Hybrid Stepwise External Wrapping for Type A Acute Aortic Dissection with Cerebral Malperfusion

10.21203/rs.3.rs-70045/v1 ◽

2020 ◽

Author(s):

Yoshihiro Suematsu ◽

Satoshi Nishi ◽

Daisuke Arima ◽

Akihiro Yoshimoto

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Aortic Rupture ◽

False Lumen ◽

Type A ◽

Good Physical Condition ◽

Threatening Condition ◽

Valve Insufficiency ◽

Life Threatening ◽

Cerebral Malperfusion

Abstract Background: Acute aortic dissection (AAD) is a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A AAD (TAAAD) still remains high, and treatment for such patients remains controversial. We report a successful treatment of TAAAD with a communicating false lumen in a 60-year-old man with acute hemi-cerebral malperfusion. Case presentation: The ascending aorta was wrapped with stepwise external wrapping (SEW) procedure, and subsequent thoracic endovascular aortic repair (TEVAR) was successfully performed. The patient was discharged in good physical condition without any complications. Conclusions: Hybrid therapy with SEW and TEVAR with TAAAD associated with major cerebral malperfusion should be considered, especially in patients for whom open surgery is extremely risky.

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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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Efficacy of entry exclusion strategy for DeBakey type III retrograde Stanford type A acute aortic dissection

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa329 ◽

2020 ◽

Author(s):

Yosuke Inoue ◽

Hitoshi Matsuda ◽

Jiro Matsuo ◽

Takayuki Shijo ◽

Atsushi Omura ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

False Lumen ◽

Type A ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Descending Aorta ◽

Type Iii ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique

Abstract OBJECTIVES Resection of a primary entry tear is essential for the treatment of Stanford type A acute aortic dissection (AAAD). In DeBakey type III retrograde AAAD (DBIII-RAAAD), resection of the primary entry tear in the descending aorta is sometimes difficult. The frozen elephant trunk technique and thoracic endovascular aortic repair (TEVAR) enable the closure of the primary entry in the descending aorta. The aim of this study was to investigate the efficacy of resection or closure of primary entry, i.e. entry exclusion, in patients with DeBakey type III retrograde-AAAD. METHODS The medical records of 654 patients with AAAD who underwent emergency surgery between January 2000 and March 2019 were retrospectively reviewed, and 80 eligible patients with DeBakey type III retrograde-AAAD were divided into the excluded (n = 50; age, 62 ± 12 years) and residual (n = 30; age, 66 ± 14 years) groups according to postoperative computed tomography angiographic data of the false lumen around the primary entry. The excluded group was defined as having a postoperative false lumen at the level of the elephant trunk or thrombosis of the endograft including primary entry. Patients with early false lumen enhancement around the elephant trunk or an unresected primary entry tear after isolated hemiarch replacement were included in the residual group. The early and long-term surgical outcomes were compared between the groups. RESULTS The in-hospital mortality rate was 8% (6/80), with no significant difference observed between the excluded and the residual groups (10% and 7%, respectively; P > 0.99). Ninety-five percentage of the patients (20/21) achieved entry exclusion with stent grafts including the frozen elephant trunk procedure and TEVAR. Spinal cord ischaemia was not observed in either group. The cumulative overall survival at 5 years was comparable between the 2 groups (76% and 81% in the excluded and residual groups, respectively; P = 0.93). The 5-year freedom from distal aortic reoperation rate was significantly higher in the excluded group (97%) than in the residual group (97% vs 66%; P = 0.008). CONCLUSIONS Not only resection but also closure using the entry exclusion approach for DeBakey type III retrograde-AAAD utilizing new technologies including the frozen elephant trunk technique and TEVAR might mitigate dissection-related reoperations.

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Aortic Dissection in a Pregnant Patient without Other Risk Factors

Case Reports in Obstetrics and Gynecology ◽

10.1155/2019/1583509 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Priya V. Patel ◽

Raanan Alter ◽

Recia Frenn ◽

Thaddeus P. Waters

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Aortic Rupture ◽

Treatment Options ◽

Pregnant Patient ◽

Physical Exam ◽

Vascular Events ◽

Increased Risk ◽

Threatening Condition ◽

Life Threatening

Background. An aortic dissection is a life-threatening condition in which the intima of the artery tears causing separation of the intima and media. Pregnancy places women at a significantly increased risk of common vascular events including venous thromboembolism, myocardial infarction, and stroke, while also increasing the risk of rarer vascular events such as aortic dissection and aortic rupture. Case. A 30-year-old previously healthy multiparous woman presenting at 36 weeks of pregnancy with a Type A aortic dissection. She underwent a combined emergent cesarean delivery followed by repair of her aortic root. Conclusions. Aortic dissection should be high on the differential for pregnant patients presenting with the characteristic complaints and physical exam findings given the high mortality rate associated with this vascular event. Teaching Points. (1) This report reviews the characteristic presentation, risk factors, and physical exam findings in a patient with an aortic dissection. (2) The report includes treatment options for pregnant patients based on the classification of the dissection.

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Acute Aortic Dissection Mimicking STEMI in the Catheterization Laboratory: Early Recognition Is Mandatory

Case Reports in Cardiology ◽

10.1155/2012/367542 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3

Author(s):

Alessio Arrivi ◽

Gaetano Tanzilli ◽

Paolo Emilio Puddu ◽

Giovanni Truscelli ◽

Marcello Dominici ◽

...

Keyword(s):

Aortic Dissection ◽

Early Recognition ◽

Type A ◽

Type A Aortic Dissection ◽

Catheterization Laboratory ◽

Arterial Complication ◽

Threatening Condition ◽

Life Threatening ◽

Previously Treated ◽

Pathophysiologic Mechanisms

Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction. Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting. Recognition of these occurrences in the catheterization laboratory is important to look immediately for surgery.

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Strategy for Stanford Type A Acute Aortic Dissection with Thrombosed False Lumen of the Ascending Aorta.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.30.280 ◽

2001 ◽

Vol 30 (6) ◽

pp. 280-284

Author(s):

Hidefumi Obo ◽

Tsutomu Shida ◽

Syuuichi Kozawa ◽

Tatsurou Asada ◽

Nobuhiko Mukohara ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

False Lumen ◽

Type A ◽

Ascending Aorta

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Type A Acute Aortic Dissection Complicated With Cerebral Malperfusion

Cardiology: Study & Research ◽

10.24966/csr-768x/100012 ◽

2016 ◽

Vol 3 (1) ◽

pp. 1-2

Author(s):

Ying-Fu Chen

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Type A ◽

Cerebral Malperfusion

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P5607Clinical characteristics and treatment strategy for acute aortic dissection in Tokyo Acute Aortic Disease Super-Network System

European Heart Journal ◽

10.1093/eurheartj/ehz746.0551 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Yoshino ◽

K Akutsu ◽

T Takahashi ◽

T Shimokawa ◽

H Ogino ◽

...

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Treatment Strategy ◽

Acute Aortic Dissection ◽

False Lumen ◽

Type A ◽

Network System ◽

Care Hospital ◽

Type B ◽

New System

Abstract Introduction Acute aortic dissection (AAD) is one of the most fatal cardiovascular diseases. The prevalence of AAD is reported to be low. The clinical data of AAD from representative cardiovascular centers are not enough to show the whole range of clinical feature of AAD. We have to know the exact prevalence and clinical pictures of AAD under the new system, the Tokyo AAD Super-Network System (TAAD-SNS), for strategy of emergency transport and treatment of AAD which would cover the entire metropolitan area of Tokyo. TAAD-SNS started in 2011, and after slight modification, the new system of AAD re-started in 2013. The aim of this study is to elucidate the whole range of clinical characteristics and recent trends of treatment of AAD. Methods Out of 73 hospitals included in Tokyo CCU Network system, 41 hospitals are chosen for TAAD-SNS. These hospitals provide around-the-clock surgery. In this system, the availability of surgical division is monitored in real time. All of the patients suspected of AAD are transferred directly or from primary care hospital to the hospitals of TAAD-SNS. Results After exclusion of 237 patients with cardiopulmonary arrest on arrival, 4877 consecutive patients (2923 male, mean age of 69±14 y/o) were admitted to the hospitals with diagnosis of AAD from 2013 to 2016. Prevalence of AAD in Tokyo was about 10 patients per 100,000 populations in every year. After exclusion of 37 patients undetermined into type A or B, 4840 patients (2694 with type A and 2146 with type B) were analyzed. Among the type A patients, 1752 (65%) were classified into type of patent false lumen (classic-type), 721 (27%) of closed false lumen (intramural hematoma: IMH-type), and 221 (8%) were undetermined. Among the type B, 880 (41%) were classified into classic-type, 1129 (53%) of IMH-type, and 137 (6%) were undetermined. Both among type A and B, mean ages were younger in classic-type than in IMH-type (type A: 66±14 vs. 73±12 y/o, p<0.05; type B: 64±15 vs. 72±12 y/o, p<0.05). Prevalence of male population and risk factor of hypertension was higher in type B than in type A both among classic-type and IMH-type. Systolic blood pressure at the emergency room was lower in type A than in type B among both classic-type and IMH-type (classic-type: 124±34 vs. 161±38 mmHg, IMH-type: 130±51 vs. 163±56 mmHg). In-hospital mortality of surgical treatment for type A classic-type and type A IMH-type, conservative strategy for type B classic-type and type B IMH-type was 9.6%, 4.2%, 3.1% and 1.7%, respectively. Stentgraft implantation for type B AAD started and shows a favorable in-hospital mortality compared to the operative treatment (Stentgraft vs. surgery in type B classic-type: 7.8% vs. 6.5%, in type B IMH-type: 10.7% vs. 11.8%, respectively). Conclusion Our study showed that prevalence of AAD was 2–3 times higher than previous reports. We should consider to choose the treatment strategy according to the type of AAD, A or B, classic-type or IMH-type. Acknowledgement/Funding Tokyo Metropolitan government

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