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Extended total arch replacement for acute type a aortic dissection: experience with seventy patients.
T Kazui1, N Washiyama, B A Muhammad
1First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, and the Second Department of Surgery, Sapporo Medical University, Sapporo, Japan. surg1ss@hama-med.ac.jp
The Journal of Thoracic and Cardiovascular Surgery
|March 1, 2000
Summary
Extended total arch replacement is a viable option for acute type A aortic dissection. Factors like renal-mesenteric ischemia and anastomotic leakage impact patient outcomes and reoperation rates.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease
Background:
- Acute type A aortic dissection is a life-threatening condition requiring prompt surgical intervention.
- Extended total arch replacement addresses complex aortic pathologies involving the aortic arch.
Purpose of the Study:
- To report clinical outcomes of extended total arch replacement for acute type A aortic dissection.
- To identify predictors of early mortality, late survival, and need for reoperation.
Main Methods:
- Retrospective analysis of 70 patients undergoing emergency extended total arch replacement.
- Techniques included hypothermic extracorporeal circulation and selective cerebral perfusion.
- Concomitant procedures were performed as needed.
Main Results:
- Early mortality was 16%; renal-mesenteric ischemia and coronary artery bypass grafting predicted early death.
- 3- and 5-year survival rates were 75% and 73%, respectively.
- Renal-mesenteric ischemia and en bloc repair predicted late death; anastomotic leakage predicted reoperation.
Conclusions:
- Extended total arch replacement can be safely performed in selected patients with acute type A aortic dissection.
- Careful patient selection and surgical technique are crucial for favorable outcomes.
- Identifying and mitigating risk factors can improve survival and reduce reoperation.