Early Spontaneous Resolution of an Iatrogenic Acute Type A Aortic Dissection

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.

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

Aorta ◽

10.1055/s-0041-1722897 ◽

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.

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Computed Tomography Scan Predicts Abdominal Interventions but Not Stroke after Surgery for Acute Type A Aortic Dissection

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0035-1548732 ◽

2015 ◽

Vol 64 (02) ◽

pp. 108-115 ◽

Cited By ~ 1

Author(s):

Prerana Banerjee ◽

Christoph Theus ◽

Jens Bremerich ◽

Thomas Wolff ◽

Oliver Reuthebuch ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Dissection ◽

Type A ◽

Acute Type ◽

Computed Tomography Scan ◽

Type A Aortic Dissection ◽

Abdominal Interventions ◽

Tomography Scan

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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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Impact of GERAADA Score in Patients With Acute Type A Aortic Dissection

10.21203/rs.3.rs-1113329/v1 ◽

2021 ◽

Author(s):

Kayo Sugiyama ◽

Hirotaka Watanuki ◽

Masato Tochii ◽

Yasuhiro Futamura ◽

Yuka Kitagawa ◽

...

Keyword(s):

Mortality Rate ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Acute Type ◽

Postoperative Results ◽

Entire Study ◽

Type A Aortic Dissection ◽

Actual Mortality ◽

Aortic Dissection Type A

Abstract Background Despite continuous developments and advances in the perioperative management of patients suffering from acute aortic dissection type A (AADA), the associated postoperative morbidity and mortality remain high and strongly depend on the preoperative clinical status. The associated postoperative mortality is still hard to predict prior to the surgical procedure. The so-called German Registry of Acute Aortic Dissection Type A (GERAADA) score uses very basic and easily retrievable parameters and was specifically designed for predicting the 30-day mortality rate in patients undergoing surgery for AADA. This study evaluated impact of the GERAADA score in the authors’ institutional results. MethodsAmong 101 acute type A aortic dissection patients treated at our hospital during August 2015–March 2021, the GERAADA was calculated individually and retrospectively. Predicted and actual mortalities were assessed, and independent predicted factors were searched. The primary endpoint was defined as comparison of GERAADA scores and early mortality, and the secondary endpoints were defined as comparison of GERAADA scores and other postoperative results, and comparison of preoperative factors and postoperative results regardless to GERAADA scores.ResultsWhile the overall 30-day mortality for the entire study cohort calculated by the GERAADA score was 14.3 (8.1-77.6) %, the actual mortality rate was 6%. However, the GERAADA score was significantly high in some postoperative complications and showed significant correlation with some peri- and post-operative factors. In addition, factors not belonging to GERAADA score such as time from onset to arrival at the hospital, time from onset to arrival at the operation room, spouse presence, and hemodialysis were significantly associated with 30-day mortality.ConclusionsAlthough the actual mortality was lower than predicted, GERAADA score may impact on the postoperative course. In addition, it would be desirable to add parameters such as the time from onset to arrival, family background, and hemodialysis for further accuracy.

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Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2004.09.005 ◽

2005 ◽

Vol 129 (1) ◽

pp. 112-122 ◽

Cited By ~ 328

Author(s):

Santi Trimarchi ◽

Christoph A. Nienaber ◽

Vincenzo Rampoldi ◽

Truls Myrmel ◽

Toru Suzuki ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

International Registry ◽

Results Of Surgery

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Successful treatment of an acute type A aortic dissection presented with ST segment elevation on ECG and pericardial tamponade. Case report

Orvosi Hetilap ◽

10.1556/oh.2014.30028 ◽

2014 ◽

Vol 155 (44) ◽

pp. 1763-1767

Author(s):

Miklós Pólos ◽

Zoltán Szabolcs ◽

Astrid Apor ◽

István Édes ◽

Erzsébet Paulovich ◽

...

Keyword(s):

Aortic Dissection ◽

Successful Treatment ◽

Acute Aortic Dissection ◽

Type A ◽

Pericardial Tamponade ◽

Left Ventricular ◽

Acute Type ◽

Type A Aortic Dissection ◽

St Segment Elevation ◽

St Segment

Successful treatment of type A acute aortic dissection depends on the promptness of diagnostic evaluation and therapy. Fast diagnosis can be challenged by numerous complications such as myocardial ischemia, acute aortic insufficiency, and disturbances in organ perfusion and pericardial tamponade. The authors report the case history of a 72-year-old woman, who was admitted after resuscitation with ST segment elevation. Echocardiography revealed acute type A aortic dissection with signs of pericardial tamponade. An emergency operation consisting of the resection of the ascending aorta and the reconstruction of the aortic root was performed, which took six hours from admission until the end of the operation. Follow-up examinations demonstrated good left ventricular function and competent aortic valve. The authors propose that with the development of diagnostic and therapeutic options, faster and less invasive interventions will be introduced in near future for the treatment of acute aortic dissection, which may reduce the morbidity and mortality rates of this lethal illness. Orv. Hetil., 2014, 155(44), 1763–1767.

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Fate of the preserved aortic root after treatment of acute type A aortic dissection: 23-year follow-up

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2012.09.049 ◽

2013 ◽

Vol 146 (6) ◽

pp. 1456-1460 ◽

Cited By ~ 19

Author(s):

Angelo M. Dell'Aquila ◽

Giovanni Concistrè ◽

Alina Gallo ◽

Stefano Pansini ◽

Alessandro Piccardo ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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A Reoperation for Pseudoaneurysm of the Proximal Anastomotic Site and Distal Enlargement of the Dissecting Arch and Descending Aorta after Ascending Aortic Replacement for Acute Type A Aortic Dissection

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.45.284 ◽

2016 ◽

Vol 45 (6) ◽

pp. 284-289

Author(s):

Yuji Morishima ◽

Katsuya Arakaki ◽

Yukio Kuniyoshi

Keyword(s):

Aortic Dissection ◽

Type A ◽

Anastomotic Site ◽

Acute Type ◽

Descending Aorta ◽

Type A Aortic Dissection ◽

Aortic Replacement ◽

Ascending Aortic Replacement

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Florida Sleeve is a Safe and Effective Technique for Valve Salvage in Acute Stanford Type A Aortic Dissection

10.22541/au.163256960.06606439/v1 ◽

2021 ◽

Author(s):

Mahmoud Alhussaini ◽

Eric Jeng ◽

Tomas Martin ◽

Amber Filion ◽

Thomas Beaver ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Long Term Results ◽

Acute Type ◽

Type A Aortic Dissection ◽

Valve Sparing

Objective: Valve-sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute Type-A Aortic Dissection (ATAAD). The Florida Sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the Florida Sleeve (FS) repair in patients with dilated roots in the setting of an ATAAD. Methods: We retrospectively reviewed 24 consecutive patients (2002-2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow-up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. Results: Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal-perfusion or shock. The FS was combined with hemi-arch replacement in 15 (62.5%) patients and a zone-2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow-up period was 46 months (range; 0.3-146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. Conclusion: FS is simplified and reproducible valve-sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type-A aortic dissection with excellent early and long-term results.

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