Combined Surgical Treatment in Aortic Type A Dissection (original) (raw)
Combined interventional and surgical treatment for acute aortic type a dissection
International Journal of Surgery, 2008
Background: Surgical repair and endovascular stent-graft placement are both therapies for thoracic aortic dissection. A combination of these two approaches may be effective in patients with type A dissection. In this study, we evaluated the prognosis of this combined technique. Methods: From December 2003 to December 2006, 15 patients with type A dissection were admitted to our institute; clinical data were retrospectively reviewed. Follow-up was performed at discharge and approximately 12 months after operation. Results: Endovascular stent-graft placement by interventional radiology and surgical repair for reconstruction of aortic arch was performed in all patients. Total arch replacement for distal arch aneurysm was carried out under deep hypothermia with circulatory arrest; antegrade-selected cerebral perfusion was used for brain protection. Four patients concomitantly received a coronary artery bypass graft. Hospital mortality rate was 6.7%; the patient died of cerebral infarction. Neural complications developed in two patients. Multi-detector-row computed tomography scans performed before discharge revealed complete thrombosis of the false lumen in six patients and partial thrombosis in eight patients. At the follow-up examination, complete thrombosis was found in another three patients, aortic rupture, endoleaks or migration of the stent-graft was not observed and injuries of peripheral organs or anastomotic endoleaks did not occur. Conclusions: For patients with aortic type A dissection, combining intervention and surgical procedures is feasible, and complete or at least partial thrombosis of the false lumen in the descending aorta can be achieved. This combined approach simplified the surgical procedures and shortened the circulatory arrest time, minimizing the necessity for further aortic operation.
Journal of Thoracic and Cardiovascular Surgery, 2004
T he criterion standard treatment for acute Stanford type A aortic dissection is emergency surgical intervention. Stent-graft placement has emerged as an alternative treatment for various descending aortic pathologic conditions, including complicated type B dissections, aortic rupture, giant penetrating ulcers, aneurysms, and stent-graft coverage of the primary intimal tear. 1,2 A combined surgical and endovascular approach for acute ascending aortic dissection has been reported. We report on percutaneous stent-graft placement in the ascending aorta as a primary and sole treatment for acute Stanford type A dissection.
Combined Surgical and Endovascular Treatment of Acute Aortic Dissection Type A
The Annals of Thoracic Surgery, 2002
Methods. From April 2001 to February 2002, 8 consecutive patients (3 women [37.5%] and 5 men [62.5%]) with a mean age of 55.7 years (range, 45 to 70 years) were intended to be treated with the combined method of surgical repair of the ascending aorta and transluminal stent ...
International journal of cardiology, 2018
Type A acute aortic dissection represents one of the most complex and life-threatening disorders of the cardiovascular system. Cardiac tamponade caused by ascending aorta rupture is the most common cause of death. In light of this, emergent surgery with ascending and partial arch replacement represents, in most of cases, the best and the faster therapeutic option. The natural history of aortic dissection, however, teaches us that in most cases there is a distal progression of the aortic disease that often requires further surgical and/or endovascular treatments. In light of this, it can be hypothesized that, by increasing the extent of aortic replacement during the first operation, it may improve the outcome of these patients by reducing the probability of a second surgery or, in selected cases and for appropriate indications, by treating with a single surgical step, the disease. In this short review of the literature, we focalized on the rationale and outcome of an extensive repair...
Current and Future Management Strategies of Type A Aortic Dissection
Aortic Valve Disease [Working Title], 2020
Type A Aortic dissection is a life-threatening emergency. It has varied clinical presentation from acute severe chest pain radiating to the back, collapse due to aortic rupture or pericardial tamponade or features of myocardial infarction, end organ or limb ischemia. The outcome is determined by the extent of the dissection, timing of presentation, comorbid factors, prompt diagnosis, adequate cerebral protection strategies, and skilled post-operative intensive care. Good immediate and mid-term results have been obtained with standard surgical techniques of aortic root, ascending aorta +/− hemi arch replacement. Endovascular techniques can be used as a hybrid procedure to provide more durable long term results.
Acute type A aortic dissection - a case beyond the guidelines
Srpski arhiv za celokupno lekarstvo, 2020
Introduction. There are not many cases among acute type-A aortic dissection survivors who get to be called ?incredible.? Here we present such a case followed-up for more than five years. Case outline. A 48-year-old male with acute type A aortic dissection, complicated with cardiac tamponade and severe aortic valve regurgitation, was submitted to emergent surgical treatment. Distal reconstruction was performed by complete aortic arch replacement with ?elephant trunk? extension and separate arch branch bypasses, while the proximal reconstruction was done with Bentall procedure. Total of 11 anastomoses was necessary to complete this procedure. Straight profound hypothermic (18o C) circulatory arrest, with a saturation of the venous blood from the jugular bulb of 97%, lasted 133 minutes. The patient was discharged stable without any neuro-cognitive deficit. Two years later, he was admitted with late prosthetic valve endocarditis and subvalvular abscess. Good response on treatment with e...
Chronic Type A aortic dissection: Two cases and a review of current management strategies
Aorta, 2016
Stanford Type A aortic dissection is a rapidly progressing disease process that is often fatal without emergent surgical repair. A small proportion of Type A dissections go undiagnosed in the acute phase and are found upon delayed presentation of symptoms or incidentally. These chronic lesions may have a distinct natural history that may have a better prognosis and could potentially be managed differently then those presenting acutely. The method of repair depends on location and extent of the false lumen, as well as involvement of critical structures and branch arteries. Surgical repair techniques similar to those employed for acute dissection management are currently first-line therapy for chronic cases that involve the aortic valve, sinuses of Valsalva, coronary arteries, and supra-aortic branch arteries. In patients with high-risk for surgery, endovascular repairs have been successful, and active development of delivery systems and grafts will continue to enhance outcomes. We present two cases of chronic Type A aortic dissection and review the current literature.
The future of stenting in patients with type A aortic dissection: a systematic review
Journal of International Medical Research, 2019
Acute type A aortic dissection (ATAAD) carries high morbidity and mortality rates and is a clinical emergency. The reported mortality rate is 50% to 65% within the first 48 hours without surgical intervention. Open surgery therefore remains the gold standard management for ATAAD. However, in patients who are deemed unfit for surgery and where possible, endovascular repair offers a useful alternative to medical treatment alone or high-risk open surgical repair. Several case reports, case series, and retrospective studies have reported good outcomes following endovascular treatment. The endovascular option also has comparable early and late outcomes, favourable aortic remodelling, and satisfactory overall survival despite having a higherrisk patient cohort. However, stenting in patients with ATAAD undoubtedly still has several limitations and technical challenges.