Treatment of Acute Aortic Dissections: A Single Centre Experience

Abstract

The objective is to summarize initial experience in the management of acute aortic dissections. From January 2010 to July 2014, we had Debakey I aortic dissection 17 (39.5), Debakey II 4 (9.3%) and Debakey III 22(51.2%). Surgery was performed in 10 patients. Thoracic endovascular repair was performed in 15 patients. The other 10 patients received medical therapy. Aortic remodeling was evaluated comparing preoperative and most recent computed tomography scans during their follow up. In surgical treatment of 10 cases, the mean cardiopulmonary bypass time was 203.50 ± 109.64 min, mean myocardial ischemia time was 82.20 ± 49.68 min, and mean time of selective cerebral perfusion at 25°C was 36.24 ± 15.48 min. Main complications were bleeding (10%), low cardiac output syndrome(10%), stroke (10%), prolonged mechanical ventilation (20%) and acute renal failure (20%). In-hospital mortality of 10.0%. There was no need for second-stage operation. Thoracic endovascular repair was successfully performed in 10 cases. False-lumen thrombosis was obtained in 80%. Follow up duration ranged from 20-60 months. There was no death, reoperation or no rupture during the follow up. Timely and accurate diagnosis in early stage and individualized treatment can improve the survival of aortic dissections and reduce the incidence of serious complication. The severity of the underlying disease justifies high mortality rates. The learning curve is a reality.