Surgical treatment of acute arch dissection

Abstract

Surgical treatment of acute type A-arch dissections can be done with reasonable mortality and mid-term survival comparable with those of other subgroups with acute type A dissection. As with series of arch dissections, our patient population is too small to draw specific conclusions, but our experience leads us to conclude that the sites of intimal tears should be resected in acute type A arch dissection.

Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period

“…This proportion is lower than that in most reported clinical series of arch dissections. 14,16,20,22,32 Although in this series, these patients' operative mortality of 8.6% was higher than the 6.0% in patients with TAAD with an entry tear located elsewhere (6.0%), it is still comparable to that of most series (Table 7). [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]25,32 The rates of stroke, spinal cord injury, and other early morbidities were also consistently low in this study.…”

“…14,16,20,22,32 Although in this series, these patients' operative mortality of 8.6% was higher than the 6.0% in patients with TAAD with an entry tear located elsewhere (6.0%), it is still comparable to that of most series (Table 7). [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]25,32 The rates of stroke, spinal cord injury, and other early morbidities were also consistently low in this study. While Uchida and colleagues 27 and Shimamura and colleagues 28 reported lower early mortality rates in patients with acute TAAD (4.5% and 6.5%, respectively), the locations of entry tears were not disclosed.…”

“…5 Most authors recommend surgical repair for aortic dissections with arch entry tear; however, the appropriate extent of resection is a matter of debate, and various surgical techniques have been reported, including isolated ascending aortic replacement (with a composite graft if needed), hemiarch replacement, total arch replacement (TAR), possible elephant trunk techniques, and even extra-anatomic bypass. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] The frozen elephant trunk (FET) technique is being increasingly used to repair aortic dissections involving the aortic arch and proximal descending aorta, and has improved clinical outcomes considerably. 23,24 The general consensus is that the FET approach will achieve complete arch repair and reduce the need for subsequent reoperations, 23 and there is some evidence to support this.…”

Thromboelastometry Based Early Goal-Directed Coagulation Management Reduces Blood Transfusion Requirements, Adverse Events, and Costs in Acute Type A Aortic Dissection: A Pilot Study

“…Surgery of the aortic arch is complex, and bleeding complications are still within the leading causes of death [1][2][3][4][5][6]. Furthermore, blood transfusion is associated with increased morbidity and mortality [7][8][9][10][11][12].…”