Combined Surgical Treatment in Aortic Type A Dissection (original) (raw)
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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 review
Scandinavian Cardiovascular Journal, 2019
Acute type A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate.
Annals of cardiothoracic surgery, 2016
Acute type A dissection (ATAAD) remains a morbid condition with reported surgical mortality as high as 25%. We describe our surgical approach to ATAAD and discuss the indications for adjunct techniques such as the frozen elephant trunk or complete aortic repair with endovascular methods. Arch replacement using the "branch-first technique" allows for complete root, ascending aorta, and arch replacement. A long landing zone is created for proximal endografting with a covered stent. Balloon-assisted intimal disruption and bare metal stenting of all residual dissected aorta to the level of the aortic bifurcation is then performed to obliterate the false lumen (FL) and achieve single true lumen (TL) flow. Additional branch vessel stenting is performed as required.
Surgical results in acute type A aortic dissection
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 2005
Currently international registry data present the patient mortality with acute type A aortic dissection managed non-surgically to be 58%, and managed surgically to be 26%. Many articles consistently report the hospital mortality exceeding 20% in western countries. Many factors, such as cardiac tamponade and dissection-related organ malperfusion, contribute to hospital mortality and morbidity. In Japan, the number of patients enrolled in the annual reports has been increasing and the surgical results have been improving year by year. In-hospital mortality has decreased to less than 20% since 1999. Since the beginning of our aortic program, a total of 98 patients underwent emergency operations, and the operative mortality and in-hospital mortality were 5.1% and 6.1%, respectively. In a recent series since 2001, the operative and in-hospital mortalities were remarkably low; 2.8% and 3.2% respectively. We were able to benefit greatly by various innovative technologies which include open...