Surgical repair of type A aortic dissection by the circulatory arrest-graft inclusion technique in sixty-six patients

Galloway, Aubrey C.; Colvin, S B; Grossi, Eugene A.; Parish, Michael A.; Culliford, Alfred T.; Asai, Tadahiko; Rofsky, N. M.; Weinreb, Jeffrey C.; Shapiro, Shepard; Baumann, F.Gregory

doi:10.1016/s0022-5223(19)34151-0

Cited by 37 publications

(9 citation statements)

References 24 publications

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“…The rate of cerebral, respiratory, and renal complications has been reported as 2.5% to 11.8%, 6% to 19%, and 5% to 12.2%, respectively, in the conventional surgical treatment. 3,[5][6][7]19 In our series the rates of cerebral and renal complications (5.3% and 10.6%, respectively) were comparable with those of conventional treatment. The rate for respiratory complication in our series (0%, no patient needed a tracheostomy) was much lower than that seen in previous reports because our technique does not require us to touch the recurrent nerve and phrenic nerve or to open the thorax and compress the left lung.…”

Section: Discussionsupporting

confidence: 74%

“…The surgical mortality for graft replacement of the ascending aorta for type A dissection has been reported as ranging from 9% to 21.8%, 5,11,19 and that of total arch graft replacement has been reported as ranging from 17% to 55%. [19][20][21][22][23][24][25][26][27] Surgical mortality in our series was 5.3%.…”

Section: Discussionmentioning

confidence: 99%

“…onventional surgical treatment for proximal aortic dissection (ie, type A aortic dissection) is graft replacement or resection of the entry site in the ascending aorta to prevent intrapericardial rupture. [1][2][3][4] However, because this surgical treatment has improved the life prognosis for the acute phase in recent years, [5][6][7][8][9] the discussion has been changing from the acutephase mortality rate to postoperative morbidity and the prognosis of residual dissection in the chronic phase. [10][11][12][13][14][15][16] The shift has been prompted by relatively high late mortality 7,[10][11][12] and experience with reoperation for enlargement of residual dissection in the aortic arch and descending aorta after the conventional operation to repair the ascending aorta.…”

mentioning

confidence: 99%

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The results of total arch graft implantation with open stent-graft placement for type A aortic dissection

Kato

Kuratani

Kaneko

et al. 2002

The Journal of Thoracic and Cardiovascular Surgery

108

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The results of total arch graft implantation with open stent-graft placement for type A aortic dissection

Kato

Kuratani

Kaneko

et al. 2002

The Journal of Thoracic and Cardiovascular Surgery

108

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“…05). Data from the Cleveland Clinic 16 also showed no significant difference, with 22% hospital mortality for the Bentall procedure and 13% for root reconstruction. Ergin et al, 3 when comparing the Bentall procedure and valve preserving reconstruction, found mortality rates of 16% and 13%, respectively and comparable morbidity rates.…”

Section: Discussionmentioning

confidence: 94%

Long-Term Effectiveness of Operative Procedures for Stanford Type A Aortic Dissections

Driever

Botsios

Schmitz

et al. 2004

Journal of Cardiac Surgery

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Background: The object was to evaluate the long-term effectiveness of strategies for managing the aortic root and distal aorta in type A dissections. Methods: From 1990 to 1999, 50 patients (32 men (64.07%); 18 women, (36.0%); mean age 57.4 ± 11.1 years) underwent operation for ascending aortic dissection. Surgical strategies included aortic root replacement with a composite graft (21/50; 42.0%), valve replacement with supracoronary ascending aortic graft (3/50, 6%), and valve preservation or repair (26/50; 52.0%). Results: Overall hospital mortality rate was 18.0%. Follow-up was completed for 47 patients (94.0%) and ranged from 1 month to 10.5 years (mean 28.8 months). Actuarial survival for patients discharged from the hospital was 84% at 1 year, 75% at 5 years, and 66% at 10 years. There was no significant difference between the various procedures regarding mortality, neurological complications, long-term survival, and proximal reoperations. The ascending aorta alone was replaced in 8 of 50 patients (16%), ascending and hemiarch in 30 of 50 patients (60%), and arch and proximal descending aorta in 12 of 50 patients (24%). Hospital mortality (11.5%, 20.0%, and 16.7%, respectively; p > 0.05) and 5-and 10-year survival (p > 0.05) were not statistically dependent on the extension of the resection distally. Residual distal dissection was not associated with a decrease in late survival. With regard to emergency surgery (36/50) there was no significant difference in hospital mortality (p > 0.05) and 5-year survival (p > 0.05) between those who had undergone coronary angiography (19/36; 52.8%) on the day of surgery with those who had not (17/36; 47.2%). Conclusions: Preservation or repair of the aortic valve can be recommended in the majority of patients with type A dissection. Distal extension of the resection does not increase surgical risk. Residual distal dissection does not decrease late survival. Preoperative coronary angiography may not affect survival in patients undergoing emergency surgery

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“…These results are consistent with previous reports. [6,16,17]. Late re-operations in our patient group were only necessary in the case of aneurysms in the thoracoabdominal aorta.…”

Section: Distal Extend Of Replacementmentioning

confidence: 99%

Long-Term Effectiveness of Operative Procedures for Stanford Type A Aortic Dissections

Driever

Botsios

Schmitz

et al. 2003

Cardiovascular Surgery

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Background: To evaluate long-term effectiveness of strategies for managing the aortic root and distal aorta in type A dissections. Methods: From 1990 to 1999, 50 patients (32 men, 64.07%; 18 women, 36.0%; mean age 57.4 y ± 11.1) underwent operation for ascending aortic dissection. Surgical strategies included aortic root replacement with a composite graft (21/50; 42.0%), valve replacement with supracoronary ascending aortic graft (3/50, 6%), and valve preservation or repair (26/50; 52.0%). Results: Overall hospital mortality rate was 18.0%. Follow-up was completed for 47 patients (94.0%) and ranged from 1 month to 10.5 years (mean 28.8 months). Actuarial survival for patients discharged from the hospital was 84% at 1 year, 75% at 5 years, and 66% at 10 years. There was no significant difference between the various procedures regarding mortality, neurological complications, long term survival and proximal re-operations. The ascending aorta alone was replaced in 8/50 patients (16%), ascending and hemiarch in 30/50 patients (60%) and arch and proximal descending aorta in 12/50 patients (24%) Hospital mortality (11.5, 20.0 and 16.7% respectively; p > 0.05) and 5- and 10-year survival ( p > 0.05) were not statistically dependent on the extension of the resection distally. Residual distal dissection was not associated with a decrease in late survival. With regard to emergency surgery (36/50) there was no significant difference in hospital mortality ( p > 0.05) and 5 year survival ( p > 0.05) between those who had undergone coronary angiography (19/36; 52.8%) on the day of surgery with those who had not (17/36; 47.2%). Conclusions: Preservation or repair of the aortic valve can be recommended in the majority of patients with type A dissection. Distal extension of the resection does not increase surgical risk. Residual distal dissection does not decrease late survival. Preoperative coronary angiography may not affect survival in patients undergoing emergency surgery.

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Surgical repair of type A aortic dissection by the circulatory arrest-graft inclusion technique in sixty-six patients

Cited by 37 publications

References 24 publications

The results of total arch graft implantation with open stent-graft placement for type A aortic dissection

The results of total arch graft implantation with open stent-graft placement for type A aortic dissection

Long-Term Effectiveness of Operative Procedures for Stanford Type A Aortic Dissections

Long-Term Effectiveness of Operative Procedures for Stanford Type A Aortic Dissections

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