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[The controversy on the treatment of aortic dissection]
1Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Japan.
Insights
This study clarifies aortic dissection classification and presents outcomes for thrombosed types and simultaneous aortic arch graft replacement. Surgical results demonstrate benefits for specific aortic dissection patient groups.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Context:
- Aortic dissection treatment remains controversial.
- Classification systems vary, impacting surgical approach.
- Thrombosed dissection and complex arch repairs present unique challenges.
Purpose:
- To propose a comprehensive classification for aortic dissection.
- To evaluate clinical features and outcomes of thrombosed aortic dissection managed non-surgically.
- To assess the efficacy of simultaneous ascending and aortic arch graft replacement with cervical branch reconstruction.
Summary:
- A dual classification system (patho-morphological and anatomical) is presented for clearer aortic dissection categorization.
- Clinical data from 76 patients with thrombosed aortic dissection treated medically are analyzed.
- Surgical outcomes from 35 patients undergoing simultaneous ascending aorta and aortic arch graft replacement are detailed.
Impact:
- Provides a refined classification framework for aortic dissection.
- Offers insights into non-surgical management of thrombosed aortic dissection.
- Demonstrates the benefits of an extended surgical procedure for specific aortic dissection types.
Abstract:
It is obvious that there are many controversies regarding to the treatment of aortic dissection. In this report, we discuss following points such as 1) classification, 2) thrombosed type dissection, and 3) simultaneous graft replacement of ascending and aortic arch with the reconstruction of cervical branches. From the patho-morphological status, dissection will be classified into two types, localized and extended types. From the anatomical and surgical points of view, it will be also classified as 1) ascending-arch, 2) descending-thoracoabdominal, and 3) abdominal. With the combination of these two, dissection will be classified more clearly. The thrombosed type will be incorporated into localized type. We have experienced 76 cases of this dissection, and clinical features and outcome by medical treatment only are presented. The simultaneous reconstruction of ascending aorta and aortic arch for the dissection at ascending-arch type was undertaken in total of 35 patients. The surgical results as well as follow up data are presented and the benefit of this extended procedure is presented as well.