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Is extended aortic replacement in acute type A dissection justifiable?

Paul P Urbanski1, Alexander Siebel, Michael Zacher

  • 1Herz- und Gefaess-Klinik, Bad Neustadt, Germany. urbanski@kardiochirurg.de

The Annals of Thoracic Surgery
|February 28, 2003
PubMed
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Complete aortic dissection replacement offers good outcomes, even with complex techniques. This surgical strategy aims to resect all dissected aortic segments for better results in acute aortic dissection patients.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Acute aortic dissection presents significant surgical challenges.
  • Surgical strategies must consider dissection extent and entry site.
  • Resection of all dissected aortic segments is a key consideration.

Purpose of the Study:

  • To evaluate a surgical strategy for acute aortic dissection.
  • To assess effectiveness based on dissection extent and entry site.
  • To emphasize complete resection of dissected aortic segments when feasible.

Main Methods:

  • 43 patients with acute aortic dissection underwent surgery (1995-2001).
  • Distal repair utilized circulatory arrest without aortic cross-clamping.
  • Complete dissection replacement was achieved in 21 patients; partial in 22.

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Main Results:

  • Low early mortality (4.7%) and perioperative cerebrovascular events (7.0%).
  • Cerebrovascular events were significantly higher in patients with incomplete dissection replacement (p < 0.025).
  • 39% of survivors had a persisting patent false lumen after 6 years.

Conclusions:

  • Extended aortic replacement for dissection is feasible with good early/midterm results.
  • Complex surgical techniques are necessary for complete dissection replacement.
  • Complete resection of dissected aorta is advocated when technically possible.