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Total arch graft replacement in patients with acute type A aortic dissection
1Second Department of Surgery, Sapporo Medical University School of Medicine, Japan.
The Annals of Thoracic Surgery
|November 1, 1994
Summary
Emergency total aortic arch graft replacement for acute type A aortic dissection is debated. This study found it justified in selected patients, showing lower mortality in those without shock or ischemia complications.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Dissection
Background:
- Acute type A aortic dissection is a life-threatening condition.
- Surgical treatment, particularly total aortic arch replacement, remains controversial.
Purpose of the Study:
- To evaluate the safety and efficacy of emergency total aortic arch graft replacement in acute type A aortic dissection.
- To identify risk factors influencing outcomes.
Main Methods:
- Retrospective analysis of 30 patients undergoing emergency ascending aorta and total aortic arch replacement.
- Use of extracorporeal circulation, blood cardioplegia, selective cerebral perfusion, and open distal anastomosis.
Main Results:
- Overall early mortality was 23.3%.
- Mortality was significantly higher in patients with shock (57%) or renal/mesenteric ischemia (66.7%).
- Patients without these complications had a low mortality rate (8.7%) and high 4-year survival (87.0%).
Conclusions:
- Emergency total aortic arch replacement can be a safe and effective treatment for selected patients with acute type A aortic dissection.
- Risk stratification is crucial for patient selection and improving outcomes.