Surgical techniques in type A dissection

Hussain, Syed T.; Svensson, Lars

doi:10.21037/acs.2016.05.08

Cited by 14 publications

(12 citation statements)

References 13 publications

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“…The operative principle for ADIAD lies in: 1) resection of the aortic wall where the intimal tear situates or occlusion of intimal tear; 2) implantation of befitting artificial blood vessels; 3) restoration of blood flow of true lumen; 4) repair or replacement of aortic valve and transplantation of coronary artery if necessary [ 9 ]. Specifically, how diseased aortic arch is surgically managed is varied in each patient with ADIAD.…”

Section: Recent Surgical Advances In Acute Debakey Type I Aortic Dissmentioning

confidence: 99%

“…The very first successful attempt in the human history to treat AD by surgical means could be dated back to the year of 1965 by Debakey and his colleagues. More than fifty years from then has witnessed the remarkable achievements of surgical strategy for AD along with a great many advances in diagnosis, anesthesia, cardiopulmonary bypass (CPB), perioperative management and artificial implantation material [ 9 ]. For ADIAD, involvement of aortic arch and its three main branches complicates the disease and challenges the cardiovascular surgeons all over the world, to a large extent.…”

Section: Introductionmentioning

confidence: 99%

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Surgical repair and reconstruction of aortic arch in debakey type I aortic dissection: recent advances and single-center experience in the application of branched stent graft

Zhang

et al. 2017

J Cardiothorac Surg

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BackgroundAortic dissection (AD) represents a clinically uncommon aortic pathology which predicts a dismal prognosis if not promptly treated. In acute Debakey type I AD (ADIAD), aortic lesion extends from aortic root to even distal abdominal aorta among which aortic arch and its three main branches still remain a great surgical challenge for repair and reconstruction. Several decades have witnessed the painstaking efforts of cardiovascular surgeons across the globe for optimizing the surgical procedures, from total or hemi-arch replacement, “elephant trunk” technique to branched stent graft. However, operative mortality and morbidity still remain to be reduced and surgical strategy is to be advanced and simplified, particularly the repair and reconstruction of aortic arch and supra-aortic vessels.MethodsIn this paper, we reviewed the relevant literature concerning recent advances in surgical intervention of aortic arch and summarized our opinions in the application of branched stent graft in ADIAD.ResultsThe operative strategy for acute Debakey type I aortic dissection still remain to be advanced and simplified, especially the repair and reconstruction of aortic arch and supra-aortic vessels. For selection of branched stent grafts, the anatomic features and pathological changes of diseased arch are the crucial factors for clinical decision making.ConclusionsBranched stent graft is potentially an effective alternative for the treatment of type I AD with diseased aortic arch and supra-aortic vessels. The selection of branched stent grafts still remains to be further discussed in large-scale studies in the future.

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Section: Recent Surgical Advances In Acute Debakey Type I Aortic Dissmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical repair and reconstruction of aortic arch in debakey type I aortic dissection: recent advances and single-center experience in the application of branched stent graft

Zhang

et al. 2017

J Cardiothorac Surg

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“…Type A aortic dissections are surgical emergencies that occur in three to four out of 100,000 patients annually. 1 If left untreated, mortality in the initial 24-48 hours is approximately 2% per hour. 2 While the most common surgical approach for Stanford Type A dissections involves replacement of the dissected aorta with a synthetic graft, adjunct maneuvers have been described, including a secondary wrap around the aortoplasty.…”

Section: Introductionmentioning

confidence: 99%

Hemolysis following wrap aortoplasty for Type A aortic dissection repair: Case report and review of the literature

et al. 2018

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A Dacron wrap aortoplasty has been described as an adjunct to reduction ascending aortoplasty for the repair of Type A aortic dissections. We report a case of an uncomplicated hemiarch repair with wrap aortoplasty of the distal anastomosis which resulted in severe acute hemolysis. Despite only minimal focal graft deformation on imaging, the patient was found to have a flow gradient across the distal anastomosis, which was reduced by > 50% following release of the outer graft wrap. To our knowledge, only 29 additional cases of hemolytic anemia following aortic dissection repair have been described in the English literature. The reported mechanisms included aortic graft stenosis (50%), graft kinking (23%), external compression of the graft (20%), and a folded elephant trunk appendage (7%). The mean onset of hemolysis following aortic dissection repair occurred 32.2 ± 44.4 months after surgery, with only 16.7% of cases occurring within 2 weeks. This review details the clinical, laboratory, and imaging findings suggestive of mechanical hemolysis following aortic surgery.

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“…Our practice evolved to a systematic historical axillary artery cannulation approach for managing acute type A dissection (Video 1). 3 Initial femoral or central cannulation has typically been selected when axillary cannulation is not the ideal choice or when the patient's presentation indicates preference for another site.…”

mentioning

confidence: 99%

Cannulation strategies in acute type A dissection repair: A systematic axillary artery approach

Rosinski

Idrees

Roselli

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objectives: Consensus regarding initial cannulation site for acute type A dissection repair is lacking. Objectives were to review our experience with systematic initial axillary artery cannulation, characterize patients on the basis of cannulation site, and assess outcomes.Methods: From January 2000 to January 2017, 775 patients underwent emergency acute type A dissection repair. Initial axillary cannulation was performed in 617 (80%), femoral in 93 (12%), and central in 65 (8.4%). In-hospital mortality and stroke risk factors were identified using logistic regression. Results:Reasons for selecting initial central or femoral instead of axillary cannulation included unsuitable axillary anatomy (n ¼ 67; 42%), surgeon preference (n ¼ 38; 24%), hemodynamic instability (n ¼ 34; 22%), and preexisting cannulation (n ¼ 19; 12%). Cannulation site was shifted or added intraoperatively in 82 (11%), with initial cannulation site being axillary (n ¼ 23 of 617; 3.7%), central (6 of 65; 9.2%), or femoral (n ¼ 53 of 93; 57%), for surgeon preference (n ¼ 60; 73%), high flow resistance (n ¼ 13; 16%), increased aortic false lumen flow (n ¼ 6; 7.3%), and other (n ¼ 3; 3.7%). In-hospital mortality was 8.6% (n ¼ 67; lowest for axillary, 7.3% [P ¼ .02]) and stroke 8.3% (n ¼ 64). Hemodynamic instability (odds ratio [OR], 7.

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Surgical techniques in type A dissection

Cited by 14 publications

References 13 publications

Surgical repair and reconstruction of aortic arch in debakey type I aortic dissection: recent advances and single-center experience in the application of branched stent graft

Surgical repair and reconstruction of aortic arch in debakey type I aortic dissection: recent advances and single-center experience in the application of branched stent graft

Hemolysis following wrap aortoplasty for Type A aortic dissection repair: Case report and review of the literature

Cannulation strategies in acute type A dissection repair: A systematic axillary artery approach

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