Surgical treatment for acute aortic arch dissection

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Acute aortic dissection involving the aortic arch or innominate artery presents significant surgical challenges.
• Conventional surgical methods for these dissections had high mortality and reoperation rates.

Purpose of the Study:

• To evaluate the efficacy of a surgical technique using hypothermic circulatory arrest for acute aortic dissection involving the proximal aortic arch.
• To compare outcomes between conventional surgery and the open technique with circulatory arrest.

Main Methods:

• Retrospective analysis of 24 patients with acute aortic dissection (March 1983-December 1993).
• Group 1 (n=11): Conventional surgery before 1988.
• Group 2 (n=13): Open technique with brief hypothermic circulatory arrest after 1989.

Main Results:

• Group 1 hospital mortality: 36.4%; 2/7 survivors required reoperation.
• Group 2 operative mortality: 15.4%; 10/13 survivors free from reoperation (40-month follow-up).
• Hypothermic circulatory arrest facilitated secure distal anastomosis, accurate intimal tear assessment, and avoided cross-clamp injury.

Conclusions:

• The open technique with brief hypothermic circulatory arrest is advocated for acute aortic dissection involving the proximal aortic arch.
• This method improves surgical outcomes, reducing mortality and reoperation rates.
• It allows for a more secure anastomosis and better management of intimal disruption.