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

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.

scholarly journals Surgical Management of Acute Type A Aortic Dissection: An Overview

2021 ◽  
pp. 263246362097804
Author(s):  
Sreedhar Reddy Nagaradona ◽  
Krishna Machiraju ◽  
Srinivasulu Reddy Kurapati ◽  
Srinivas Boggula ◽  
Sridhar Anumala Setty ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Wall ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Aortic Arch Replacement ◽  
Type A Aortic Dissection ◽  
The Past ◽  
Catastrophic Disease

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.

scholarly journals A case report of aortic root repair using a pericardial autograft for type A aortic dissection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yi Chang ◽  
Hongwei Guo ◽  
Xiangyang Qian ◽  
Fang Fang
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Aortic Wall ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Intimal Flap ◽  
Root Repair ◽  
Coronary Ostia

Abstract Background Acute type A aortic dissection with a dissection flap extending into the sinus segment often involves the commissures and the coronary ostia. In most cases, the intimal flap must be retained in order to restore aortic valve competence and reconstruct the coronary ostia. Residual dissection flap has the potential risks of proximal bleeding and adverse effects on long-term durability. We established a novel technique to reconstruct the aortic root using a pericardial autograft and significantly reduce remnant dissection tissues. Case presentation A 50-year-old female was admitted to our center with acute anterior chest pain and backache lasting about 10 h. Computed tomographic (CT) scans showed type A aortic dissection, with both coronary ostia being involved. Doppler echocardiography showed moderate aortic insufficiency. The dissection intimal flap was removed to the normal aorta wall near the annulus at the noncoronary sinus, leaving a 5 mm rim of intimal flap near the commissures and coronary ostia. Using a pericardial patch as a new aortic wall to reconstruct the root while preserving the aortic adventitia to fix and strengthen the new pericardial aortic wall. Ascending aorta and total arch replacement combined with frozen elephant trunk procedure was performed at the same time. The patient got an uneventful postoperative course. Conclusion Aortic root repair with a pericardial autograft is a safe and effective technique to treat acute type A dissection involving the sinus. Using this technique, residual dissection tissues could be significantly reduced, which subsequently decreases the risk of proximal bleeding and hence increases long-term durability.

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

2018 ◽  
Vol 9 (3_suppl) ◽  
pp. S13-S20 ◽  
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.

scholarly journals Preservation of the Aortic Root During Type A Aortic Dissection Surgery: An Effective Strategy?

Aorta ◽  
2021 ◽  
Author(s):  
Christophe Baufreton ◽  
Olivier Fouquet ◽  
Simon Dang Van ◽  
Jihed Laribi ◽  
Frédéric Pinaud ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Regurgitation ◽  
Aortic Root ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Long Term Follow Up

Abstract Background Management of the aortic root during acute Type A aortic dissection (TAAD) repair remains controversial in term of long-term evolution and reoperation. The aim of this study was to assess the long-term outcomes of the aortic root after conservative management during primary surgery. Methods One hundred sixty-four consecutive patients were included in this monocentric retrospective study. The primary endpoint was reoperation on the aortic root during long-term follow-up. Forty-six patients had aortic root replacement (ARR) and 118 had supracoronary aortic replacement (SCR). The 10-year survival, occurrence of significant aortic regurgitation, and radiologic aortic root dilatation in each group were assessed during follow-up. Results Patients from ARR group were younger than those from SCR group (p < 0.0001). Median follow-ups of ARR group and SCR group are 4.4 (interquartile range [IR]: 2.6–8.3) and 6.15 (IR: 2.8–10.53) years, respectively. Reoperation of the aortic root during long-term follow-up was similar in both groups (ARR group: 5.1%, SCR group: 3.3%, p = 0.636). The 10-year survivals of ARR and SCR groups were 64.8 ± 12.3% and 46.3 ± 5.8% (p = 0.012), respectively. Long-term significant aortic regurgitation occurred in one patient (1.7%) and seven patients (7.6%) of the ARR and SCR groups (p = 0.176), respectively. Radiologic aortic root diameters in the SCR group were similar between postoperative period and follow-up studies (p = 0.58). Reoperation on the distal aorta (p = 0.012) and patent radiologic false lumen of the descending aorta (p = 0.043) were independent risk factors of late death. Conclusion SCR is an effective technique for primary TAAD surgery and does not increase the rate of late reoperation on the aortic root.

scholarly journals Unusual, Radical Treatment of Type A Aortic Dissection: A Case Report

Aorta ◽  
2020 ◽  
Vol 08 (04) ◽  
pp. 111-115
Author(s):  
Rossella M. Benvenga ◽  
Michele Bellino ◽  
Generoso Mastrogiovanni ◽  
Donato Triggiani ◽  
Rodolfo Citro ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Root ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
High Morbidity ◽  
Type A Aortic Dissection ◽  
Native Aortic Valve ◽  
Hybrid Prosthesis

AbstractType A aortic dissection, according to Stanford classification, is a surgical emergency with high morbidity and carries 56% of in-hospital mortality when surgical intervention is not performed. The surgical mortality at 30 days is 10 to 20%. The therapeutic goals are to replace the diseased ascending aorta and to treat or to monitor the distal aortic patent false lumen. When the dissection involves the aortic root and the architecture of aortic valve is normal, the surgical techniques used could be multiple: reinforce the aortic root and spare the native aortic valve or replace the aortic valve and the aortic root. The Florida sleeve technique has been developed to treat the aortic aneurysm, sparing the aortic valve in patients with connective tissue disease. Some case reports have described the use of this technique to treat an acute aortic dissection. In the following case, we present a single stage repair of the ascending aorta, aortic arch, and proximal intrathoracic aorta in a patient with Type A aortic dissection through the contemporaneous use of two techniques: Florida sleeve and Vascutek “Thoraflex” hybrid prosthesis. The use of these two techniques allows the repair/replacement of the proximal intrathoracic aorta, the sparing of the native aortic valve, the employment of a hybrid prosthesis to replace the supraortic vessels, and the creation of a descending aortic landing zone for later, distal intervention.

Cannulating a Dissecting Aorta Using Ultrasound-Epiaortic and Transesophageal Guidance

2011 ◽  
Vol 14 (6) ◽  
pp. 373 ◽  
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>

Short- and long-term outcomes of aortic root-sparing repair and replacement in acute type A aortic dissection repair

2021 ◽  
pp. 021849232110150
Author(s):  
Tillana Nirav Tarkas ◽  
Carla Stoicescu ◽  
Wahaj Munir ◽  
Mohamad Bashir ◽  
Benjamin Adams
Keyword(s):  
Decision Making ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Definitive Answer ◽  
Significant Difference ◽  
Current Controversy ◽  
Short And Long Term

Acute type A aortic dissection is a surgical emergency with a high mortality rate if left untreated. Management of the aortic root in this setting constitutes an intricate decision-making framework, further complicated by the emergent nature of the dissection. There exists much controversy regarding pursuit of the aggressive aortic root replacement versus a conservative root-sparing repair, alongside considerations for valve-sparing root replacement. In this review, we critically appraise the current controversy in the literature considering the fate of the aortic root, discussing the aforementioned root interventions for which provides better outcomes for mortality and risk of re-intervention. Literature search was performed using electronic database through PubMed, Google scholar, and Embase focussing on studies reporting outcomes and re-intervention rates for these approaches. Limited by the heterogeneity in surgical strategy, with most studies being single-centred retrospective experiences, further fuel this ongoing debate. The literature reveals rather contrasting results whilst comparing root-sparing repair, versus the extensive root replacement; whilst some studies report no statistically significant difference, others show one superior over the other. There is greater consensus when considering risk of re-operation, with studies showing higher rates of re-operation in root-sparing group compared to replacement; however, many others show no statistically significant difference. In conclusion, the conflicting outcomes reported in the literature, with their inherent limitations, results in the current inability to reach a definitive answer. There remains support in the current literature for both approaches with much of the decision-making being surgeon-bound with many significant influencing factors on a case-by-case basis.

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