Acute type A aortic dissection: long-term results and reoperations

Bekkers, Jos A.; Raap, Goris Bol; Takkenberg, Johanna J.M.; Bogers, Ad J.J.C.

doi:10.1093/ejcts/ezs342

Cited by 86 publications

(96 citation statements)

References 24 publications

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“…It should also be acknowledged that the small sample size of our single-institution experience limits the utility of statistical comparisons of mortality rates and volume trends between time intervals. Nonetheless, we consider a 30-day/in-hospital ATAAD repair operative mortality rate of 10% or less to be the current benchmark number for high-volume aortic centers and the general target number for our program (27,(34)(35)(36)(37).…”

Section: Discussionmentioning

confidence: 99%

The utility of the aortic dissection team: outcomes and insights after a decade of experience

Andersen¹,

Benrashid²,

Ross³

et al. 2016

Ann. Cardiothorac. Surg.

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Background: Mortality rates following acute type A aortic dissection (ATAAD) repair are reduced when operations are performed by a high-volume acute aortic dissection (AAD) team, leading to efforts to centralize ATAAD care. Here, we describe our experience with ATAAD repair by our AAD team over the last 10 years, with a focus on patient selection, transfer protocols, operative approach, and volume trends over time.Methods: An AAD team was implemented at our institution in 2005, with dedicated high-volume AAD surgeons, a multidisciplinary approach to thoracic aortic disease management, and a standardized protocol for ATAAD repair. Further process improvements were made in 2013 to facilitate the rapid transfer of ATAAD patients to our institution using stream-lined triage, diagnostic, and transfer protocols for patients with suspected ATAAD (RACE-AD protocol). Volume trends and outcomes were assessed longitudinally over this period. in-hospital mortality rates of less than 10% were maintained over the study period.Conclusions: Centralization of ATAAD care has begun to occur at our center, with maintenance of low mortality rates for ATAAD repair. These data confirm a net positive impact on regional ATAAD outcomes through transfer of patients to a high-volume center with dedicated AAD surgeons.

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Section: Discussionmentioning

confidence: 99%

The utility of the aortic dissection team: outcomes and insights after a decade of experience

Andersen¹,

Benrashid²,

Ross³

et al. 2016

Ann. Cardiothorac. Surg.

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“…Moreover, most centers have added selective antegrade cerebral perfusion (9,12,(18)(19)(20)(21)(22)(23)(24)(25)(26) to their procedure to avoid stroke due to the longer open distal time compared to the conventional arch repair. Thus, hybrid procedures may be performed with acceptable risk of stroke when proper cerebral protection is provided in a selected patient group.…”

Section: Strokementioning

confidence: 99%

“…Due to increased experience with this lethal disease (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), reports on the fate of residual dissection have been published after the late 2000s ( Table 1). Risk factors for distal reoperation have been identified as non-resected intimal tear, Marfan's syndrome, younger age, high blood pressure during follow up, large aortic size at the initial presentation and large false lumen.…”

Section: Introductionmentioning

confidence: 99%

Descending endografts for type A dissections: con

Tanaka¹,

Sandhu²,

Estrera³

2016

Ann. Cardiothorac. Surg.

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An important goal of surgical repair of type A aortic dissection is to resect the intimal tear. Studies on the fate of residual dissection after acute type A aortic dissection repair in the past decade have driven surgeons to seek procedures to avoid distal reoperation. Aggressive surgical approach with total arch replacement in acute type A dissection has demonstrated lower incidence of distal reoperation and slower aortic growth rate compared to less aggressive ascending/hemiarch repair. Recently, successful results of thoracic endovascular aortic repair (TEVAR) in type B aortic dissection have encouraged surgeons to further attack acute type A aortic dissection with hybrid approach: antegrade endografting in the descending thoracic true lumen as an adjunct to hemiarch or total arch repair. However, is the hybrid approach with simultaneous descending endografting justified in all the acute type A aortic dissection cases? The outcomes of the hybrid approach reported by the several groups have demonstrated 80-100% of false lumen thrombus formation in the proximal descending aorta (stented segment); however, the complete obliteration of the false lumen is only 17-50%. The incidence of distal reoperation/reintervention after hybrid approach is as high as 14% and an adjunctive procedure is often performed. Moreover, there are concerns about additional risks associated with the hybrid procedures, such as spinal cord injury (SCI), stent graft induced new entry and stroke. The data on this new approach are still very limited. Hence, further study is warranted to prove its safety and durability.

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“…Отдаленная выживаемость пациентов с острым рас-слоением Ао типа А по классификации Stanford после экстренной операции варьирует в пределах 60-84% в те-чение 1 года, а также 45-72 и 37-56% в течение 5 и 10 лет соответственно [3,4,6]. Причиной, по которой пациент, перенесший операцию по поводу острого расслоения ВА, появляется в поле зрения хирурга, является прогрессиро-вание дилатации Ао в различных сегментах и, как след-ствие, появление аортальной регургитации, развитие сер-дечной недостаточности, а также риск разрыва или рас-слоения, что обусловливает высокую частоту летальных исходов среди наблюдаемых пациентов [2,4,6].…”

Section: Discussionunclassified

“…Хирургическое лечение в большинстве случаев является единственным способом сохранения жизни пациента с относительно вы-сокой госпитальной летальностью от 12 до 30% [1][2][3][4]6]. Главной целью операции является предотвращение раз-рыва аорты (Ао) и, как следствие, тампонады сердца, вос-становление адекватного кровотока при развитии син-дрома мальперфузии, коррекция недостаточности аор-тального клапана (АК).…”

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