Surgical Management of Acute Type A Aortic Dissection: An Overview

Acute type A aortic dissection is a catastrophic disease that develops from a tear within the intima of the aortic wall, thereby creating a false lumen in the ascending aorta. Early suspicion, diagnosis, and prompt surgery play a key role in the survival of patients. It is a surgical emergency and requires replacement of the ascending aorta/aortic root with or without aortic arch replacement. Over the past decade the surgical outcomes have improved in specialized tertiary centers.

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A Modified Adventitial Inversion With Graft Insertion Technique in Acute Type A Aortic Dissection

10.21203/rs.3.rs-958943/v1 ◽

2021 ◽

Author(s):

Wei-Tao Liang ◽

Hong-Hua Yue ◽

Zhong Wu

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Aortic Wall ◽

False Lumen ◽

Type A ◽

Ascending Aorta ◽

Acute Type ◽

Insertion Technique ◽

Type A Aortic Dissection ◽

Anastomotic Technique

Abstract Acute type A aortic dissection may originate from a primary intimal tear located in the ascending aorta and often extends retrogradely into the aortic root. How to prevent bleeding in the aortic root and eliminate false lumen is very important in aortic dissection. We have developed a modified anastomotic technique that involves inverting adventitial and graft into aorta and reinforcing with a felt strip on the external border of the aortic wall. 45 consecutive patients had undergone this surgical procedure for aortic root reconstruction in aortic dissection, there had been no reoperations either for bleeding or remnant dissection so far.

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

Aorta ◽

10.1055/s-0039-3401810 ◽

2019 ◽

Vol 07 (06) ◽

pp. 155-162 ◽

Cited By ~ 1

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.

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Initial medical management in acute type A aortic dissection patients with a thrombosed false lumen in the ascending aorta combining intramural hematoma and retrograde dissection from the descending to the ascending aorta

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872618777724 ◽

2018 ◽

Vol 9 (3_suppl) ◽

pp. S13-S20 ◽

Cited By ~ 4

Author(s):

Kenji Sadamatsu ◽

Susumu Takase ◽

Shuichiro Sagara ◽

Kensuke Ohe ◽

Jun-ichiro Nishi ◽

...

Keyword(s):

Aortic Dissection ◽

Medical Management ◽

False Lumen ◽

Intramural Hematoma ◽

Type A ◽

Daily Practice ◽

Ascending Aorta ◽

Maximum Diameter ◽

Acute Type ◽

Type A Aortic Dissection

Background: The feasibility of medical management for select patients with acute type A aortic dissection has been reported from a few institutions. In this study, we retrospectively investigated the safety and feasibility of our conservative approach for patients with type A aortic dissection in daily practice. Methods: From January 2013 to December 2017, 131 consecutive patients were admitted to our institution for acute aortic dissection, including 58 patients of type A. Initial medical management was attempted in select patients who were clinically stable and had a thrombosed false lumen of the ascending aorta without ulcer-like projections in the ascending aorta. Results: Except for nine patients contraindicated for surgery, urgent surgery was performed in 26 patients (SRG group), while 23 patients (MED group) were treated with the initial medical management. The maximum diameter of the ascending aorta was significantly larger in the SRG group than in the MED group. In the MED group, the heart rate and blood pressures were well-controlled at admission to the intensive-care unit, and the systolic blood pressure was further reduced at 24 h after. The in-hospital mortality rates of the MED and SRG groups were 0% and 15%, respectively. During the follow-up period, the survival rate was significantly higher in the MED group than in the SRG group, and the aortic event-free survival at one year was 80%. Conclusions: The initial medical management for select patients with a thrombosed false lumen in the ascending aorta was a safe and feasible strategy in real-world practice.

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Cannulating a Dissecting Aorta Using Ultrasound-Epiaortic and Transesophageal Guidance

The Heart Surgery Forum ◽

10.1532/hsf98.20101170 ◽

2011 ◽

Vol 14 (6) ◽

pp. 373 ◽

Cited By ~ 4

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>

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Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

Journal of Endovascular Therapy ◽

10.1177/1526602816680089 ◽

2016 ◽

Vol 24 (1) ◽

pp. 75-80 ◽

Cited By ~ 17

Author(s):

Tilo Kölbel ◽

Christian Detter ◽

Sebastian W. Carpenter ◽

Fiona Rohlffs ◽

Yskert von Kodolitsch ◽

...

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Open Surgery ◽

Type A ◽

Ascending Aorta ◽

Type I ◽

Acute Type ◽

Stent Grafts ◽

Type A Aortic Dissection ◽

Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

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