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[Early operation for acute type a closing dissection]
E Suenaga1, H Suda, J Sadakari
1Department of Cardiovascular Surgery, Nagasaki Kouseikai Hospital, Nagasaki, Japan.
Insights
Immediate graft replacement for Stanford type A acute aortic dissection is recommended, even without severe complications. Early surgical intervention in acute aortic dissection cases improves outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Context:
- Stanford type A acute aortic dissection presents a critical surgical challenge.
- This study reviewed cases operated between March 1997 and January 2000.
- Patients were elderly, with a mean age of 71 years, and frequently presented with cardiac tamponade (81%) and shock (45%).
Purpose:
- To evaluate the outcomes of surgical intervention for Stanford type A acute aortic dissection.
- To determine the efficacy of immediate graft replacement in these patients.
Summary:
- Eleven patients with Stanford type A acute aortic dissection underwent surgery using deep hypothermia and circulatory arrest.
- Ascending aortic replacement was performed in 9 cases, and total arch replacement in 2.
- Despite high rates of cardiac tamponade and shock, malperfusion and end-organ ischemia were absent. Operative and hospital mortality were low (1 death each), with 63% of patients not requiring blood transfusion.
Impact:
- The findings suggest that prompt surgical graft replacement is beneficial for Stanford type A acute aortic dissection.
- Early intervention may lead to favorable outcomes even in patients without immediate life-threatening complications.
Abstract:
From March 1997 to January 2000, we operated eleven cases of Stanford type A acute closing dissection. The patients consisted of 4 men and 7 women with a mean age of 71 +/- 9 years. There were 9 cases (81%) of cardiac tamponade and 5 cases (45%) was in the shock state. There were no malperfusion and end organ ischemia. All cases were operated with deep hypothermia and circulatory arrest. Ascending aortic replacement were performed in 9 cases and 2 cases were performed total arch replacement. 6 cases (63%) were not required blood transfusion. There was one operative death and one hospital death. These result suggest that we had better to perform immediate graft replacement for Stanford type A acute closing dissection as soon as possible, even if there were no serious complications.