当前位置： SCI文献检索 > CIRCULATION期刊下所有文献 > Evolving strategies for treatment of acute aortic dissection type A.

Evolving strategies for treatment of acute aortic dissection type A.

Abstract：

OBJECTIVE:To assess the outcome of 3 different surgical approaches for treatment of acute aortic dissection type A (AADA). METHODS AND RESULTS:Between October 1990 and October 2003, we operated on 295 patients (pts) for AADA. Follow-up was complete for 257 pts (87%). Supracommissural replacement (SCR) of the ascending aorta was applied to 145 pts, 64 pts received a composite replacement (comp), and 48 pts were treated with the aorta valve-sparing (AVS) reimplantation technique. Pts in SCR were older compared with AVS and comp (P=0.002), gender (overall 65% male, P=0.143) and presence of Marfan syndrome (overall 5%, P=0.109) were comparable. Cannulation of the aorta was performed more often in AVS (58%) than in comp (19%) or SCR (22%; P<0.001). Mean operation time, extracorporeal circulation time, and aortic cross-clamp time differ significantly between groups (P<0.001, respectively). Stay in the intensive care unit (P=0.12) and time of hospitalization (P=0.32) were comparable. Overall perioperative mortality was 24% and did not show significant differences between groups (AVS 10.4% versus comp 28% versus SCR 26%; P=0.053). Incidence of neurological complications was similar between groups (P=0.95). Mean time of follow-up was shorter for AVS (19+/-20 months) compared with comp (48+/-48 months) and SCR (46+/-45 months). Survival at 5 years was comparable with 89% for AVS, 85% for comp, and 80% for SCR (P=0.61). Two patients from AVS (4.1%) required reoperation for failure of the reconstructed valve. Pts in comp required less aortic reoperations than pts in SCR (comp 6.3% versus SCR 22%; P=0.005). CONCLUSIONS:In acute aortic dissection type A, the reimplantation technique leads to results comparable to established techniques. Complete removal of diseased tissue, low incidence of reoperation, and lack of anticoagulation may favor this approach in selected patients.

journal_name

Circulation

journal_title

Circulation

authors

Kallenbach K,Oelze T,Salcher R,Hagl C,Karck M,Leyh RG,Haverich A

doi

10.1161/01.CIR.0000138948.14144.d6

subject

Has Abstract

pub_date

2004-09-14 00:00:00

pages

II243-9

issue

11 Suppl 1

eissn

0009-7322

issn

1524-4539

pii

110/11_suppl_1/II-243

journal_volume

110

pub_type

杂志文章

在线工具

Evolving strategies for treatment of acute aortic dissection type A.