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Acute type A dissecting aortic aneurysm requiring emergency arch replacement
D Boulafendis1, E Bastounis, Y P Panayiotopoulos
1Department of Cardiovascular Surgery, Spring Branch Memorial Hospital, Houston, Texas.
Cardiovascular Surgery (London, England)
|August 1, 1993
Summary
Emergency arch replacement for acute type A aortic dissection with arch involvement is feasible. This aggressive surgical approach can avoid late deaths from residual aneurysm, offering a survival benefit.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease
Background:
- Acute type A aortic dissection (aTAAD) involves the aortic arch in 10-20% of cases.
- Multiple intimal tears are rare in aTAAD.
- Conventional treatment often involves ascending aorta replacement only, leading to significant late mortality due to residual aneurysm formation.
Purpose of the Study:
- To evaluate the safety and efficacy of emergency aortic arch replacement in patients with aTAAD involving the aortic arch.
- To assess the outcomes of an aggressive surgical strategy compared to more conservative approaches.
Main Methods:
- Retrospective analysis of 14 patients with aTAAD involving the aortic arch.
- Five patients underwent emergency aortic arch replacement.
- Surgical technique involved moderate hypothermia for ascending aorta resection and profound hypothermia with circulatory arrest for arch exploration.
Main Results:
- None of the five patients who underwent emergency arch replacement died.
- One patient experienced transient hemiparesis.
- No recurrent aneurysms were observed during the follow-up period.
Conclusions:
- Emergency aortic arch replacement in selected aTAAD patients is associated with acceptable mortality and morbidity.
- This aggressive surgical approach can prevent late deaths related to residual aneurysm formation.
- The findings support the consideration of aortic arch repair in cases of aTAAD with arch involvement or multiple tears.