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[Dissection of the ascending aorta (type A): diagnostic aspects, surgical treatment and long-term follow-up]
E Larraín1, M J Irarrázaval, R Zalaquett
1Departamento de Enfermedades Cardiovasculares, Hospital Clínico de la Pontificia Universidad Católica de Chile.
Insights
Aortic dissection surgery improves outcomes for ascending aorta dissections. Early diagnosis and prompt surgical intervention, followed by close monitoring, are crucial for patient survival.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Context:
- Aortic dissection involving the ascending aorta requires surgical intervention to improve patient prognosis.
- A study was conducted at Hospital Clínico de la Universidad Católica involving 40 patients.
- Diagnostic imaging modalities include angiography, computed axial tomography, and transesophageal echocardiography.
Purpose:
- To evaluate the outcomes of aortic replacement surgery for ascending aorta dissections.
- To identify predictors of operative mortality in patients undergoing aortic replacement.
- To assess long-term survival rates and the necessity of follow-up care.
Summary:
- Forty patients underwent aortic replacement for ascending aorta dissections, with 26 presenting acutely.
- Ascending aorta replacement was performed in 60% of patients; operative mortality was 27.5%.
- Early surgical intervention and close follow-up are recommended for managing ascending aorta dissections.
Impact:
- Operative mortality was influenced by the timing of surgery and the presence of limb ischemia.
- Long-term actuarial 5-year survival was 87.9% (excluding operative mortality).
- This study underscores the importance of timely surgical management and vigilant post-operative surveillance.
Abstract:
Aortic replacement is the treatment of choice and improves the natural history of dissections involving the ascending aorta. Forty patients (23 male), aged 49.4 years, have been operated at the hospital Clínico de la Universidad Católica. Twenty six presented with acute dissections. Angiography conformed the dissection in 63.3% and computed axial tomography in 84.6% of patients; lately, transesophageal echocardiography has become the most sensitive diagnostic method. Twenty three patients (57.5%) were subjected to emergency operations and 17 to semielective procedures. In 24 patients (60%) ascending aorta was replaced and in 16 a composite graft was used. Operative mortality was 27.5%. Univariate analysis showed that the period in which the operation was performed and the presence of limb ischemia were the only independent predictors of operative mortality. Long term follow up was achieved in 26 patients (89.6%). Actuarial 5 year survival without considering operative mortality was 87.9%. It is concluded that patients with acute dissections involving the ascending aorta should be operated as soon as the imaging diagnosis is complete and, since this is a palliative procedure, a close follow up is required for early detection of complications.