Abstract
Background
Hemiarch replacement for acute type A aortic dissection is less invasive than total arch replacement but involves increased risk of late aortic arch dilation because of patent false lumen of the aortic arch. If we can predict this risk, it may be a valuable prognostic indicator for selecting surgical procedures for acute type A aortic dissection.
Methods
We reviewed our surgical experience to predict patent false lumen. From January 2009 to November 2014, we performed 108 hemiarch replacement procedures for acute type A aortic dissection that had patent false lumen of the ascending aortic arch. We identified 56 patients who had preoperative and postoperative contrast-enhanced computed tomography. Patients’ preoperative characteristics, preoperative and postoperative contrast-enhanced computed tomography findings, intraoperative findings and postoperative course were investigated.
Results
Of the 56 patients, 32 (57.1 %) were men and their mean age at surgery was 63.7 ± 11.8 years. Overall in-hospital mortality rate was 7.1 % (4 patients). According to postoperative imaging findings, 56 patients were classified into two groups: group A (39 patients), with patent false lumen, and group B (17 patients), with thrombosed false lumen. Logistic regression analysis revealed that brachiocephalic artery dissection and no tear resection contributed to postoperative patent false lumen of the aortic arch more strongly than did other factors.
Conclusions
Brachiocephalic artery dissection and no tear resection are potential predictors of patent false lumen of the aortic arch after hemiarch replacement.
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References
Suenaga E, Sato M, Fumoto H. Ascending aortic replacement for acute type A aortic dissection in octogenarians. Gen Thorac Cardiovasc Surg. 2016;64:138–43.
Aizawa K, Kawahito K, Misawa Y. Long-term outcomes of tear-oriented ascending/hemiarch replacements for acute type A aortic dissection. Gen Thorac Cardiovasc Surg. 2016;64:403–8.
Rylski B, Beyersdorf F, Kari FA, Schlosser J, Blanke P, Siepe M. Acute type A aortic dissection extending beyond ascending aorta: Limited or extensive distal repair. J Thorac Cardiovasc Surg. 2014;148:949–54.
Di Eusanio M, Berretta P, Cefarelli M, Jacopo A, Murana G, Castrovinci S, et al. Total arch replacement versus more conservative management in type A acute aortic dissection. Ann Thorac Surg. 2015;100:88–94.
Li B, Ma WG, Liu YM, Sun LZ. Is extended arch replacement justified for acute type A aortic dissection? Interact CardioVasc Thorac Surg. 2015;20:120–6.
Rylski B, Milewski RK, Bavaria JE, Vallabhajosyula P, Moser W, Szeto WY, et al. Long-term results of aggressive hemiarch replacement in 534 patients with type A aortic dissection. J Thorac Cardiovasc Surg. 2014;148:2981–5.
Halstead JC, Meier M, Etz C, Spielvogel D, Bodian C, Wurm M, et al. The fate of the distal aorta after repair of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2007;133:127–35.
Kimura N, Tanaka M, Kawahito K, Yamaguchi A, Ino T, Adachi H. Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2008;136:1160–6.
Kimura N, Itoh S, Yuri K, Adachi K, Matsumoto H, Yamaguchi A, et al. Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2015;149:S91–8.
Bing F, Rodiere M, Martinelli T, Monnin-Bares V, Chavanon O, Bach V, et al. Type A acute aortic dissection: Why does the false channel remain patent after surgery? Vasc Endovascular Surg. 2014;48:239–45.
Zieliński T, Wołkanin-Bartnik J, Janaszek-Sitkowska H, Biederman A, Rynkun D, Makowiecka-Cieśla M, et al. Persistent dissection of carotid artery in patients operated on for type A acute aortic dissection—carotid ultrasound follow-up. Int J Cardiol. 1999;70:133–9.
Kamohara K, Furukawa K, Koga S, Yunoki J, Morokuma H, Noguchi R, et al. Surgical strategy for retrograde type A aortic dissection based on long-term outcomes. Ann Thorac Surg. 2015;99:1610–5.
Kawaharada N, Kurimoto Y, Ito T, Koyanagi T, Yamauchi A, Nakamura M, et al. Hybrid treatment for aortic arch and proximal descending thoracic aneurysm: experience with stent grafting for second-stage elephant trunk repair. Eur J Cardiothorac Surg. 2009;36:956–61.
Hiraoka A, Chikazawa G, Tamura K, Totsugawa T, Sakaguchi T, Yoshitaka H. Clinical outcomes of different approaches to aortic arch disease. J Vasc Surg. 2015;61:88–95.
Preventza O, Price MD, Simpson KH, Cooley DA, Pocock E, Kim I, et al. Hemiarch and total arch surgery in patients with previous repair of acute type I aortic dissection. Ann Thorac Surg. 2015;100:833–8.
Malvindi PG, Van Putte BP, Sonker U, Heijmen RH, Schepens MA, Morshuis WJ. Reoperation after acute type A aortic dissection repair: a series of 104 patients. Ann Thorac Surg. 2013;95:922–7.
Acknowledgments
We are greatful to Dr.Kunikazu Hisamochi and Dr.Yutaka Kawakami for helpful discussions.
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Uchino, G., Ohashi, T., Iida, H. et al. Predictors of patent false lumen of the aortic arch after hemiarch replacement. Gen Thorac Cardiovasc Surg 64, 722–727 (2016). https://doi.org/10.1007/s11748-016-0691-7
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DOI: https://doi.org/10.1007/s11748-016-0691-7