Brain Protection During Ascending Aortic Repair for Stanford Type A Acute Aortic Dissection Surgery

Abstract Objective This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes. Methods From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n = 41) and total arch replacement + stent elephant trunk implantation (TAR + SET, n = 62). Results There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR + SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality (P = 0.04). The overall survival rates at 5-year follow-up were 82.5 ± 6.0% in LAR group and 75.2 ± 5.6% in TAR + SET group, but with no difference (p = 0.151). The freedom from adverse aortic events at 5-year was 84.3 ± 6.5% in LAR group versus 97.9 ± 2.1% in TAR + SET group, with a statistical difference (p = 0.03). Conclusion These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.

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Midterm Results of Aortic Repair Using a Fabric Neomedia and Fibrin Glue for Type A Acute Aortic Dissection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2007.01.006 ◽

2007 ◽

Vol 83 (5) ◽

pp. 1615-1620 ◽

Cited By ~ 24

Author(s):

Takayuki Nakajima ◽

Kohei Kawazoe ◽

Tsuyoshi Kataoka ◽

Hajime Kin ◽

Toshinobu Kazui ◽

...

Keyword(s):

Aortic Dissection ◽

Fibrin Glue ◽

Acute Aortic Dissection ◽

Type A ◽

Midterm Results ◽

Aortic Repair

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Emergency pericardial drainage without aortic repair for type A intramural haematoma complicated by cardiac tamponade

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivab014 ◽

2021 ◽

Author(s):

Tadashi Kitamura ◽

Kagami Miyaji

Keyword(s):

Aortic Dissection ◽

Cardiac Tamponade ◽

Acute Aortic Dissection ◽

Rating Scale ◽

Type A ◽

Ascending Aorta ◽

Brachiocephalic Artery ◽

Intramural Haematoma ◽

Pericardial Drainage ◽

Aortic Repair

Abstract From April 2011 to March 2020, 87 patients with type A intramural haematoma and acute aortic dissection with thrombosed false lumen of the ascending aorta were treated at Kitasato University Hospital. The initial watch-and-wait strategy without emergency aortic repair was taken in 52 cases in which the maximum aortic diameter was ≤50 mm, pain score on arrival at our hospital was ≤3/10 on the numerical rating scale and there was no ulcer-like projection (ULP) in the ascending aorta. Eleven patients who fulfilled the criteria but developed cardiac tamponade underwent emergency pericardial drainage without aortic repair. Among these 11 patients, 3 patients developed an aortic event during the hospitalization; 1 patient developed enlargement of the ULP 18 days later but refused surgery, another patient developed rupture of the dissected brachiocephalic artery 4 days later and underwent emergency repair of the ascending aorta and the brachiocephalic artery and the other patient developed a new ULP in the ascending aorta 14 days later and underwent aortic repair. All 11 patients were discharged home. During follow-up (3.0 ± 2.4 years), 1 patient developed a recurrent type A acute aortic dissection and underwent emergency aortic repair 29 months later. There was no aorta-related death.

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Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?

10.21203/rs.3.rs-23129/v2 ◽

2020 ◽

Author(s):

Wei Qin ◽

Cunhua Su ◽

Liangpeng Li ◽

Michael Carmichael ◽

Fuahua Huang ◽

...

Keyword(s):

Aortic Dissection ◽

Elderly Patients ◽

Acute Aortic Dissection ◽

Group Versus ◽

Type A ◽

Surgical Approaches ◽

Elephant Trunk ◽

Aortic Repair ◽

Aortic Replacement ◽

Significant Difference

Abstract Background: This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes.Methods: From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n=41) and total arch replacement + stent elephant trunk implantation (TAR+SET, n=62). Results: There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR+SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality (P=0.04). The overall survival rates at 5-year follow-up were 82.5±6.0% in LAR group and 75.2±5.6% in TAR+SET group, but with no difference (p=0.151). The freedom from adverse aortic events at 5-year was 84.3±6.5% in LAR group versus 97.9±2.1% in TAR+SET group, with a statistical difference (p=0.03). Conclusion: These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.

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