scholarly journals Total Arch versus Hemiarch Replacement for Type A Acute Aortic Dissection: A Single-Center Experience

2016 ◽  
Vol 43 (6) ◽  
pp. 488-495 ◽  
Author(s):  
Antonio Lio ◽  
Francesca Nicolò ◽  
Emanuele Bovio ◽  
Andrea Serrao ◽  
Jacob Zeitani ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
Operative Mortality ◽  
Type A ◽  
Total Arch Replacement ◽  
Operative Death ◽  
Aortic Arch Surgery ◽  
Intermediate Outcomes ◽  
Hemiarch Replacement

We retrospectively evaluated early and intermediate outcomes of aortic arch surgery in patients with type A acute aortic dissection (AAD), investigating the effect of arch surgery extension on postoperative results. From January 2006 through July 2013, 201 patients with type A AAD underwent urgent corrective surgery at our institution. Of the 92 patients chosen for this study, 59 underwent hemiarch replacement (hemiarch group), and 33 underwent total arch replacement (total arch group) in conjunction with ascending aorta replacement. The operative mortality rate was 22%. Total arch replacement was associated with a 33% risk of operative death, versus 15% for hemiarch (P=0.044). Multivariable analysis found these independent predictors of operative death: age (odds ratio [OR]=1.13/yr; 95% confidence interval [CI], 1.04–1.23; P=0.002), body mass index >30 kg/m2 (OR=9.9; 95% CI, 1.28–19; P=0.028), postoperative low cardiac output (OR=10.6; 95% CI, 1.18–25; P=0.035), and total arch replacement (OR=8.8; 95% CI, 1.39–15; P=0.021) The mean overall 5-year survival rate was 59.3% ± 5.5%, and mean 5-year freedom from distal reintervention was 95.4% ± 3.2% (P=NS). In type A AAD, aortic arch surgery is still associated with high operative mortality rates; hemiarch replacement can be performed more safely than total arch replacement. Rates of distal aortic reoperation were not different between the 2 surgical strategies.

scholarly journals Total Arch Replacement in a Patient with Type A Acute Aortic Dissection and Situs Inversus Totalis

2016 ◽  
Vol 45 (6) ◽  
pp. 299-301
Author(s):  
Muneaki Yamada ◽  
Yasuyuki Kato ◽  
Aya Takahashi ◽  
Daisuke Shiomi ◽  
Hiroshi Kiyama
Keyword(s):  
Aortic Dissection ◽  
Situs Inversus ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Situs Inversus Totalis ◽  
Total Arch Replacement

scholarly journals 125 * TOTAL ARCH REPLACEMENT VERSUS MORE CONSERVATIVE MANAGEMENT IN TYPE A ACUTE AORTIC DISSECTION

2014 ◽  
Vol 19 (suppl 1) ◽  
pp. S38-S38
Author(s):  
M. Di Eusanio ◽  
P. Berretta ◽  
G. Folesani ◽  
M. Cefarelli ◽  
J. Alfonsi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Conservative Management ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Total Arch Replacement

scholarly journals Different aortic arch surgery methods for type A aortic dissection: clinical outcomes and follow-up results

2020 ◽  
Vol 31 (2) ◽  
pp. 254-262
Author(s):  
Yunxing Xue ◽  
Jun Pan ◽  
Hailong Cao ◽  
Fudong Fan ◽  
Xuan Luo ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Clinical Outcomes ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Aortic Arch Surgery

Abstract OBJECTIVES The aim of this study was to investigate the clinical outcomes and follow-up results among 5 main aortic arch surgery methods for type A aortic dissection in a single centre. METHODS From 2002 to 2018, 958 type A aortic dissection patients who received surgical repair were divided into 5 groups according to the arch surgery method: hemiarch replacement (n = 206), island arch replacement (n = 54), total arch replacement with frozen elephant trunk (n = 425), triple-branched stent (n = 39) and fenestrated stent (n = 234). The indications for the different arch methods were related to the patient’s preoperative status, the location and extent of the dissection and the surgical ability of the surgeons. A comparative study was performed to identify the differences in the perioperative data, and the Kaplan–Meier analysis was used to assess the long-term survival and reintervention rates. Thirty matched surviving patients that were included in each group completed Computed tomography angiography to determine long-term reshaping effect. RESULTS The 30-day mortality rate was 15.8%, and there was no difference among the 5 groups (P = 0.848). The follow-up survival rates were similar among the 5 groups (P = 0.130), and the same was true for patients without reintervention (P = 0.471). In the propensity matching study, patients with stents (frozen elephant trunk, triple-branched stent, fenestrated stent) had a slower aortic dilation rate and a higher ratio of thrombosis in the false lumen at the descending aortic and abdominal aortic levels than patients without stents. CONCLUSIONS No standard method is available for arch surgery, and indications and long-term effects should be identified with clinical data. In our experiences, simpler surgical procedures could reduce mortality in critically ill patients and stents in the distal aorta could improve long-term reshape effects.

Replacement of the transverse aortic arch for type a acute aortic dissection

1993 ◽  
Vol 55 (4) ◽  
pp. 864-867 ◽  
Author(s):  
Koichi Tabayashi ◽  
Koki Niibori ◽  
Atsuchi Iguchi ◽  
Yoshimi Shoji ◽  
Mikio Ohmi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
Type A

ARCH Replacement in Acute Aortic Dissection Type a in Normothermia

2001 ◽  
Vol 71 (3) ◽  
pp. 282-286
Author(s):  
Ovidiu Stiru ◽  
Roxana Carmen Geana ◽  
Adrian Tulin ◽  
Raluca Gabriela Ioan ◽  
Victor Pavel ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Ct Scan ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Ascending Aorta ◽  
Descending Aorta ◽  
The Right ◽  
Aortic Dissection Type A

The purpose of this case presentation is to present a simplified surgical technique when in a patient with acute aortic dissection type A (AAD), aortic arch, and ascending aorta is completely replaced without circulatory arrest. A 67-year old male was presented in our institution with severe chest and back pain at 12 h after the onset of the symptoms. Imaging studies by 3D contrast-enhanced thoracic computed tomography (CT-scan) and transesophageal echocardiography (TEE) revealed ascending aortic dissection towards the aortic arch, which was extending in the proximal descending aorta. We practiced emergency median sternotomy and established cardiopulmonary bypass (CBP) between the right atrium and the right femoral artery with successive cross-clamping of the ascending and descending aorta below the origin of the left subclavian artery (LSA). In normothermic condition without circulatory arrest and with antegrade cerebral perfusion, we replaced the ascending aorta and aortic arch with a four branched Dacron graft. Patient evolution was uneventful, and he was discharged, after fourteen days from the hospital. At a one-year follow-up, 3D CT-scan showed no residual dissection with a well-circulated lumen of the supra-aortic arteries. Using the described surgical approach, CPB was not interrupted, the brain was protected, and hypothermia was no used. This approach made these surgical procedures shorter, and known complications of hypothermia and circulatory arrest are avoided.Acute aortic dissection aortic type A, total arch replacement, normothermia

Comparison of Risk Scores for the Prediction of Outcomes after Surgery for Acute Type A Aortic Dissection

2019 ◽  
pp. 1-4
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Operative Mortality ◽  
External Validation ◽  
Type A ◽  
Risk Scores ◽  
Acute Type ◽  
Risk Models ◽  
Type A Aortic Dissection ◽  
Malperfusion Syndrome

We compared the performance of four existing risk models and a newly developed risk score for type A acute aortic dissection surgery. In 327 consecutives with type A aortic dissection surgery patients during 2003/03-2017/03 at our centre, operative mortality occurred in 65 (19.9%). Independent predictors of operative mortality were critical pre-operative state and malperfusion syndrome, and a novel additive “CritMal” Score was constructed from this. C-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.60 (0.52-0.67), EuroSCORE II 0.64 (0.57-0.72), Rampoldi 0.68 (0.59-0.76), Leontyev 0.56 (0.48-0.64), and CritMal 0.72 (0.64-0.80) respectively. This is the first study externally assessing surgical scores for aortic dissection surgery, with modest accuracy for all and moderate for CritMal. There is room for improvement of these risk models, and further refinements and external validation are warranted for clinical application.

scholarly journals Changes in the Hemostatic System of Patients With Acute Aortic Dissection Undergoing Aortic Arch Surgery

2016 ◽  
Vol 101 (3) ◽  
pp. 945-951 ◽  
Author(s):  
Xin Liang Guan ◽  
Xiao Long Wang ◽  
Yu Yong Liu ◽  
Feng Lan ◽  
Ming Gong ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
Aortic Arch Surgery ◽  
Hemostatic System

Total Arch Replacement Versus More Conservative Management in Type A Acute Aortic Dissection

2015 ◽  
Vol 100 (1) ◽  
pp. 88-94 ◽  
Author(s):  
Marco Di Eusanio ◽  
Paolo Berretta ◽  
Mariano Cefarelli ◽  
Alfonsi Jacopo ◽  
Giacomo Murana ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Conservative Management ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Total Arch Replacement
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