Outcomes After Surgical Treatment for Type A Acute Aortic Dissection in Octogenarians: A Multicenter Study

Piccardo, Alessandro; Regesta, Tommaso; Zannis, Konstantinos; Gariboldi, Vlad; Pansini, Stefano; Tapia, Michel; Concistrè, Giovanni; Collart, Frédéric; Kreitmann, P; Kirsch, Matthias; Martinelli, Luigi; Passerone, Giancarlo; Caus, Thierry

doi:10.1016/j.athoracsur.2009.04.096

Cited by 68 publications

(54 citation statements)

References 18 publications

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“…On the other hand, 14.5% of patients older than 80 years underwent surgery or endovascular treatment because they did not present additional risk factors. The results in these selected patients were acceptable [28] and surgical treatment should not be denied.…”

Section: Discussionmentioning

confidence: 91%

Acute aortic dissection: Epidemiology and outcomes

Pacini

Marco

Fortuna

et al. 2013

International Journal of Cardiology

130

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Section: Discussionmentioning

confidence: 91%

Acute aortic dissection: Epidemiology and outcomes

Pacini

Marco

Fortuna

et al. 2013

International Journal of Cardiology

130

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“…Third, the initial conception of preventing distal enlargement beyond the stented segment of the descending aorta has not been confirmed and, even if false-lumen thromboexclusion around the stent graft is achieved, this could not prevent distal re-operations during follow-up, as for example, residual distal patent false lumen favors aortic enlargement [56][57][58][59]. Moreover, the extensive use of more aggressive surgical procedures, such as total arch replacement with or without an ET or FET extension to the descending aorta in acute aortic dissection, has been recently questioned by some authors [97,98], who perform a more conservative surgery, by replacing the ascending aorta with or without the hemiarch, as in some patients, especially the older ones, aortic growth rates related to false-lumen patency seem to be slower, probably due to the presence of a stiffer and less elastic aortic adventitia [99].…”

Section: Discussionmentioning

confidence: 95%

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Ius¹,

Hagl²,

Haverich³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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The treatment of complex aortic pathology involving both the ascending and descending aortic segments at the same time represents a surgical challenge, with high postoperative morbidity and mortality rates reported. Over the past 27 years, different open surgical and endovascular techniques have been introduced and applied in various two-stage- or one-stage approaches to such cases. Thus, in 1983, Hans Borst significantly changed the traditional two-stage approach by introducing his elephant trunk technique. Leaving a segment of Dacron prosthesis reaching into the descending aorta during the first stage, the second-stage replacement of the residual dilated descending aorta was made far easier. The presence of interval mortality between the two stages, the unaffected need for two large operations to complete aortic repair, and the general failure of some patients to return for the second-stage repair set the scene for the development of one-stage procedures, both open surgical or hybrid surgical and endovascular, such as the frozen elephant trunk. However, the size of the operation, on the one hand, and the risk of spinal cord injury and need for surgical or endovascular completion during follow-up, on the other, have dampened enthusiasm. Recently, the introduction of supra-aortic debranching and endovascular aortic arch stent-graft repair has yet extended treatment to high-risk patients unsuitable to the more aggressive surgery, but mid- and long-term follow-up results are lacking. The lack of randomization and the presence of procedural and complication-related limitations for each technique do not allow for definitive conclusions about the ideal procedure to treat complex aortic pathology. However, the technical revolution experienced over the past 27 years, along with the improvement in perioperative management, has produced outstanding morbidity and mortality results even in this challenging patient population, but the decision regarding which pathology correlates with what operation remains highly debated and dependent also on regional competence.

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“…4 However, octogenarians and patients with previous cardiac surgery have higher mortality and morbidity when treated with open repair and therefore are often turned down for surgery and left to medical treatment alone. 1 with previous cardiac surgery. Endovascular treatment may provide a less invasive treatment option in these high-risk patients.…”

Section: Discussionmentioning

confidence: 97%