Surgery for acute type A aortic dissection: the Hopital Foch experience (1977–1998)

Bachet, Jean; Goudot, B; Dreyfus, Gilles; Brodaty, D; Dubois, Claude; Delentdecker, Philippe; Guilmet, D

doi:10.1016/s0003-4975(99)00433-6

Cited by 131 publications

(82 citation statements)

References 12 publications

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“…The overall perioperative mortality rate of 15.3% in our study is comparable to other recent studies. 11,12 Five variables were found to be statistically significant risk factors for death in our patient population: Of these, advanced age, hemodynamic instability, and the presence of a contained hematoma at the time of operation are not surprising. Both common sense and results reported by others would lead to the expectation that patients with frank or contained rupture would have a worse outcome than patients who are more stable before surgery, and it is the rare surgical series in which older patients fail to have a higher operative mortality rate.…”

Section: Discussionmentioning

confidence: 77%

Results of Immediate Surgical Treatment of All Acute Type A Dissections

Ehrlich

Ergin²,

McCullough³

et al. 2000

Circulation

148

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Section: Discussionmentioning

confidence: 77%

Results of Immediate Surgical Treatment of All Acute Type A Dissections

Ehrlich

Ergin²,

McCullough³

et al. 2000

Circulation

148

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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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“…In Europe during the 1980s and 1990s, gelatin-resorcinolformaldehyde (GRF) "French" glue was popular for reconstructing the friable Sinus of Valsalva tissue. It reduced bleeding and facilitated sewing the proximal anastomosis with adequate mid-term outcomes (62)(63)(64)(65)(66). Subsequently, the occurrence of false aneurysms in glued aortic segments with pathological evidence of reactive fibrosis and tissue necrosis dampened enthusiasm for glue in aortic surgery, and this was especially the case with GRF French glue due to concerns about the toxicity of its formalin component (64,(67)(68)(69).…”

Section: Replacement Of the Valve And Rootmentioning

confidence: 99%

Evolution of surgical therapy for Stanford acute type A aortic dissection

Chiu¹,

Miller²

2016

ASVIDE

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Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small?The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results.

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Surgery for acute type A aortic dissection: the Hopital Foch experience (1977–1998)

Cited by 131 publications

References 12 publications

Results of Immediate Surgical Treatment of All Acute Type A Dissections

Results of Immediate Surgical Treatment of All Acute Type A Dissections

Aortic Medial Elastic Fiber Loss in Acute Ascending Aortic Dissection

Evolution of surgical therapy for Stanford acute type A aortic dissection

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