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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.

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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.

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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.