Document Detail


Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: experience with 107 patients.
MedLine Citation:
PMID:  19660407     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: In patients with acute type A dissection, it is controversial whether to use a more aggressive strategy with extended aortic replacement to improve long-term outcome or to use a conventional strategy with limited ascending aortic or hemiarch replacement to circumvent a life-threatening situation. METHODS: Between April 2003 and June 2007, 107 patients (17 women, 90 men; mean age, 45 +/- 11 years; range, 17-78 years) with acute type A dissection underwent total arch replacement combined with stented elephant trunk implantation under hypothermic cardiopulmonary bypass and selective cerebral perfusion. Computed tomography was performed to evaluate the residual false lumen in the descending aorta during follow-up. RESULTS: Thirty-day mortality was 3.74% (4/107 patients), and in-hospital mortality was 4.67% (5/107 patients). Spinal cord injury was observed in 3 patients (1 patient with left lower-extremity paraparesis and 2 patients with paraplegia). Cerebral infarction was observed in 3 patients, ventilator support exceeding 5 days was required in 9 patients, and rebleeding was observed in 4 patients. During a mean follow-up of 35 +/- 14 months, 3 patients died and 3 patients were lost to follow-up. On postoperative computed tomography, complete thrombus formation was observed around the stented elephant trunk in 95% of patients (95/100) and at the diaphragmatic level in 69% of patients (69/100). CONCLUSION: Low morbidity and mortality were achieved using total arch replacement combined with stented elephant trunk implantation. These encouraging surgical results and postoperative outcomes favor this more aggressive procedure for acute type A dissection.
Authors:
Li-Zhong Sun; Rui-Dong Qi; Qian Chang; Jun-Ming Zhu; Yong-Min Liu; Cun-Tao Yu; Bin Lv; Jun Zheng; Liang-Xin Tian; Jin-Guo Lu
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Publication Detail:
Type:  Journal Article     Date:  2009-05-31
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  138     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2009-12-14     Revised Date:  2010-04-23    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1358-62     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. slzh_2005@yahoo.com.cn
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Adult
Aged
Aneurysm, Dissecting / mortality,  surgery*
Aorta, Thoracic / surgery*
Aortic Aneurysm / mortality,  surgery*
Cardiopulmonary Bypass / methods
Female
Follow-Up Studies
Humans
Hypothermia, Induced
Male
Postoperative Complications
Stents*
Tomography, X-Ray Computed
Treatment Outcome
Comments/Corrections
Comment In:
J Thorac Cardiovasc Surg. 2010 May;139(5):1359-60; author reply 1360   [PMID:  20412975 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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