Document Detail


Aortic dissection. Prevalence, cause, and results of late reoperations.
MedLine Citation:
PMID:  8041167     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
From January 1977 to September 1992, 143 patients underwent an emergency operation for type A acute aortic dissection. Because of the location of the intimal tear, the replacement of the ascending aorta was extended to the transverse arch in 42 patients (29.3%). One hundred ten patients (78%) survived the operation. During the same period, 32 patients had to be reoperated on once (n = 24) twice (n = 6), or three times (n = 2) for a total of 42 reoperations. Nineteen patients had had the initial repair in our institution, and 13 had been operated on elsewhere. Reoperation was indicated for aortic valve disease (n = 4), recurring dissection (n = 7) threatening aneurysmal evolution of a persisting dissection (n = 28), or false aneurysm (n = 3). The redo procedure involved the aortic root and/or ascending aorta in 15 cases (group I), the transverse arch alone in 7 cases (group II), the transverse arch and the descending aorta or the descending aorta alone in 10 cases (group III), or the thoracoabdominal aorta in 10 cases (group IV). The risk factors for reoperation have been analyzed in the 110 survivors initially operated on in our institution. Seven of 18 patients with Marfan's syndrome (38.8%) versus 12 of 92 without Marfan's syndrome (13%) were reoperated on (p = 0.023). None of the 30 patients surviving arch replacement at initial repair required a reoperation, versus 19 of 80 (23.7%) patients surviving a replacement limited to the ascending aorta (p = 0.013). The overall mortality rate of reoperation was 21.8% (7/32) with a risk of 16.6% (7/42) at each procedure (group I, 13.3%; group II, 0%; group III, 20%; group IV, 30%). Hospital mortality was influenced by emergency operation (5/10) (p < 0.005) and thoracoabdominal replacement (3/10) (p < 0.035). The late survivals after reoperation are 65.1% +/- 17.6% at 1 year and 55% +/- 19.63% at 5 years (Kaplan-Meier, confidence interval 95%). The late survivals, after the initial repair, of the patients undergoing reoperation are 89.6% +/- 11.0%, 79.3% +/- 14.7%, 53.9% +/- 18.1%, and 35.9% +/- 21.8% at 1, 5, 10, and 12 years, respectively. In conclusion, aortic dissection is an evolving process that may require one or several reoperations after the initial repair. At initial emergency operation, the resection of the entry site, when located on or extending to the transverse arch, has reduced the risk of reoperation, in our experience. Elective reoperation must be considered before the occurrence of complications, especially in patients with Marfan's syndrome.(ABSTRACT TRUNCATED AT 400 WORDS)
Authors:
J E Bachet; J L Termignon; G Dreyfus; B Goudot; L Martinelli; A Piquois; D Brodaty; C Dubois; P Delentdecker; D Guilmet
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  108     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1994 Aug 
Date Detail:
Created Date:  1994-08-25     Completed Date:  1994-08-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  199-205; discussion 205-6     Citation Subset:  AIM; IM    
Affiliation:
Service de Chirurgie Cardio-vasculaire, Hôpital Foch, Universite de Paris-Ouest, Suresnes, France.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Adult
Aged
Aneurysm, Dissecting / surgery*
Aortic Aneurysm / surgery*
Blood Vessel Prosthesis
Drug Combinations
Formaldehyde
Gelatin
Hospital Mortality
Humans
Middle Aged
Prevalence
Reoperation / mortality,  statistics & numerical data
Resorcinols
Risk Factors
Survival Analysis
Tissue Adhesives
Chemical
Reg. No./Substance:
0/Drug Combinations; 0/Resorcinols; 0/Tissue Adhesives; 0/gelatin-resorcinol-formaldehyde tissue adhesive; 50-00-0/Formaldehyde; 9000-70-8/Gelatin

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