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[Operative results and long-term prognosis of type A acute aortic dissection]
1Second Department of Surgery, Sapporo Medical University School of Medicine, Japan.
Insights
Type A acute aortic dissection outcomes vary by extent. Extensive dissections had higher mortality and lower survival rates, but simultaneous aortic arch replacement improved outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease
Context:
- Type A acute aortic dissection is a life-threatening condition.
- Surgical management involves graft replacement of the aorta.
- Extent of dissection (localized vs. extensive) impacts outcomes.
Purpose:
- To evaluate surgical outcomes for Type A acute aortic dissection based on dissection extent.
- To assess the efficacy of simultaneous ascending aorta and total aortic arch replacement.
- To compare survival and reoperation rates between localized and extensive dissections.
Summary:
- Operated on 91 patients with Type A acute aortic dissection (22 localized, 69 extensive) between 1983-1997.
- 67% underwent simultaneous ascending aorta and total aortic arch replacement.
- Hospital mortality was 9% (localized) vs. 21% (extensive). 5-year survival was 91% (localized) vs. 68% (extensive).
Impact:
- Simultaneous aortic arch replacement effectively obliterates the distal false channel in extensive dissections.
- Localized dissections showed excellent long-term survival (91% at 5 years, 76% at 10 years).
- Extensive dissections had lower survival (68% at 5 years, 62% at 10 years) and freedom from reoperation (78% at 5 years, 56% at 10 years).
Abstract:
Between 1983 and 1997, we operated upon 91 patients with type A acute aortic dissection. The dissection was localized in 22 patients and extensive in 69 patients. All patients underwent graft replacement and 61 (67%) patients underwent simultaneous replacement of ascending aorta and total aortic arch. The hospital mortality rate were 9% for the localized dissection and 21% for the extensive dissection. The actuarial survival rates in patients with localized dissection at 5 and at 10 years was 91% and 76%, whereas those in patients with extensive dissection at 5 and at 10 years was 68% and 62%. The freedom from dissection related death or reoperation in operative survivors with localized dissection at 5 and at 10 years was 100% and 83%, whereas those in patients with extensive dissection at 5 and at 10 years was 78% and 56%. The simultaneous replacement of ascending aorta and total aortic arch in patients with extensive dissection was effective to obliteration of the distal false channel, although this extended procedure has to be carefully adopted in high risk patients with associated complications such as acute dissection organ ischemia.