scholarly journals Outcomes of surgical treatment of Stanford type of aortic dissection at Hanoi Heart Hospital in the period 2015-2020

2022 ◽  
Vol 35 ◽  
pp. 138-149
Author(s):  
Nguyen Thai Minh ◽  
Le Quang Thien ◽  
Nguyen Sinh Hien ◽  
Nguyen Hoang Ha ◽  
Nguyen Dang Hung ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Survival Rate ◽  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Early Mortality ◽  
Type A Aortic Dissection ◽  
The Mean ◽  
Heart Hospital

Background: Stanford type A aortic dissection is a complex disease and a serious surgical emergency. The diagnosis is determined based on diagnostic imagines. Surgery is the mainstay of treatment, with high mortality and morbidity. This study aimed to comment on clinical and paraclinical characteristics and evaluate the results of surgical treatment of type A aortic dissection at Hanoi Heart Hospital within 5 years from 2015 to 2020. Methods: Retrospective and descriptive study of patients diagnosed with type A aortic dissection who were surgically treated at Hanoi Heart Hospital from January 2015 to May 2020. Results: 109 cases were included in the study with the mean age of 56.0 ± 14.4; 50 - 60 age accounted for the highest percentage (30.3%); men accounted for 67.9%. Classic type A aortic dissection in 95 cases (87.2%). Chest pain was the main clinical symptom (91.7%); 4.6% came to the hospital in a state of cardiogenic shock and circulatory arrest. The rate of Marfan phenotype was 13.8%. The most common surgery is replacing the ascending aorta (45.9%); total replacement of the aortic arch accounted for 17.4%; Total root replacement and aortic arch accounted for 3.7%. The average aortic pairing time was 120.7 ± 41.0 minutes, the mean running time was 179.7 ± 57.0 minutes. Re-operative bleeding accounted for 6,4%; cerebrovascular accident accounted for 2,8%. The early mortality rate after surgery was 9.2%. The mean follow-up time was 24.93 ± 16.13 months, the mean survival time was 52.0 ± 1.9 months, the survival rate was 88.1% after 1 year and 85.3% after 5 years. Conclusion: Early mortality, postoperative complications and survival rate after follow-up were positive with surgical technique and conditions of anesthesia and resuscitation at Hanoi Heart Hospital.

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.

scholarly journals Reinforced Aortic Root Reconstruction in Type A Aortic Dissection: A Prospective Study

2021 ◽  
Vol 24 (5) ◽  
pp. E828-E832
Author(s):  
Ahmed Elsharkawy ◽  
Ashraf El Midany ◽  
Ahmed Elwakeel ◽  
Eman Mahmoud ◽  
Ahmed Mohammed ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Prospective Study ◽  
Coronary Sinus ◽  
Aortic Root ◽  
Type A ◽  
Type A Aortic Dissection ◽  
Early Results ◽  
The Mean ◽  
A Prospective Study

Background: Type A aortic dissection is a challenging surgical emergency associated with high morbidity and mortality. Many techniques have evolved to repair the dissected sinus segments and restore aortic valve dynamics. Herein, we evaluate the early outcome of a novel technique for reconstruction of dissected aortic root. Methods: A prospective study was conducted on 300 patients to evaluate the early results of repair of dissected root in type A aortic dissection. The mean age was 59.65±8.52 years, and 76% of patients were males. All patients had four standard steps for aortic reconstruction: 1) commissural resuspension; 2) right coronary sinus reinforcement with pericardial and Dacron bands; 3) non-coronary sinus reinforcement using external Dacron patch; 4) circumferential inversion of adventitial layer of the root. Patients were followed up clinically, echocardiographically, and by CT scan. Results: The in-hospital mortality was 8%. The mean cross-clamp time was 120±30 minutes, and circulatory arrest time was 25+10 minutes. Twenty-seven patients (9%) experienced postoperative complications, including bleeding and acute kidney injury. During a mean follow-up time of 48±12 months, there were no recurrent aortic dissection, aortic dilatation, pseudoaneurysm, or progression of aortic regurgitation during the entire study period. Conclusions: This reconstructive technique technically is undemanding, feasible, safe, and durable with good early results. A larger cohort of patients with longer period of follow up should generate a more powerful evaluation of this technique.

Abstract 13583: Left Ventricular Remodeling After Type a Aortic Dissection Surgery: a Comparison Between Different Surgical Techniques

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Madelien V Regeer ◽  
Michel I Versteegh ◽  
Robert J Klautz ◽  
Martin J Schalij ◽  
Jeroen J Bax ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Ejection Fraction ◽  
Ventricular Remodeling ◽  
Surgical Techniques ◽  
Type A ◽  
Left Ventricular ◽  
Type A Aortic Dissection ◽  
The Mean ◽  
Lv Volumes

Introduction: Type A aortic dissection (AADA) requires emergency surgery with different options including valve-sparing aortic root replacement (VSRR), supracoronary ascending aorta replacement (SCR) and aortic valve and root replacement (AVRR). Recurrence of aortic regurgitation (AR) and extent of left ventricular (LV) remodeling in patients with AADA was compared between these surgical techniques. Methods: A total of 120 patients (59 ± 12 years, 63% male) with AADA who underwent VSRR (n=22), SCR (n=62) or AVRR (n=36) were included in the present retrospective evaluation. AR grade and LV volumes and ejection fraction were assessed postoperatively (before hospital discharge) and during follow-up. Estimated marginal means ± standard error of the mean were obtained using linear mixed models. Results: Patients who underwent VSRR were significantly younger (49 ± 6 years) and more often male (84%). There were more patients in SCR group with hypertension compared to VSRR and AVRR (67% vs. 27% and 47%; p=0.006). The EuroSCORE II was highest in patients who underwent AVRR. After a median follow up of 53 months, the mean AR grade was 1.2 ± 0.2 in VSRR vs. 1.8 ± 0.2 in SCR vs. 0.2 ± 0.1 in AVRR (p<0.001). LV end-diastolic and end-systolic volumes remained stable in VSRR, while a significant increase was observed in SCR (table). The ejection fraction remained stable in all groups, however, a trend towards improvement was observed in VSRR (p=0.055). Conclusions: Patients with AADA who underwent SCR experienced more AR compared to AVRR resulting in larger LV volumes during follow up. Despite higher AR grade during follow up in patients who underwent VSRR compared to AVRR; there was no deterioration in LV volumes and function after VSRR.

scholarly journals Aortic Aneurysm and Dissection in Pregnancy: Report of a Rare Case in a Marfan with Bicuspid Aortic Valve

2020 ◽  
Vol 5 (04) ◽  
pp. 331-334
Author(s):  
Paolo Masiello ◽  
Rocco Leone ◽  
Rossella Maria Benvenga ◽  
Severino Iesu
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Arch ◽  
Bicuspid Aortic Valve ◽  
Rare Case ◽  
Unplanned Pregnancy ◽  
Type A ◽  
Cardiac Biomarkers ◽  
High Morbidity ◽  
Type A Aortic Dissection

Abstract Background Type A aortic dissection is an emergency with high morbidity and mortality when surgery is not performed. Few cases are described in the literature about aortic dissection during pregnancy. A correlation between pregnancy and aortic dissection is mainly reported in patients with family history and connective tissue disorders, such as Marfan’s syndrome (MS), Loeys–Dietz’s syndrome, and Ehlers–Danlos’s syndromes, and patients with bicuspid aortic valve (BAV); exceptional cases are also described in patients without risk factors. Case presentation A 22-year-old young woman with MS, ascending aorta dilation, and BAV became pregnant. During labor, she experienced a short-term chest pain with spontaneous resolution. The electrocardiogram (ECG) and cardiac biomarkers were negative for acute coronary artery disease, but no transthoracic echocardiogram (TTE) was performed. A caesarean section was performed without complications. After 1 month, a routine TTE showed a chronic ascending aortic dissection involving the aortic arch and supra-aortic vessels. Due to a normally functioning aortic valve, the David operation was performed (sparing aortic valve) with the replacement of the aortic arch and supra-aortic vessels. Conclusions Aortic dissection is a rare cardiovascular complication that can occur during pregnancy and is associated with very high-risk mortality. We have reported a rare case of undiagnosed type A aortic dissection involving the aortic arch during unplanned pregnancy in patients with BAV and MS, subsequently treated with the David surgery and replacement of ascending aortic arch and supra-aortic vessels. A closer clinical and instrumental follow-up is necessary in this particular group of patients at risk. Awareness of all physicians involved is mandatory.

scholarly journals Enlargement of aortic arch vessels after surgical repair of type A aortic dissection

2017 ◽  
Vol 65 (3) ◽  
pp. 669-675 ◽  
Author(s):  
Takashi Yamauchi ◽  
Suguru Kubota ◽  
Toshihiro Ohata ◽  
Kosei Hasegawa ◽  
Hideki Ueda
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Surgical Repair ◽  
Type A ◽  
Type A Aortic Dissection

Extended and Total Aortic Resection in the Surgical Treatment of Acute Type A Aortic Dissection: Experience with 54 Patients

1988 ◽  
Vol 46 (4) ◽  
pp. 420-424 ◽  
Author(s):  
Carlo G. Massimo ◽  
Luigi F. Presenti ◽  
Piezluigi Marranci ◽  
Piero P. Favi ◽  
Alberto G. Poma ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

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

Aorta ◽  
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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