Efficacy of limited proximal arch replacement for type A acute aortic dissection with critical complications
| Autor: | Tetsuya Nakamura, Mitsumasa Hata, Shinji Wakui, Kenji Akiyama, Yukihiko Orime, Rei Hinoura |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Reoperation Pulmonary and Respiratory Medicine medicine.medical_specialty Operative Time Subclavian Artery 030204 cardiovascular system & hematology Brain Ischemia law.invention 03 medical and health sciences Postoperative Complications 0302 clinical medicine law Cardiac tamponade medicine.artery Cardiopulmonary bypass Humans Medicine Survival rate Subclavian artery Aged Aged 80 and over Aortic dissection Aorta Cardiopulmonary Bypass Aortic Aneurysm Thoracic business.industry Brain General Medicine Middle Aged medicine.disease Cardiac surgery Surgery Survival Rate Aortic Dissection Circulatory Arrest Deep Hypothermia Induced 030228 respiratory system Cardiothoracic surgery Cerebrovascular Circulation Female Vascular Grafting Cardiology and Cardiovascular Medicine business |
| Zdroj: | General Thoracic and Cardiovascular Surgery. 64:651-656 |
| ISSN: | 1863-6713 1863-6705 |
| Popis: | We assessed the efficacy of limited proximal arch replacement for type A acute aortic dissection (AAD) with critical complications. Sixty-four patients with average age of 64.5 ± 13.0 years, who were intubated prior to arriving at hospital due to cardiopulmonary arrest, cardiac tamponade, or vital organ mal-perfusion, were divided into two groups: group PA consisted of 52 patients undergoing proximal arch repair with mild hypothermic circulatory arrest; group TA consisted of 12 patients who underwent total arch replacement with moderate hypothermia and selective cerebral perfusion. The intimal tear on the distal side of the left subclavian artery was not excised in 11 patients (21.2 %) of group PA. The intimal tear was excised in all patients in group TA. The durations of cerebral protection (PA, 18.7; TA, 70.3 min), cardiopulmonary bypass (PA, 121.5; TA, 206 min), and overall operation (PA, 181.8; TA, 403.8 min) were significantly shorter in group PA. The incidence of postoperative brain damage was significantly lower in group PA (9.6 %) than in group TA (33.3 %). The mortality rate was significantly lower in group PA (5.8 %) than in group TA (58.3 %). Distal arch to descending aortic replacement was required in four patients of group PA during follow-up period. There were no complications or mortality during the reoperation. The actuarial survival rate at 10 years was significantly better in group PA (66.5 %) than in group TA (25 %). Limited proximal arch repair is suitable for high-risk patients with AAD, despite no excision of the intimal tear. |
| Databáze: | OpenAIRE |
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