Influence of operative strategy for the aortic arch in DeBakey type I aortic dissection: Analysis of the German Registry for Acute Aortic Dissection Type A

Easo, Jerry; Weigang, Ernst; Hölzl, P.; Horst, Michael; Hoffmann, Isabell; Blettner, Maria; Dapunt, O

doi:10.1016/j.jtcvs.2011.07.066

Cited by 142 publications

(126 citation statements)

References 40 publications

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“…For the open distal anastomosis a period of hypothermic circulatory arrest often with the use of neuroprotective strategies like selective cerebral perfusion is needed (7). Survival of AADA patients is strongly dependent on an appropriate operative strategy, but the major influencing factors on mortality still remain uncertain.…”

Section: Introductionmentioning

confidence: 99%

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Klotz¹,

Bucsky²,

Richardt³

et al. 2016

Ann. Cardiothorac. Surg.

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Background: The purpose of this study was to evaluate the single-center experience in initial femoral versus central cannulation of the extracorporeal circulation for acute aortic dissection type A (AADA). Conclusions: AADA can be operated with both femoral and central cannulation with similar results. Risk for early mortality was driven by the preoperative clinical and hemodynamic status before operation rather than the cannulation technique. Methods

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Section: Introductionmentioning

confidence: 99%

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Klotz¹,

Bucsky²,

Richardt³

et al. 2016

Ann. Cardiothorac. Surg.

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“…Patency of the false lumen in the descending aorta remains a major risk factor for adverse long-term outcomes [53]. There is an increasing tendency for more aggressive surgery including antegrade stent deployment in the descending thoracic aorta at the time of open aortic arch repair [54][55][56][57].…”

Section: Surgical Resultsmentioning

confidence: 99%

Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiothoracic Surgeons

Iacona¹

2018

SMOAJ

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An intimal tear propagating within the media either proximally or distally is the primary etiology of aortic dissection. The tear can occurs anywhere in the aorta but more frequently in the ascending portion. The blood will flow predominantly in a new lumen called "false lumen" separated from the true lumen by a thin intimal flap and contained by the aortic adventitia. The false lumen may propagates propagate proximally all the way to the aortic valve and CRIMSONpublishers http://www.crimsonpublishers.com AbstractAcute type A aortic dissection is a catastrophic event in which blood exits the vascular lumen and dissects the media, creating a false lumen. Surgery is the best possible treatment but it is complex. The surgical team needs to understand the anatomy and physiopathology before dealing with the repair. While there are just a few surgical solutions for the repair of the dissected ascending aorta, debate is still ongoing about the best surgical option for the disease involving the arch and the descending aorta. Late reoperations are relatively common on the aortic valve and/or the distal aorta after primary repair. Results are excellent in specialized centers with high volume and complexity. Lifelong follow-up is required in survivors.

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“…Even registry data demonstrated no differences in early mortality in patients who had more extensive aortic replacement (22,23). The German Registry for Acute Aortic Dissection Type A (GERAADA) (23), that represents the largest registry worldwide documenting patients undergoing surgery for AAAD, showed a lower postoperative mortality in those receiving hemiarch replacement compared with total arch replacement (18.7% vs. 25.7%), but the difference was not statistically significant.…”

Section: Indications For Aortic Arch Replacementmentioning

confidence: 97%

“…The German Registry for Acute Aortic Dissection Type A (GERAADA) (23), that represents the largest registry worldwide documenting patients undergoing surgery for AAAD, showed a lower postoperative mortality in those receiving hemiarch replacement compared with total arch replacement (18.7% vs. 25.7%), but the difference was not statistically significant. Similar results have been also reported by the International registry of Acute Aortic Dissection (IRAD), early mortality rate was 22.9%, 20.9%, and 23.7% for patients that underwent ascending aorta replacement, hemiarch replacement, and total arch replacement respectively (24).…”

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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Influence of operative strategy for the aortic arch in DeBakey type I aortic dissection: Analysis of the German Registry for Acute Aortic Dissection Type A

Cited by 142 publications

References 40 publications

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiothoracic Surgeons

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

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