Mitsumasa Hata1, Yukihiko Orime2, Shinji Wakui2, Tetsuya Nakamura2, Rei Hinoura2, Kenji Akiyama2. 1. Department of Cardiovascular Surgery, Nihon University Hospital, 1-6 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan. hata.mitsumasa@nihon-u.ac.jp. 2. Department of Cardiovascular Surgery, Nihon University Hospital, 1-6 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
Abstract
OBJECTIVE: We assessed the efficacy of limited proximal arch replacement for type A acute aortic dissection (AAD) with critical complications. METHODS: Sixty-four patients with average age of 64.5 ± 13.0 years, who were intubated prior to arriving at hospital due to cardiopulmonary arrest, cardiac tamponade, or vital organ mal-perfusion, were divided into two groups: group PA consisted of 52 patients undergoing proximal arch repair with mild hypothermic circulatory arrest; group TA consisted of 12 patients who underwent total arch replacement with moderate hypothermia and selective cerebral perfusion. RESULTS: The intimal tear on the distal side of the left subclavian artery was not excised in 11 patients (21.2 %) of group PA. The intimal tear was excised in all patients in group TA. The durations of cerebral protection (PA, 18.7; TA, 70.3 min), cardiopulmonary bypass (PA, 121.5; TA, 206 min), and overall operation (PA, 181.8; TA, 403.8 min) were significantly shorter in group PA. The incidence of postoperative brain damage was significantly lower in group PA (9.6 %) than in group TA (33.3 %). The mortality rate was significantly lower in group PA (5.8 %) than in group TA (58.3 %). Distal arch to descending aortic replacement was required in four patients of group PA during follow-up period. There were no complications or mortality during the reoperation. The actuarial survival rate at 10 years was significantly better in group PA (66.5 %) than in group TA (25 %). CONCLUSION: Limited proximal arch repair is suitable for high-risk patients with AAD, despite no excision of the intimal tear.
OBJECTIVE: We assessed the efficacy of limited proximal arch replacement for type A acute aortic dissection (AAD) with critical complications. METHODS: Sixty-four patients with average age of 64.5 ± 13.0 years, who were intubated prior to arriving at hospital due to cardiopulmonary arrest, cardiac tamponade, or vital organ mal-perfusion, were divided into two groups: group PA consisted of 52 patients undergoing proximal arch repair with mild hypothermic circulatory arrest; group TA consisted of 12 patients who underwent total arch replacement with moderate hypothermia and selective cerebral perfusion. RESULTS: The intimal tear on the distal side of the left subclavian artery was not excised in 11 patients (21.2 %) of group PA. The intimal tear was excised in all patients in group TA. The durations of cerebral protection (PA, 18.7; TA, 70.3 min), cardiopulmonary bypass (PA, 121.5; TA, 206 min), and overall operation (PA, 181.8; TA, 403.8 min) were significantly shorter in group PA. The incidence of postoperative brain damage was significantly lower in group PA (9.6 %) than in group TA (33.3 %). The mortality rate was significantly lower in group PA (5.8 %) than in group TA (58.3 %). Distal arch to descending aortic replacement was required in four patients of group PA during follow-up period. There were no complications or mortality during the reoperation. The actuarial survival rate at 10 years was significantly better in group PA (66.5 %) than in group TA (25 %). CONCLUSION: Limited proximal arch repair is suitable for high-risk patients with AAD, despite no excision of the intimal tear.
Entities:
Keywords:
Aorta; Aortic dissection; Cardiovascular surgery
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