Influence of a Collapsed True Lumen in Acute Type A Aortic Dissection

We evaluated patients with acute type A aortic dissection (ATAAD) who were suffering from a collapsed true lumen in the descending aorta.

Among 146 patients with ATAAD who underwent surgery, 6 (4.1%) with a collapsed true lumen of <10% of the total area at the level of the diaphragmatic transition in the descending aorta were detected. Preoperative and postoperative computed tomography images, preoperative characteristics, surgical techniques, and major adverse aortic events were assessed.

Patients with a collapsed true lumen tended to have spinal cord or peripheral malperfusion preoperatively. In two patients, because intraoperative transesophageal echocardiography showed no improvement in the collapsed true lumen after femoral artery cannulation, ascending aortic cannulation was added. Entry resection was achieved in five patients; however, three of them needed thoracic endovascular aortic repair (TEVAR). All six patients survived for one year, and after staged TEVAR, aortic remodeling was achieved.

Patients with a collapsed true lumen in the descending aorta tended to develop lower body malperfusion, and usual cardiopulmonary bypass may be ineffective. Even if entry resection was achieved, aortic remodeling could not be obtained in some cases; therefore, staged repair with TEVAR can solve this issue.