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GW25-e3492 Comparison of chronic type A aortic dissection with acute type A dissection of short-term and long-term survival rate

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2014.06.453 ◽

2014 ◽

Vol 64 (16) ◽

pp. C97

Author(s):

Ma Xiang ◽

Yuan Qinghua ◽

Ma Yitong

Keyword(s):

Survival Rate ◽

Type A ◽

Acute Type ◽

Chronic Type ◽

Short Term ◽

Term Survival ◽

Type A Aortic Dissection ◽

Acute Type A Dissection ◽

Type A Dissection

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

Circulation ◽

10.1161/circ.118.suppl_18.s_612-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Anthony L Estrera ◽

Charles C Miller ◽

Ali Azizzadeh ◽

Taek-Yeon Lee ◽

Saad Abdullah ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Circulatory Arrest ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Acute Type A Dissection ◽

Initial Symptoms ◽

Type A Dissection ◽

Poor Outcomes

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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Endovascular Treatment of Rapidly Expanding Thoracoabdominal Aortic Aneurysm After Surgical Repair of Acute Type A Dissection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2007.08.069 ◽

2008 ◽

Vol 85 (2) ◽

pp. 636-638 ◽

Cited By ~ 1

Author(s):

Sahin Senay ◽

Cem Alhan ◽

Hasan Karabulut ◽

Fevzi Toraman ◽

Huseyin Cagil

Keyword(s):

Aortic Aneurysm ◽

Endovascular Treatment ◽

Surgical Repair ◽

Thoracoabdominal Aortic Aneurysm ◽

Type A ◽

Acute Type ◽

Acute Type A Dissection ◽

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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