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

<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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Watch-and-wait strategy for type A intramural haematoma and acute aortic dissection with thrombosed false lumen of the ascending aorta: a Japanese single-centre experience

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa080 ◽

2020 ◽

Vol 58 (3) ◽

pp. 590-597 ◽

Cited By ~ 4

Author(s):

Tadashi Kitamura ◽

Shinzo Torii ◽

Takashi Miyamoto ◽

Toshiaki Mishima ◽

Hirotoki Ohkubo ◽

...

Keyword(s):

Aortic Dissection ◽

Pain Score ◽

Acute Aortic Dissection ◽

False Lumen ◽

Type A ◽

Ascending Aorta ◽

Aortic Diameter ◽

Intramural Haematoma ◽

Watch And Wait ◽

Significant Difference

Abstract OBJECTIVES In this study, we investigated the early and midterm outcomes of initial watch-and-wait strategy for Stanford type A intramural haematoma and acute aortic dissection with thrombosed false lumen of the ascending aorta in patients with a maximum aortic diameter of ≤50 mm, pain score of ≤3/10 and no ulcer-like projection in the ascending aorta. METHODS Inpatient and outpatient records were retrospectively reviewed. RESULTS Of the 81 patients with type A intramural haematoma and acute aortic dissection with the thrombosed false lumen of the ascending aorta between April 2011 and April 2019, a watch-and-wait strategy was selected in 46 patients. The mean age of the patients was 68 years, and 22 (48%) patients were female. Ten patients underwent emergency pericardial drainage for cardiac tamponade at the time of presentation and 8 patients underwent aortic repair during hospitalization for new ulcer-like projection, re-dissection or rupture. In-hospital mortality occurred in 2 (4%) patients. During follow-up, survival at 1 and 2 years was 95% and 92%, respectively. There was no significant difference in survival or aortic events between patients in whom the watch-and-wait strategy and emergency surgical treatment were indicated. CONCLUSIONS The early and midterm outcomes of the initial watch-and-wait strategy were favourable for type A intramural haematoma and acute aortic dissection with the thrombosed false lumen of the ascending aorta in Japanese patients with a maximum aortic diameter of ≤50 mm, pain score of ≤3/10 and no ulcer-like projection. Further study is required to show the safety of this strategy.

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Epiaortic Ultrasound-Guided True Lumen Cannulation of Ascending Aorta in Acute Aortic Dissection Type A

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.04.11895 ◽

2021 ◽

Vol 104 (4) ◽

pp. 604-609

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Axillary Artery ◽

Type A ◽

Ascending Aorta ◽

Ultrasound Guided ◽

True Lumen ◽

Artery Cannulation ◽

Aortic Cannulation ◽

Aortic Dissection Type A

Background: The choice of arterial inflow for acute Stanford type A aortic dissection repair remains controversial. The axillary artery should be considered as first choice for cannulation, but this technique is time-consuming. The ascending aortic cannulation provides antegrade perfusion and can be performed rapidly but there are several concerns such as aortic rupture, extension of dissection, and false lumen cannulation. Objective: To compare the establishment time of cardiopulmonary bypass (CPB) and postoperative outcomes of the two cannulation techniques that provide antegrade perfusion, which was direct true lumen cannulation on the dissected ascending aorta using epiaortic ultrasound-guided and axillary artery cannulation in Siriraj Hospital. Materials and Methods: The authors retrospectively reviewed all the 30 cases of acute aortic dissection type A using two different cannulation methods performed between February 2011 and May 2017. Direct true lumen ascending aortic cannulation was performed using the epiaortic ultrasound-guide with Seldinger technique in 12 patients, and axillary artery cannulation was performed in 18 patients. Results: The direct true lumen ascending aortic cannulation was safely performed in all patients. None of them had aortic rupture. Skin incision to CPB time was significantly faster in the epiaortic ultrasound-guided ascending aortic cannulation group at 29±8 versus 49±14 minutes (p<0.001). The 30-day mortality and postoperative adverse events, such as ischemic stroke, acute kidney injury, visceral organ and limb malperfusion showed no statistically significant difference from the axillary artery cannulation method. Conclusion: Epiaortic ultrasound-guided true lumen cannulation of ascending aorta in the treatment of acute aortic dissection type A is safe and feasible. Skin incision to CPB time can be performed faster and provided good outcome compared to the axillary artery cannulation technique. Keywords: Acute aortic dissection, Ascending cannulation, Epiaortic ultrasound

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Aorto-Cutaneous Fistula and False Aneurysm of the Ascending Aorta Five Years after its Prosthetic Replacement for Stanford Type A Acute Aortic Dissection

Aorta ◽

10.12945/j.aorta.2017.16.015 ◽

2017 ◽

Vol 05 (02) ◽

pp. 57-60

Author(s):

Pierre Demondion ◽

Dorian Verscheure ◽

Pascal Leprince

Keyword(s):

Aortic Dissection ◽

Carotid Arteries ◽

Acute Aortic Dissection ◽

False Aneurysm ◽

Type A ◽

Aneurysm Rupture ◽

Ascending Aorta ◽

Cutaneous Fistula ◽

The Right ◽

Selective Cannulation

AbstractAorto-cutaneous fistula and false aneurysm of the ascending aorta in patients who previously underwent Stanford Type A acute aortic dissection are rare and severe complications. Surgical correction remains a demanding challenge. In a case of false aneurysm rupture during redo sternotomy, selective cannulation of the right axillary and left carotid arteries allowed an efficient method of cerebral perfusion.

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Outcomes of patients who declined surgery for acute Stanford type A aortic dissection with patent false lumen of the ascending aorta†

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivw451 ◽

2017 ◽

Vol 25 (1) ◽

pp. 47-51 ◽

Cited By ~ 4

Author(s):

Tadashi Kitamura ◽

Shinzo Torii ◽

Tetsuya Horai ◽

Koichi Sughimoto ◽

Yusuke Irisawa ◽

...

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Type A ◽

Ascending Aorta ◽

Type A Aortic Dissection ◽

Patent False Lumen

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Values of aortic dissection detection risk score combined with ascending aorta diameter >40 mm for the early identification of type A acute aortic dissection

Journal of Thoracic Disease ◽

10.21037/jtd.2018.02.42 ◽

2018 ◽

Vol 10 (3) ◽

pp. 1815-1824 ◽

Cited By ~ 3

Author(s):

Di Wang ◽

Zhi-Yan Wang ◽

Ju-Fang Wang ◽

Li-Li Zhang ◽

Ju-Mo Zhu ◽

...

Keyword(s):

Aortic Dissection ◽

Risk Score ◽

Early Identification ◽

Acute Aortic Dissection ◽

Type A ◽

Ascending Aorta ◽

Aorta Diameter

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Early misdiagnosis of acute aortic dissection: A case report and analysis of the causes

International Journal of Diagnostic Imaging ◽

10.5430/ijdi.v4n1p15 ◽

2016 ◽

Vol 4 (1) ◽

pp. 15

Author(s):

Xiao-yan Chen ◽

Fan-liang Kong ◽

Tong-guo Wu

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Case Report ◽

Aortic Dissection ◽

Emergency Room ◽

Male Patient ◽

Acute Aortic Dissection ◽

Type A ◽

Ascending Aorta ◽

Type A Aortic Dissection

Type A aortic dissection is a catastrophic clinical entity involving the ascending aorta. In this case report, a patient was admitted to the emergency room with a presentation resembling acute myocardial infarction (AMI) that led to the inappropriate administration of anticoagulant agents or platelet. This is a case report of a 69-year-old male patient with early misdiagnosis and analysis of type A aortic dissection with discussion on the causes of misdiagnosis in light of the literature.

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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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