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Type III dissection according to DeBakey. Comments on 45 cases treated.
P P Zanetti1, V Sorisio, G Rosa
1Department of Surgery, Thoracic Aortic Surgery Center, General Regional Hospital, Asti, Italy.
The Journal of Cardiovascular Surgery
|April 30, 1999
Summary
Treatment for DeBakey type III aortic dissection varies. Surgery is recommended for acute cases with complications and chronic cases with large diameters or false lumen thrombosis. Medical management is suitable for uncomplicated acute dissections.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Uncertainty exists regarding optimal treatment strategies for DeBakey type III aortic dissections, encompassing both acute and chronic forms.
- This retrospective study investigates treatment indications and outcomes for 45 patients with DeBakey type III aortic dissection (20 acute, 25 chronic).
Purpose of the Study:
- To analyze the indications and methods employed in managing acute and chronic DeBakey type III aortic dissections.
- To evaluate the effectiveness of medical versus surgical treatment based on disease presentation and complications.
Main Methods:
- Retrospective analysis of 45 patients with DeBakey type III aortic dissection.
- Patient selection prioritized high operability, with data collected from multiple coronary units.
- Treatment decisions were based on complication status in acute cases and aortic diameter/false lumen thrombosis in chronic cases.
Main Results:
- Surgical mortality was 33.3% for acute dissections and 15% for chronic dissections.
- Mortality was significantly higher in non-operated patients (87.5% for acute, 60% for chronic).
- Post-operative complications included hemothorax requiring rethoracotomy in one case and prolonged respiratory support in several patients.
Conclusions:
- Surgical intervention is increasingly favored for acute DeBakey type III dissections, even with threatened complications or medical treatment failure.
- Key indications for surgery in chronic DeBakey type III dissections include aneurysmal evolution (diameter > 5-6 cm) and lack of false lumen thrombosis.