| Combining classic surgery with descending stent grafting for acute DeBakey type I dissection. | |
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MedLine Citation:
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PMID: 18573404 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: To possibly prevent late complications after classic type A aortic dissection repair, the radical concept of ascending/arch replacement with simultaneous antegrade descending stent grafting using a hybrid prosthesis was applied and compared with conventional repair leaving the distal false lumen untreated. METHODS: Between January 2001 and October 2007, of 71 consecutive patients with acute type A aortic dissection (AAAD), 45 had DeBakey type I dissection and underwent emergency surgery within 24 hours after onset of symptoms. These patients were separated into group 1 (n = 23) undergoing conventional surgery, and group 2 (n = 22) undergoing combined repair with antegrade stent grafting. RESULTS: Patients were comparable for baseline characteristics, but more group 2 patients had severely compromised hemodynamics (p = 0.05) and cerebral malperfusion at arrival (p < 0.01). Intraoperative and postoperative characteristics were similar, with an overall hospital mortality of 16% (5 [22%] versus 2 [9%], group 1 versus group 2; p = 0.22). At a mean follow-up time of 48 months for group 1 versus 23 months for group 2 (p < 0.01), late mortality did not differ between groups (p = 0.38) and was mainly related to additional surgical procedures and persisting neurologic sequelae and not to the aortic pathology. Persisting distal false lumen patency was observed in 89% of group 1 versus 10% of group 2 patients (p < 0.01). CONCLUSIONS: This hybrid approach to patients with type I acute aortic dissection is technically feasible without increasing the operative risk and offers the chance of persistent occlusion of the persistent graft distal false lumen. |
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Authors:
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Heinz Jakob; Konstantinos Tsagakis; Paschalis Tossios; Parwis Massoudy; Matthias Thielmann; Thomas Buck; Holger Eggebrecht; Markus Kamler |
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Publication Detail:
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Type: Comparative Study; Evaluation Studies; Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 86 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2008 Jul |
Date Detail:
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Created Date: 2008-06-24 Completed Date: 2008-07-15 Revised Date: 2009-09-22 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 95-101 Citation Subset: AIM; IM |
Affiliation:
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Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Essen, Germany. heinz.jakob@uk-essen.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adult Aged Anastomosis, Surgical Aneurysm, Dissecting / mortality, radiography, surgery* Angioplasty / methods* Aortic Aneurysm, Thoracic / mortality, radiography, surgery* Blood Vessel Prosthesis Implantation / methods*, mortality Cohort Studies Combined Modality Therapy Female Follow-Up Studies Humans Male Middle Aged Postoperative Complications / mortality Probability Retrospective Studies Risk Assessment Stents* Survival Analysis Treatment Outcome |
| Comments/Corrections | |
Comment In:
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Ann Thorac Surg. 2009 Oct;88(4):1387-8; author reply 1388-9
[PMID:
19766862
]
Ann Thorac Surg. 2008 Jul;86(1):101-2 [PMID: 18573405 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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