| Total arch replacement for distal enlargement after ascending aortic replacement for acute type A aortic dissection. | |
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MedLine Citation:
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PMID: 19901886 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Distal reoperations for aortic dissection are associated with high morbidity rates. We describe distal aortic enlargement that was treated using our surgical strategy. PATIENTS AND METHODS: From January 1997 to April 2008, 63 patients underwent ascending aortic replacement for acute type A aortic dissection. Four patients (7.4%; 3 males, 1 female; mean age, 67.8 +/- 4.6 years) required reoperation for distal enlargement after long-term follow-up. Individual 5- and 10-year rates of those remaining free of reoperation after the initial procedure were 94.9% and 83.0%, respectively. At reoperation, a median sternotomy with left anterolateral thoracotomy provided a good visual field, and bilateral axillary arteries were preferentially used for systemic as well as selective cerebral perfusion. RESULTS: Mechanical ventilation was required after surgery for 3.0 +/- 1.4 days. No new phrenic or left recurrent laryngeal nerve palsy or permanent neurological dysfunction occurred in this series. Although the surgical duration and relative mechanical circulation time were significantly elongated, all patients recovered uneventfully. CONCLUSION: We postulate that the surgical principle involved in treating aortic dissection is a resection of the aortic segment containing the initial intimal tear and graft replacement, especially in acute dissection. Our results showed that total arch replacement through a median sternotomy and left anterolateral thoracotomy seem to be helpful for extended replacement of the thoracic aorta, as well as in the distal reoperation for dissecting type A. Moreover, our results suggested that perfusion from bilateral axillary arteries is useful to prevent cerebral damage. |
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Authors:
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Satoshi Yamashiro; Yukio Kuniyoshi; Katsuya Arakaki; Hitoshi Inafuku; Yuji Morishima; Yuya Kise |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia Volume: 15 ISSN: 2186-1005 ISO Abbreviation: Ann Thorac Cardiovasc Surg Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-11-10 Completed Date: 2010-01-14 Revised Date: 2012-06-18 |
Medline Journal Info:
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Nlm Unique ID: 9703158 Medline TA: Ann Thorac Cardiovasc Surg Country: Japan |
Other Details:
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Languages: eng Pagination: 318-23 Citation Subset: IM |
Affiliation:
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Division of Thoracic and Cardiovascular Surgery, Department of Bioregulatory Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aged Aneurysm, Dissecting / surgery* Aorta, Thoracic / surgery* Aortic Aneurysm, Thoracic / surgery* Blood Vessel Prosthesis Implantation* / adverse effects Female Humans Length of Stay Male Middle Aged Perfusion Reoperation Respiration, Artificial Sternotomy Thoracotomy Time Factors Treatment Outcome |
| Comments/Corrections | |
Comment In:
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Ann Thorac Cardiovasc Surg. 2010 Jun;16(3):222-3; author reply 223
[PMID:
20930690
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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