Document Detail

Combining classic surgery with descending stent grafting for acute DeBakey type I dissection.
MedLine Citation:
PMID:  18573404     Owner:  NLM     Status:  MEDLINE    
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.
Heinz Jakob; Konstantinos Tsagakis; Paschalis Tossios; Parwis Massoudy; Matthias Thielmann; Thomas Buck; Holger Eggebrecht; Markus Kamler
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  86     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-24     Completed Date:  2008-07-15     Revised Date:  2009-09-22    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  95-101     Citation Subset:  AIM; IM    
Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Essen, Germany.
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MeSH Terms
Acute Disease
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
Follow-Up Studies
Middle Aged
Postoperative Complications / mortality
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome
Comment In:
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 ]

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