Aortic Remodeling Following Sun’s Procedure for Acute Type A Aortic Dissection

Luo, Jiawen; Fu, Xian‐ming; Tang, Hao; Song, Guo-Bao; Tang, Tao; Liao, Xiao‐Bo; Zhou, Xin

doi:10.12659/msm.900345

Cited by 10 publications

(5 citation statements)

References 30 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Follow-up CT scans showed good anastomotic patency (Figure 3). Thrombosis and remodeling of the false lumen in the distal aorta were similar to those in other's report (29).…”

Section: Discussionsupporting

confidence: 87%

“Aorta-clamp” technique for surgical repair of acute type A aortic dissection—5 min circulatory arrest at 30 °C

Peng

et al. 2019

J. Thorac. Dis.

View full text Add to dashboard Cite

Background: Deep hypothermic circulatory arrest (HCA), which causes perioperative complications, is the foundation of surgical treatment for acute type A aortic dissection (AAAD). To extensively replace the dissected aorta and avoid the negative impacts of HCA, we developed an "aorta-clamp" technique and examined its efficacy in repairing AAAD.Methods: From November 2014 to August 2016, we recruited 59 consecutive patients (51.3±10.9 years) with AAAD into this study. We performed total arch replacement combined with an elephant trunk implantation using the "aorta-clamp" technique under a 30 ℃ HCA with continual bilateral antegrade cerebral perfusion. Results:The average HCA time was 4.9±1.0 min. Twenty-three patients had increased serum creatinine (sCr) before surgery, suggesting an AAAD-associated acute kidney injury (AKI). The sCr level returned to normal in five patients after operation and in 15 before discharge. Six patients (10.2%) with preoperative AKI required postoperative dialysis, and two of these patients (3.4%) died of multiple organ failure. Two patients (3.4%) required re-exploration due to bleeding. One patient (1.7%) exhibited temporary neurologic deficits. There were no late deaths. Computed tomography (CT) examination confirmed the patency of the anastomotic sites and thrombus obliteration of the residual false lumen.Conclusions: Using the "aorta-clamp" technique with continual bilateral antegrade cerebral perfusion, total arch replacement combined with an elephant trunk implantation can be performed under five minutes of mild (30 ℃) HCA. Our data suggest that this technique for the surgical repair of AAAD is a safe, feasible and effective surgical approach with satisfactory early outcomes.

show abstract

“…Follow-up CT scans showed good anastomotic patency (Figure 3). Thrombosis and remodeling of the false lumen in the distal aorta were similar to those in other's report (29).…”

Section: Discussionsupporting

confidence: 87%

“Aorta-clamp” technique for surgical repair of acute type A aortic dissection—5 min circulatory arrest at 30 °C

Peng

et al. 2019

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…When compared with similar literature, the Teflon group had similar mortality rate, shorter hospital length of stay, and similar or slightly higher stroke and MOF rates. When compared with the literature, the operative time was shorter in both groups [3][4][5].…”

Section: Discussionmentioning

confidence: 67%

“…Despite all improvements, the mortality rate in conventional surgery of aortic dissection ranges from 10% to 27%. Today, open surgery continues its importance for treatment with acceptable results [4].…”

mentioning

confidence: 99%

Comparison of the results of Teflon felt and Dacron strip usage in Stanford type A dissection

Demir

Kahraman

2019

The European Research Journal

View full text Add to dashboard Cite

Objectives: In patients who undergo surgery for aortic dissection, the anastomotic leakage and the bleeding in these regions affect surgical success and mortality rate significantly. Various surgical materials are used for this purpose. We examined the results obtained from patients in whom Teflon felt strip or Dacron strip was used for creating a more secure anastomotic suture line. Methods: Twenty-eight patients who underwent surgery for ascending aortic dissection between 2013 and 2017 were examined retrospectively. Teflon felt strip or Dacron strip was used to create a more secure anastomotic suture line and to reduce bleeding in these patients. The patients were divided into the Teflon and Dacron groups according to the materials used. The amount of drainage, the amount of tissue adhesive used, the number of red blood cell (RBC) transfusions, and the morbidity and mortality rates were mainly compared between the two groups. Results: While Teflon felt strip was used in 13 (46%) patients, Dacron strip was used in 15 (53%) patients. The mean amount of drainage in the first 24 hours postoperatively was 596.15 ± 165.15 ml in the Teflon group and 546.67 ± 217.5 ml in the Dacron group. There was no statistically significant difference between the two groups in terms of mean amount of drainage (p = 0.509). Similarly, the mean number of RBC transfusions was 2.54 ± 0.51 units in the Teflon group and 2.33 ± 0.81 units in the Dacron group. There was no statistically significant difference between the two groups in terms of mean number of RBC transfusions (p = 0.416). Although the mean amount of tissue adhesive used was relatively higher in the Dacron group, there was no statistically significant difference between the two groups in terms of mean amount of tissue adhesive used (p = 0.761). The total mortality rate was 28% (8 patients). There was no statistically significant difference between the two groups in terms of mortality rate (p = 0.281). Conclusion: We concluded that the results obtained from the Teflon and Dacron groups were not significantly superior to each other. We think that Dacron strip may be used as an alternative to Teflon felt strip, which is used routinely in the surgical treatment of aortic dissection.

show abstract

“…Type A AD affects the ascending aorta with or without distal aorta, whereas type B AD only affects the descending aorta. 1 For patients with type A AD, open surgery which includes replacement of ascending aorta and partial or total aortic arch has considered to be the most effective treatment, 2,3 and the following lifelong clinical and imaging assessment of residual aorta are crucial for the complication detection and further improvement of long-term survival. 4,5 Computed tomography angiography (CTA), which has the characteristics of fast speed, high resolution, and contrast enhancement, 6 is one of the most important imaging assessments used during post-operative follow-ups.…”

Section: Introductionmentioning

confidence: 99%

Automatic segmentation of thrombosed aortic dissection in post‐operative CT‐angiography images

Feng

Wang

et al. 2023

Medical Physics

View full text Add to dashboard Cite

Purpose The thrombus in the false lumen (FL) of aortic dissection (AD) patients is a meaningful indicator to determine aortic remodeling but difficult to measure in clinic. In this study, a novel segmentation strategy based on deep learning was proposed to automatically extract the thrombus in the FL in post‐operative computed tomography angiography (CTA) images of AD patients, which provided an efficient and convenient segmentation method with high accuracy. Methods A two‐step segmentation strategy was proposed. Each step contained a convolutional neural network (CNN) to segment the aorta and the thrombus, respectively. In the first step, a CNN was used to obtain the binary segmentation mask of the whole aorta. In the second step, another CNN was introduced to segment the thrombus. The results of the first step were used as additional input to the second step to highlight the aorta in the complex background. Moreover, skip connection attention refinement (SAR) modules were designed and added in the second step to improve the segmentation accuracy of the thrombus details by efficiently using the low‐level features. Results The proposed method provided accurate thrombus segmentation results (0.903 ± 0.062 in dice score, 0.828 ± 0.092 in Jaccard index, and 2.209 ± 2.945 in 95% Hausdorff distance), which showed improvement compared to the methods without prior information (0.846 ± 0.085 in dice score) and the method without SAR (0.899 ± 0.060 in dice score). Moreover, the proposed method achieved 0.967 ± 0.029 and 0.948 ± 0.041 in dice score of true lumen (TL) and patent FL (PFL) segmentation, respectively, indicating the excellence of the proposed method in the segmentation task of the overall aorta. Conclusions A novel CNN‐based segmentation framework was proposed to automatically obtain thrombus segmentation for thrombosed AD in post‐operative CTA images, which provided a useful tool for further application of thrombus‐related indicators in clinical and research application.

show abstract

Aortic Remodeling Following Sun’s Procedure for Acute Type A Aortic Dissection

Cited by 10 publications

References 30 publications

“Aorta-clamp” technique for surgical repair of acute type A aortic dissection—5 min circulatory arrest at 30 °C

“Aorta-clamp” technique for surgical repair of acute type A aortic dissection—5 min circulatory arrest at 30 °C

Comparison of the results of Teflon felt and Dacron strip usage in Stanford type A dissection

Automatic segmentation of thrombosed aortic dissection in post‐operative CT‐angiography images

Contact Info

Product

Resources

About