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[Late results of emergency operation in acute type A dissection]
R Toda1, Y Moriyama, S Watanabe
1Second Department of Surgery, Faculty of Medicine, Kagoshima University, Japan.
Insights
This study on acute type A aortic dissection found that using GRF glue significantly reduced hospital mortality after emergency surgery. Long-term survival remains high, with few late complications.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Context:
- Acute type A aortic dissection is a life-threatening condition requiring immediate surgical intervention.
- Traditional surgical approaches carry significant risks, including high mortality and late complications.
- Optimizing surgical techniques and adjuncts is crucial for improving outcomes.
Purpose:
- To evaluate the impact of GRF glue on hospital mortality in patients undergoing emergency surgery for acute type A aortic dissection.
- To assess the long-term survival rates and incidence of late complications after aortic dissection repair.
- To investigate strategies for managing remnant false lumen and aortic valve-related issues.
Summary:
- A 5-year study analyzed 77 cases of acute type A aortic dissection treated with emergency surgery, employing selective brain perfusion and deep hypothermic circulatory arrest.
- The overall hospital mortality rate was 24.7%, significantly decreasing to 14% with the use of GRF glue.
- Five-year actuarial survival was 87%, with late complications in 6.9% of patients, including two deaths from remnant false lumen rupture.
Impact:
- GRF glue demonstrates a significant reduction in hospital mortality for acute type A aortic dissection surgery.
- Surgical repair offers good long-term survival, but vigilance for remnant false lumen complications is necessary.
- Preoperative aortic valve regurgitation did not necessitate late re-operation in this cohort.
Abstract:
77 cases of acute type A dissection underwent emergency operation during 5 years were studied. There were 37 men and 40 women, and 58 cases in type I, 19 cases in type II on DeBakey type. The grafting for the aorta including the tear was basically performed under selective brain perfusion and deep hypothermic circulatory arrest. The overall hospital mortality rate was 24.7%. However, it was 14% after using GRF glue. The overall actuarial survival rate for 58 patients who survived operation was 87% at 5 years after surgery. Late remnant false lumen-related complications were recognized in four patients (6.9%). For two of them, subsequent operations were performed. Another two patients died of rupture of remnant false lumen during observation. Aortic valve regurgitation was recognized preoperatively in 13 patients. None of them required subsequent operation in late phase. Results and countermeasure for late remnant false lumen-related and aortic valve-related complications were investigated.