Risk of late reoperations in patients with acute type A aortic dissection: impact of a more radical surgical approach

Pugliese, Peppino; Pessotto, Renzo; Santini, Francesco; Montalbano, Giuseppe; Luciani, Giovanni Battista; Mazzucco, Alessandro

doi:10.1016/s1010-7940(98)00065-7

Cited by 68 publications

(41 citation statements)

References 17 publications

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“…Although there have been many reports on favorable results of total arch replacement with or without elephant trunk procedure [14,18,[54][55][56], it is still controversial [57][58][59]. Rampoldi et al demonstrated in their large multi-center analysis involving 682 patients with acute type A aortic dissection that the partial arch replacement was associated with reduced mortality [57].…”

Section: Resultsmentioning

confidence: 99%

Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch?☆

Kretzler

Kamiya

2008

European Journal of Cardio-Thoracic Surgery

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Patients with extensive aortic aneurysms involving the ascending aorta, aortic arch, and the descending aorta are still considered to be a challenge for many cardiovascular surgeons. The introduction of the elephant trunk technique by Borst et al. in 1983 has greatly facilitated surgery on this kind of pathology and this technique has been recognized as a standard modality for treatment of extended aortic aneurysms. As a next step, the frozen elephant trunk technique has been introduced in some institutes in the late 1990s. With this technique, surgery is performed through a median sternotomy, and an endovascular stent-graft is placed into the descending aorta in an antegrade fashion through the opened aortic arch. Then the ascending aorta and the aortic arch are replaced conventionally. The frozen elephant trunk technique enables one-stage repair of extended aortic aneurysms in a certain patient cohort with similar operative mortality as with the conventional elephant trunk technique, in which a second-stage operation is a prerequisite. Although the surgical strategy should be adjusted specifically to each patient's individual pathology, the frozen elephant trunk technique may become the next standard treatment for extended aortic aneurysm instead of its conventional variant.

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Section: Resultsmentioning

confidence: 99%

Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch?☆

Kretzler

Kamiya

2008

European Journal of Cardio-Thoracic Surgery

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“…A closed technique results in nearuniform PFL persistence in DeBakey I dissections (257,272). Because it facilitated more complete repair and hypothetically reduced PFL risk, ODA became both popular (277) and the accepted surgical norm (14,278). An ODA allows a more accurate approximation of the dissected layers and a direct visual inspection for further arch tears (279).…”

Section: Surgical Management Of the Distal Aortamentioning

confidence: 99%

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Bonser

Ranasinghe

Loubani

et al. 2011

Journal of the American College of Cardiology

216

175

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Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.

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“…Zero percent to 14% hospital mortality and 8% to 21% long-term mortality have been reported in other series [22][23][24][25], but these series had very small patient cohorts (n ¼ 24, 21, 19, and 17) and even smaller numbers of patients who underwent procedures involving replacement of the entire arch. Of interest, in our series, full arch replacement versus hemiarch replacement was not significantly associated with either operative or long-term mortality (p ¼ 0.54 and 0.28, respectively).…”

Section: Commentmentioning

confidence: 84%

Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection

Preventza

Price

Simpson

et al. 2015

The Annals of Thoracic Surgery

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Risk of late reoperations in patients with acute type A aortic dissection: impact of a more radical surgical approach

Cited by 68 publications

References 17 publications

Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch?☆

Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch?☆

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection

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