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[Progress in surgery of the aortic arch].

M J Jurmann1, J Laas, M Heinemann

  • 1Klinik für Thorax-, Herz- und Gefässchirurgie, Zentrum Chirurgie, Medizinische Hochschule Hannover.

Helvetica Chirurgica Acta
|January 1, 1992
PubMed
Summary

This study reviewed 133 aortic arch operations in 130 patients over 13 years. While early mortality was 14.3%, 5-year survival was 69.1%, with better outcomes for acute aortic dissection patients.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Context:

  • Aortic arch pathologies, including aneurysms and dissections, present significant surgical challenges.
  • Complex aortic arch operations require specialized techniques and experienced surgical teams.
  • Long-term outcomes and survival rates for aortic arch surgery are critical for patient management.

Purpose:

  • To summarize the surgical experience and outcomes of 133 aortic arch operations performed over 13 years.
  • To analyze the impact of different aortic pathologies (aneurysm, acute/chronic dissection) on surgical strategies and outcomes.
  • To evaluate early and late mortality, reoperation rates, and long-term survival following aortic arch surgery.

Summary:

  • The study involved 133 aortic arch operations in 130 patients, addressing aneurysmal disease (57), acute dissection (44), and chronic dissection (29).
  • Surgical approaches included partial/subtotal/total arch replacement, with 19 cases receiving simultaneous elephant trunk prosthesis implantation.
  • Operations were performed under circulatory arrest and deep hypothermia, with recent technique modifications including antegrade perfusion and false lumen sealing for dissections.

Impact:

  • Overall early mortality was 14.3%, significantly higher in acute dissection (22.7%) compared to chronic dissection (6.9%).
  • Reoperations were necessary in 16 patients (24 procedures), most commonly for descending thoracic aorta replacement.
  • Five-year actuarial survival was 69.1%, with a progressive decline in aneurysm and chronic dissection groups, but no late deaths in acute dissection patients.

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