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Is extended arch replacement for acute type a aortic dissection an additional risk factor for mortality?
M Erwin S H Tan1, Karl M E Dossche, Wim J Morshuis
1Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. erwin.tan@tiscali.nl
The Annals of Thoracic Surgery
|October 8, 2003
Summary
Surgery extending to the aortic arch for acute type A aortic dissection showed similar outcomes to ascending aorta repair. Antegrade selective cerebral perfusion significantly reduced new cerebral vascular accidents.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Dissection Research
Background:
- Acute type A aortic dissection (AADA) poses significant surgical challenges, particularly when involving the aortic arch.
- Surgical strategies for AADA with arch involvement require careful consideration of cerebral protection and long-term outcomes.
Purpose of the Study:
- To evaluate the outcomes of surgical repair for AADA involving the aortic arch.
- To compare the efficacy of different cerebral protection strategies during aortic arch surgery.
Main Methods:
- Retrospective analysis of 277 patients with AADA from 1986-2001.
- Comparison of outcomes between patients undergoing ascending aorta repair versus those with extended arch replacement (hemiarch or total arch).
- Evaluation of cerebral protection methods including deep hypothermic circulatory arrest and antegrade selective cerebral perfusion.
Main Results:
- Operative mortality was comparable between ascending aorta repair (21.7%) and extended arch replacement (18.6%).
- Antegrade selective cerebral perfusion was associated with a significant reduction in new postoperative cerebral vascular accidents (p = 0.0110).
- Early and late survival rates were similar between the two surgical approaches.
Conclusions:
- Extended aortic arch replacement in AADA does not adversely affect early or late surgical results.
- Antegrade selective cerebral perfusion is the preferred method for cerebral protection during aortic arch surgery for AADA.