| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1998;66:402-411
© 1998 The Society of Thoracic Surgeons
a Department of Surgery, The Methodist Hospital and Baylor College of Medicine, Houston, Texas, USA
Address reprint requests to Dr Safi, 6550 Fannin, Suite 1603, Houston, TX 77030
Presented at the Forty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Naples, FL, Nov 6–8, 1997.
Background. We reviewed our experience in the repair of acute and chronic aortic dissection with regard to early neurologic deficit and death.
Methods. Between February 1991 and June 1996, we performed 206 operations on 195 patients for aortic dissection. Ascending or arch repair, or a combination (type A dissection) was performed on 92 of 206 patients (45%); 44 of 92 (48%) were acute dissection and 48 of 92 (52%) were chronic. Descending or thoracoabdominal repair (type B dissection) was performed on 114 of 206 patients (55%); 22 of 114 (19%) were acute and 92 of 114 (81%) were chronic.
Results. Among type A cases, strokes occurred in 6 of 92 patients (7%) overall; 4 of 44 (9%) were acute cases and 2 of 48 (4%) were chronic (p < 0.34). Early deaths for type A were 11 of 92 (12%) overall; 9 of 44 (20%) acute and 2 of 48 (4%) chronic (p < 0.02). In type B cases, neurologic complications were 15 of 114 (13%) overall; 7 of 22 (32%) were acute cases and 8 of 92 (9%) were chronic (p < 0.004). Early deaths for type B were 12 of 114 (11%) overall; 3 of 22 (14%) acute and 9 of 92 (10%) chronic (p < 0.6). Preoperative hypotension was significant in acute type A patients, with strokes in 2 of 7 (29%) hypotensives compared with 2 of 37 (5%) normotensives (p < 0.05) and early death in 4 of 7 (57%) hypotensives versus 5 of 37 (14%) normotensives (p < 0.009).
Conclusions. Morbidity and mortality for repair of chronic dissection types A and B were acceptable. Preoperative hypotension in acute type A dissection was a major predisposing factor toward stroke (29% versus 5%, p < 0.05). Acute type B dissection had acceptable mortality (14%) but a high rate of neurologic complications (32%).
This article has been cited by other articles:
|
|
 |
|
  J. P. Verhoye, D. C. Miller, D. Sze, M. D. Dake, and R. S. Mitchell Complicated acute type B aortic dissection: midterm results of emergency endovascular stent-grafting. J. Thorac. Cardiovasc. Surg., August 1, 2008; 136(2): 424 - 430. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Matsuyama, Y. Narita, A. Usui, T. Akita, H. Oshima, and Y. Ueda Entry Closure and Aortic Tailoring for Chronic Type B Aortic Dissection Asian Cardiovasc Thorac Ann, June 1, 2008; 16(3): 249 - 251. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. B. Reece, G. R. Green, and I. L. Kron Aortic Dissection Card. Surg. Adult, January 1, 2008; 3(2008): 1195 - 1222. [Full Text]
|
|
|
|
 |
|
 C. Gaul, W. Dietrich, I. Friedrich, J. Sirch, and F. J. Erbguth Neurological Symptoms in Type A Aortic Dissections Stroke, February 1, 2007; 38(2): 292 - 297. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Rampoldi, S. Trimarchi, K. A. Eagle, C. A. Nienaber, J. K. Oh, E. Bossone, T. Myrmel, G. M. Sangiorgi, C. De Vincentiis, J. V. Cooper, et al. Simple Risk Models to Predict Surgical Mortality in Acute Type A Aortic Dissection: The International Registry of Acute Aortic Dissection Score Ann. Thorac. Surg., January 1, 2007; 83(1): 55 - 61. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Ates and A. U. Gullu Which temperature is better in acute type A aortic dissection? Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 138 - 138. [Full Text] [PDF]
|
|
|
|
|
|
M. Ates Which suture technique is better in acute type A aortic dissection? Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 199 - 199. [Full Text] [PDF]
|
|
|
|
|
|
F. Santini, G. Montalbano, A. Messina, A. D'Onofrio, G. Casali, F. Viscardi, G. B. Luciani, and A. Mazzucco Survival and quality of life after repair of acute type A aortic dissection in patients aged 75 years and older justify intervention Eur. J. Cardiothorac. Surg., March 1, 2006; 29(3): 386 - 391. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Kawaharada, K. Morishita, J. Fukada, Y. Hachiro, Y. Fujisawa, T. Saito, Y. Kurimoto, and T. Abe Stroke in surgery of the arteriosclerotic descending thoracic aortic aneurysms: influence of cross-clamping technique of the aorta Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 622 - 625. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. L. Estrera, Z. Garami, C. C. Miller III, R. Sheinbaum, T. T.T. Huynh, E. E. Porat, B. S. Allen, and H. J. Safi Cerebral monitoring with transcranial Doppler ultrasonography improves neurologic outcome during repairs of acute type A aortic dissection J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 277 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Trimarchi, C. A. Nienaber, V. Rampoldi, T. Myrmel, T. Suzuki, R. H. Mehta, E. Bossone, J. V. Cooper, D. E. Smith, L. Menicanti, et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 112 - 122. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Chiappini, M. E. Tan, W. Morshuis, H. Kelder, K. Dossche, and M. Schepens Surgery for acute type a aortic dissection: is advanced age a contraindication? Ann. Thorac. Surg., August 1, 2004; 78(2): 585 - 590. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Kawachi, A. Nakashima, Y. Toshima, T. Kosuga, K. Imasaka, and H. Tomoeda Stroke in Thoracic Aortic Surgery: Outcome and Risk Factors Asian Cardiovasc Thorac Ann, March 1, 2003; 11(1): 52 - 57. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. LeMaire, C. C. Miller III, L. D. Conklin, Z. C. Schmittling, and J. S. Coselli Estimating group mortality and paraplegia rates after thoracoabdominal aortic aneurysm repair Ann. Thorac. Surg., February 1, 2003; 75(2): 508 - 513. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. R. Green and I. L. Kron Aortic Dissection Card. Surg. Adult, January 1, 2003; 2(2003): 1095 - 1122. [Full Text]
|
|
|
|
|
|
U. Herold, J. Piotrowski, D. Baumgart, H. Eggebrecht, R. Erbel, and H. Jakob Endoluminal stent graft repair for acute and chronic type B aortic dissection and atherosclerotic aneurysm of the thoracic aorta: an interdisciplinary task Eur. J. Cardiothorac. Surg., December 1, 2002; 22(6): 891 - 897. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Bonser, C. H. Wong, D. Harrington, D. Pagano, M. Wilkes, T. Clutton-Brock, and M. Faroqui Failure of retrograde cerebral perfusion to attenuate metabolic changes associated with hypothermic circulatory arrest J. Thorac. Cardiovasc. Surg., May 1, 2002; 123(5): 943 - 950. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Harrington, C. H. Wong, and R. S. Bonser Neurological Complications of Aortic Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2002; 6(1): 7 - 16. [Abstract] [PDF]
|
|
|
|
|
|
N. Ad, P. Lee, and J. L Cox Type A aortic dissection with associated anomaly of the carotid and vertebral vessels J. Thorac. Cardiovasc. Surg., March 1, 2002; 123(3): 570 - 571. [Full Text] [PDF]
|
|
|
|
|
|
Y. Takahara, Y. Sudo, K. Mogi, M. Nakayama, and M. Sakurai Total aortic arch grafting for acute type A dissection: analysis of residual false lumen Ann. Thorac. Surg., February 1, 2002; 73(2): 450 - 454. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H. Mehta, T. Suzuki, P. G. Hagan, E. Bossone, D. Gilon, A. Llovet, L. C. Maroto, J. V. Cooper, D. E. Smith, W. F. Armstrong, et al. Predicting Death in Patients With Acute Type A Aortic Dissection Circulation, January 15, 2002; 105(2): 200 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. S.H. Tan, J. C. Kelder, W. J. Morshuis, and M. A.A.M. Schepens Risk stratification in acute type A dissection: proposition for a new scoring system Ann. Thorac. Surg., December 1, 2001; 72(6): 2065 - 2069. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kawahito, H. Adachi, A. Yamaguchi, and T. Ino Preoperative risk factors for hospital mortality in acute type A aortic dissection Ann. Thorac. Surg., April 1, 2001; 71(4): 1239 - 1243. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Sinatra, G. Melina, I. Pulitani, B. Fiorani, G. Ruvolo, and B. Marino Emergency operation for acute type A aortic dissection: neurologic complications and early mortality Ann. Thorac. Surg., January 1, 2001; 71(1): 33 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kawahito, H. Adachi, A. Yamaguchi, and T. Ino Early and late surgical outcomes of acute type a aortic dissection in patients aged 75 years and older Ann. Thorac. Surg., November 1, 2000; 70(5): 1455 - 1459. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Reardon, R. J. Brewer, S. A. LeMaire, J. C. Baldwin, and H. J. Safi Surgical management of primary aortoesophageal fistula secondary to thoracic aneurysm Ann. Thorac. Surg., March 1, 2000; 69(3): 967 - 970. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Okita, O. Tagusari, K. Minatoya, M. Ando, S. Kitamura, N. Nakajima, and S. Takamoto Is distal anastomosis only to the true channel in chronic type B aortic dissection justified? Ann. Thorac. Surg., November 1, 1999; 68(5): 1586 - 1591. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
