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[Surgery of recurrent aortic dissection. Apropos of 6 cases]
Insights
Recurrent aortic dissection requires surgical intervention due to poor prognosis. Advances like biological glue aid in prophylaxis, while staged surgery and long-term follow-up are crucial for managing this condition.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Recurrent aortic dissection presents a significant challenge in vascular surgery.
- Understanding the different types of recurrent dissection is crucial for effective management.
Purpose of the Study:
- To analyze the incidence and management of recurrent aortic dissection.
- To evaluate surgical and non-surgical treatment strategies for recurrent aortic dissection.
Main Methods:
- Retrospective review of 64 acute aortic dissections, identifying 6 cases of recurrent dissection.
- Surgical intervention in 4 of the 6 recurrent dissection cases.
- Classification of recurrent dissection into 'de novo', extension, and 'in situ' types.
Main Results:
- Surgery is the preferred treatment for recurrent aortic dissection due to its poor prognosis.
- Extensive resection with deep hypothermia is valuable for aortic segments supplying vital organs.
- GRF biological glue demonstrated efficacy in preventing distal false lumen persistence (27%).
Conclusions:
- Staged surgical repair is recommended for extensive aortic replacement, particularly in young patients with Marfan syndrome.
- Lifelong clinical and radiological follow-up, including advanced imaging, is essential for all aortic dissection patients.
- GRF biological glue represents a significant advancement in preventing recurrent aortic dissection.
Abstract:
The authors report a series of 6 cases of recurrent dissection, 4 of which were treated surgically, out of a total of 64 acute dissections of the aorta referred to the CMC Foch, between January 1969 and October 1981. Three types of recurrent dissection were identified: --"de novo" recurrent dissection: a new dissection occurring in part of the aorta previously unaffected with a new intimal tear; --recurrent dissection due to extension of the previous dissection; --"in situ" recurrent dissection. Surgery is the treatment of choice because of the poor prognosis. Extensive resection (sometimes carried out in several stages) and deep hypothermia are valuable techniques when part of the aorta giving off arteries to vital organs has to be replaced. The use of GRF biological glue in the treatment of the original acute dissection has been a significant advance in the prophylaxis of recurrent dissection as it ensures better repair of the distal false lumen (27% persistent false lumens). With respect to an extensive replacement of the dissected vessel, the authors advise operation in several stages, especially in young subjects with Marfan's syndrome who are at high risk of recurrent dissection. All cases of acute dissection of the aorta, operated or not, should be followed up indefinitely with clinical and radiological examination, completed, when necessary, by an angioscan and an aortography.