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Related Experiment Videos

Subtypes of acute aortic dissection

S L Lansman1, J D Galla, J S Schor

  • 1Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York 10029.

Journal of Cardiac Surgery
|November 1, 1994
PubMed
Summary

This study on acute type A aortic dissection found that tear location impacts outcomes. Descending aortic tears had better survival rates than ascending or arch tears when using open distal anastomosis with deep hypothermic circulatory arrest.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Disease

Background:

  • Acute type A aortic dissection is a life-threatening condition requiring complex surgical intervention.
  • The location of the intimal tear can influence surgical approach and patient outcomes.
  • Deep hypothermic circulatory arrest is a critical component in managing complex aortic dissections.

Purpose of the Study:

  • To evaluate the outcomes of open distal anastomosis with deep hypothermic circulatory arrest in acute type A aortic dissection.
  • To analyze the impact of intimal tear location (ascending aorta, arch, descending aorta) on clinical characteristics and complications.
  • To propose a new classification system for aortic dissection based on tear origin and propagation.

Main Methods:

  • Surgical technique: Open distal anastomosis with deep hypothermic circulatory arrest.

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  • Patient cohort: 69 cases of acute type A aortic dissection.
  • Data analysis: Subcategorization by intimal tear site, comparison of mortality and survival rates.

    • Main Results:

    • Hospital mortality was 14.5% overall, with variations by tear site: 14.6% (ascending), 18.2% (arch), and 0% (descending).
    • Six-year survival rates were comparable across tear locations: 69% (ascending), 69% (arch), and 80% (descending).
    • No statistically significant difference in survival was observed between the tear location groups (p = NS).

    Conclusions:

    • The site of the intimal tear in acute type A aortic dissection influences immediate outcomes, with descending tears showing lower mortality.
    • Long-term survival appears similar across different tear locations, suggesting the effectiveness of the surgical technique.
    • A proposed classification system based on tear origin and propagation may aid in standardizing aortic dissection management.