Aortic Enlargement and Late Reoperation After Repair of Acute Type A Aortic Dissection

Zierer, Andreas; Voeller, Rochus K.; Hill, Karen E.; Kouchoukos, Nicholas T.; Damiano, Ralph J.; Moon, Marc R.

doi:10.1016/j.athoracsur.2007.03.084

Cited by 248 publications

(227 citation statements)

References 40 publications

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“…В 2008г группа авторов из г. Лейпциг описала 15 случаев повторных вмешательств на ТаАо у пациентов с синдромом Мар-фана в период от двух месяцев до 10 лет после первич-ной операции [9]. Единственным достоверным фак-тором риска дистальных вмешательств было опреде-лено расслоение аорты типа А. Zierer, et al опубликовал работу [10], посвященную росту ТаАо после хирургического лечения острого проксималь-ного расслоения аорты, в которой была прослежена достоверная связь между данной патологией и фор-мированием аневризм в средне-и долгосрочном периодах. Среди 201 отслеженного пациента присут-ствовали 10 с подтвержденным синдромом Марфана.…”

Section: Discussionunclassified

The Condition of Distal Aorta After Proximal Reconstruction for Dissection in Marfan Syndrome

Чернявский¹,

Ляшенко²,

Сирота³

et al. 2016

Russ J Cardiol

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Marfan syndrome is a disease associated with high prevalence of aorta-related morbidity and mortality. Dissections and ruptures of thoracal aorta (ThAo) lead to decreased life duration in persons with Marfan syndrome with mediana at 30 year-old. Aim. To study the changes of distal aorta and clinical outcomes after surgical treatment for proximal aorta dissection in Marfan syndrome. Material and methods. In the SRICP, among patients operated for proximal aorta dissection, 14 were selected, who had histologically proven Marfan syndrome. They were followed-up. Results. In the long-term follow-up after the intervention on thoracoabdominal aorta (TAAo) was required in 2 patients. Reasons for transforming of the distal aorta were the age of the disease onset (p=0,04), acute stage of dissection (p=0,02). Changes in TAAo developed during first months after primary intervention, as in several years. Conclusion.Surgery for proximal dissections in Marfan syndrome patients is related to acceptable levels of morbidity and mortality in early and post-operation periods. Regular follow-up is required of such patients in post-operation period for on-time diagnostics and performing of secondary interventions.Russ J Cardiol 2016, 11 (139): 7-11 http://dx

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Section: Discussionunclassified

The Condition of Distal Aorta After Proximal Reconstruction for Dissection in Marfan Syndrome

Чернявский¹,

Ляшенко²,

Сирота³

et al. 2016

Russ J Cardiol

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“…They reported a growth rate of the descending aorta of 3.7 mm/year in patients with a patent false lumen, a rate that was significantly higher than in patients without patent false lumen (only 1.1 mm/year) (6). Zierer demonstrated that the expansion of the aorta was most common and more rapid at the level of the descending segment, and identified three independent predictors for aortic dilatation: aortic diameter, elevated systolic blood pressure at late follow-up and a patent false lumen (7). Another study by Park et al (8) evaluated the postoperative computed tomography (CT) images of 122 patients who underwent aortic repair for AAAD.…”

Section: Indications For Aortic Arch Replacementmentioning

confidence: 99%

When and how to replace the aortic arch for type A dissection

Bartolomeo

Leone

Marco

et al. 2016

Ann. Cardiothorac. Surg.

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Acute type A aortic dissection (AAAD) remains one of the most challenging diseases in cardiothoracic surgery and despite numerous innovations in medical and surgical management, early mortality remains high.The standard treatment of AAAD requires emergency surgery of the proximal aorta, preventing rupture and consequent cardiac tamponade. Resection of the primary intimal tear and repair of the aortic root and aortic valve are well-established surgical principles. However, the dissection in the aortic arch and descending untreated aorta remains. This injury is associated with the risk of subsequent false lumen dilatation potentially progressing to rupture, true lumen compression and distal malperfusion. Additionally, the dilatation of the aortic arch, the presence of a tear and retrograde dissection can all be considered indication for a total arch replacement in AAAD. In such cases a more aggressive strategy may be used, from the classic aortic arch operation to a single stage frozen elephant trunk (FET) technique or a two-stage approach such as the classical elephant trunk (ET) or the recent Lupiae technique. Although these are all feasible solutions, they are also complex and time demanding techniques requiring experience and expertise, with an in the length of cardiopulmonary bypass and both myocardial and visceral ischemia. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. Moreover, a correct assessment of the anatomy of the dissection, through the preoperative angio CT scan, in addition to the clinical condition of the patients, remain the decision points for the best arch repair strategy to use in AAAD.

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“…26 Song et al found the initial false lumen diameter at the upper thoracic aortic to be the most powerful independent predictor of late aneurismal change in patients with type A or type B dissections. 24 A large false lumen probably reflects high false lumen pressure, which may play a critical role in dilating the false lumen itself and generating an aortic aneurysm.…”

Section: Aortic Dissectionmentioning

confidence: 99%

“…Moreover, the importance of rigorous antihypertensive medical treatment, aiming at a systolic blood pressure less than 120 mmHg, has been stressed by several experts. 26 Beta-blocker therapy may be protective, independent of its effects on blood pressure, by reducing the impulse of left ventricular ejection. 29,30 There are indicators that losartan, an angiotensin II type 1 receptor antagonist and a drug widely used to treat arterial hypertension in humans, offers the first potential for primary prevention of clinical manifestations in Marfan syndrome.…”

Section: Medical Treatmentmentioning

confidence: 99%

The distal aorta in the Marfan syndrome

Mulder

2008

NHJL

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Prolonged survival of patients with Marfan syndrome after aortic root replacement has led to an increased number of patients with aortic complications beyond the root. Elective replacement of the aortic root removes the most important predilection site for aneurysms, but the distal aorta remains at risk. Predictors for aortic growth and adverse events in the distal aorta include aortic diameter, aortic distensiblity, previous aortic root replacement, hypertension and aortic regurgitation. After aortic dissection, the initial false lumen diameter is an independent predictor for late aneurysm formation.

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Aortic Enlargement and Late Reoperation After Repair of Acute Type A Aortic Dissection

Cited by 248 publications

References 40 publications

The Condition of Distal Aorta After Proximal Reconstruction for Dissection in Marfan Syndrome

The Condition of Distal Aorta After Proximal Reconstruction for Dissection in Marfan Syndrome

When and how to replace the aortic arch for type A dissection

The distal aorta in the Marfan syndrome

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