Does profound hypothermic circulatory arrest improve survival in patients with acute type A aortic dissection?

Lai, David; Robbins, Robert C.; Mitchell, R. Scott; Moore, Kathleen A.; Oyer, Philip E.; Shumway, Norman E.; Reitz, Bruce A.; Miller, D. Craig

doi:10.1016/s1062-1458(02)01066-8

Cited by 53 publications

(66 citation statements)

References 30 publications

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“…43 Operative mortality for ascending aortic dissections at experienced centers with large surgical series varies widely between 15% and 35%, still below the 50% mortality with medical therapy. 12,59,[75][76][77][78] Adjunctive measures such as profound hypothermic circulatory arrest and selective retrograde perfusion of the head vessels have been used in the surgical management of arch repair of an open distal anastomosis with good outcomes. 46 The use of both hypothermic circulatory arrest and retrograde perfusion has yielded survival rates at 3 and 5 years of 75Ϯ5% and 73Ϯ6%.…”

Section: Definitive Therapy Ascending (Type A) Aortic Dissectionmentioning

confidence: 99%

“…[75][76][77][78][79][80][81] The long-term approach to these patients begins with an understanding that dissection of the aorta represents a systemic problem with the aortic media and the milieu in which it is bathed. Thus, the entire aorta and its branches are predisposed to dissection, aneurysm formation, and/or aortic rupture in the future.…”

Section: Long-term Follow-upmentioning

confidence: 99%

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Acute Aortic Syndromes

2005

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Section: Definitive Therapy Ascending (Type A) Aortic Dissectionmentioning

confidence: 99%

Section: Long-term Follow-upmentioning

confidence: 99%

Acute Aortic Syndromes

2005

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“…[1][2][3][4][5][6][7][8][9][10] Far fewer studies have been published on results of examination of the operatively resected portion of the ascending aorta. [11][12][13][14][15][16][17][18][19][20][21] The present report focuses on aortic medial elastic-fiber structure in 69 patients having portions of the ascending aorta operatively resected because of acute dissection involving the ascending aorta with or without involvement of other portions of the aorta.…”

mentioning

confidence: 99%

Aortic Medial Elastic Fiber Loss in Acute Ascending Aortic Dissection

Roberts

Vowels

Kitchens

et al. 2011

The American Journal of Cardiology

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The cause of acute aortic dissection continues to be debated. One school of thought suggests that underlying aortic medial cystic necrosis is the common denominator. The purpose of the present study was to determine if there was loss and, if so, how much loss of medial elastic fibers in the ascending aorta in patients with acute aortic dissection with the entrance tear in the ascending aorta. We examined operatively excised ascending aortas in 69 patients having acute dissection with tears in the ascending aorta. Patients with previous aortotomy, healed dissection, and connective tissue disorders were excluded. The 69 patients' ages ranged from 31 to 88 years (mean 56); 49 were men and 20 were women. Loss of aortic medial elastic fibers was graded as 0 (no loss), 1؉ (trace), 2؉ (mild), 3؉ (moderate), and 4؉ (full thickness loss). Of these 69 patients, 56 (82%) had 0 or 1؉ elastic fiber loss; 13 patients (18%), 2؉ to 4؉ loss including 4 with 2؉, 6 with 3؉, and 2 with 4؉. Nearly all patients (97%) had a history of systemic hypertension and/or had received antihypertensive drug therapy. In conclusion, most patients (82% in this study) having acute aortic dissection with entrance tears in the ascending aorta have normal numbers or only trace loss of aortic medial elastic fibers. Thus, underlying abnormal ascending aortic structure uncommonly precedes acute dissection.

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“…Previous studies have reported survival rates between 52% and 94% at 1 year and between 45% and 88% at 5 years. [1][2][3][4][5] However, most of these studies were single-center experiences and often included type A and type B dissections, as well as patients presenting with acute and chronic dissections. Further, most had enrollment periods spanning decades.…”

mentioning

confidence: 99%