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[Type "A" aortic dissection. Surgical technique, caseload, and follow-up]
A Rignano1, G C Keller, F Cusmai
1Istituto di Chirurgia Generale e Cardiovascolare, Università degli Studi, Milano.
Background:
The authors analyse the indications for the various surgical strategies through a retrospective study of the morbility and mortality rates in their own series of cases and during follow-up.
Methods:
107 patients were operated for type A aortic dissection between 1978 and 1998: 69 using a technique performed under moderate hypothermia (Group A) and 38 in deep hypothermia (Group B). All patients who survived from 1978 to 1994 underwent an accurate follow-up.
Results:
The mortality rate in Group A was 21.7% and 26.3% in Group B. 61.9% patients in Group B presented thrombosis of the false lumen, compared to 30.6% in Group A. Patients with a false perfused lumen underwent re-do surgery in 9.5% compared to 3.5% in those with thrombosed false lumen, and 16.6% showed an aortic dilatation rate of over 5 cm compared to 7.1%.
Conclusions:
From an analysis of these data, and in line with the data reported in the literature, although it is impossible lo indicate an ideal surgical strategy for this severe pathology, it is extremely important to achieve thrombosis of the false lumen.