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Controversies in Aortic Dissection and Aneurysmal Disease pp 227–234Cite as

Surgical Management of Acute Type A Dissection

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Abstract

Acute type A aortic dissection AAAD is a disease of poor prognosis if untreated, with death mostly occurring due to aortic rupture, tamponade, and organ malperfusion. In patients with acute AAAD, surgery represents mainstay of therapy and is centered on excision of the proximal intimal tear, replacement of the supra-coronary ascending aorta and reestablishment of a dominant flow in the distal true lumen. The purpose of this chapter was to review our current surgical algorithms for AAAD management, with a focus on arterial cannulation, management of cardiopulmonary bypass and brain protection, and extent of the surgical repair.

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References

  1. Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg. 2009;37:149–59.

    Article  CAS  PubMed  Google Scholar 

  2. Anagnostopoulos CE, Prabhakar MJ, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol. 1972;30:263–73.

    Article  CAS  PubMed  Google Scholar 

  3. Bonser RS, Ranasinghe AM, Loubani M, Evans JD, Thalji NM, Bachet JE, Carrel TP, Czerny M, Di Bartolomeo R, Grabenwöger M, Lonn L, Mestres CA, Schepens MA, Weigang E. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. J Am Coll Cardiol. 2011;58:2455–74.

    Article  PubMed  Google Scholar 

  4. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, Evangelista A, Fattori R, Suzuki T, Oh JK, Moore AG, Malouf JF, Pape LA, Gaca C, Sechtem U, Lenferink S, Deutsch HJ, Diedrichs H, Marcos y Robles J, Llovet A, Gilon D, Das SK, Armstrong WF, Deeb GM, Eagle KA. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283:897–903.

    Article  CAS  PubMed  Google Scholar 

  5. Erbel R, Alfonso F, Boileau C, Dirsch O, Eber B, Haverich A, Rakowski H, Struyven J, Radegran K, Sechtem U, Taylor J, Zollikofer C, Klein WW, Mulder B, Providencia LA, Task Force on Aortic Dissection; European Society of Cardiology. Diagnosis and management of aortic dissection. Eur Heart J. 2001;22:1642–81.

    Article  CAS  PubMed  Google Scholar 

  6. Biagini E, Lofiego C, Ferlito M, Fattori R, Rocchi G, Graziosi M, Lovato L, di Diodoro L, Cooke RM, Petracci E, Bacchi-Reggiani L, Zannoli R, Branzi A, Rapezzi C. Frequency, determinants, and clinical relevance of acute coronary syndrome-like electrocardiographic findings in patients with acute aortic syndrome. Am J Cardiol. 2007;100:1013–9.

    Article  PubMed  Google Scholar 

  7. Amsterdam EA, Kirk JD, Bluemke DA, Diercks D, Farkouh ME, Garvey JL, Kontos MC, McCord J, Miller TD, Morise A, Newby LK, Ruberg FL, Scordo KA, Thompson PD, American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council on Cardiovascular Nursing, and Interdisciplinary Council on Quality of Care and Outcomes Research. Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation. 2010;122:1756–76.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55:e27–129.

    Article  PubMed  Google Scholar 

  9. Cigarroa JE, Isselbacher EM, DeSanctis RW, Eagle KA. Diagnostic imaging in the evaluation of suspected aortic dissection. Old standards and new directions. N Engl J Med. 1993;328:35–43.

    Article  CAS  PubMed  Google Scholar 

  10. Deeb GM, Patel HJ, Williams DM. Treatment for malperfusion syndrome in acute type A and B aortic dissection: a long-term analysis. J Thorac Cardiovasc Surg. 2010;140:S98–100; discussion S142–6.

    Article  PubMed  Google Scholar 

  11. Yamashita K, Kazui T, Terada H, Washiyama N, Suzuki K, Bashar AH. Cerebral oxygenation monitoring for total arch replacement using selective cerebral perfusion. Ann Thorac Surg. 2001;72:503–8.

    Article  CAS  PubMed  Google Scholar 

  12. Sabik JF, Nemeh H, Lytle BW, Blackstone EH, Gillinov AM, Rajeswaran J, Cosgrove DM. Cannulation of the axillary artery with a side graft reduces morbidity. Ann Thorac Surg. 2004;77:1315–20.

    Article  PubMed  Google Scholar 

  13. Strauch JT, Spielvogel D, Lauten A, Lansman SL, McMurtry K, Bodian CA, Griepp RB. Axillary artery cannulation: routine use in ascending aorta and aortic arch replacement. Ann Thorac Surg. 2004;78:103–8; discussion 103–8.

    Article  PubMed  Google Scholar 

  14. Di Eusanio M, Ciano M, Labriola G, Lionetti G, Di Eusanio G. Cannulation of the innominate artery during surgery of the thoracic aorta: our experience in 55 patients. Eur J Cardiothorac Surg. 2007;32:270–3.

    Article  PubMed  Google Scholar 

  15. Moizumi Y, Motoyoshi N, Sakuma K, Yoshida S. Axillary artery cannulation improves operative results for acute type A aortic dissection. Ann Thorac Surg. 2005;80:77–83.

    Article  PubMed  Google Scholar 

  16. Mazzola A, Gregorini R, Villani C, Di Eusanio M. Antegrade cerebral perfusion by axillary artery and left carotid artery inflow at moderate hypothermia. Eur J Cardiothorac Surg. 2002;21:930–1.

    Article  PubMed  Google Scholar 

  17. Wada S, Yamamoto S, Honda J, Hiramoto A, Wada H, Hosoda Y. Transapical aortic cannulation for cardiopulmonary bypass in type A aortic dissection operations. J Thorac Cardiovasc Surg. 2006;132:369–72.

    Article  PubMed  Google Scholar 

  18. Minatoya K, Karck M, Szpakowski E, Harringer W, Haverich A. Ascending aortic cannulation for Stanford type A acute aortic dissection: another option. J Thorac Cardiovasc Surg. 2003;125:952–3.

    Article  PubMed  Google Scholar 

  19. Tanaka H, Kazui T, Sato H, Inoue N, Yamada O, Komatsu S. Experimental study on the optimum flow rate and pressure for selective cerebral perfusion. Ann Thorac Surg. 1995;59:651–7.

    Article  CAS  PubMed  Google Scholar 

  20. Kazui T, Washiyama N, Muhammad BA, Terada H, Yamashita K, Takinami M, Tamiya Y. Total arch replacement using aortic arch branched grafts with the aid of antegrade selective cerebral perfusion. Ann Thorac Surg. 2000;70:3–8; discussion 8–9.

    Article  CAS  PubMed  Google Scholar 

  21. Di Eusanio M, Schepens MAAM, Morshuis WJ, Dossche KM, Di Bartolomeo R, Pacini D, Pierangeli A, Kazui T, Ohkura K, Washiyama N. Brain protection using antegrade selective cerebral perfusion: a multicenter study. Ann Thorac Surg. 2003;76:1181–8; discussion 1188–9.

    Article  PubMed  Google Scholar 

  22. David TE, Armstrong S, Ivanov J, Barnard S. Surgery for acute type A aortic dissection. Ann Thorac Surg. 1999;67:1999–2001; discussion 2014–9.

    Article  CAS  PubMed  Google Scholar 

  23. Lai DT, Miller DC, Mitchell RS, Oyer PE, Moore KA, Robbins RC, Shumway NE, Reitz BA. Acute type A aortic dissection complicated by aortic regurgitation: composite valve graft versus separate valve graft versus conservative valve repair. J Thorac Cardiovasc Surg. 2003;126:1978–86.

    Article  PubMed  Google Scholar 

  24. Keane MG, Wiegers SE, Yang E, Ferrari VA, St John Sutton MG, Bavaria JE. Structural determinants of aortic regurgitation in type A dissection and the role of valvular resuspension as determined by intraoperative transesophageal echocardiography. Am J Cardiol. 2000;85:604–10.

    Article  CAS  PubMed  Google Scholar 

  25. Halstead JC, Spielvogel D, Meier DM, Rinke S, Bodian C, Malekan R, Ergin MA, Griepp RB. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg. 2005;27:626–32; discussion 632–3.

    Article  PubMed  Google Scholar 

  26. Graeter TP, Langer F, Nikoloudakis N, Aicher D, Schäfers HJ. Valve-preserving operation in acute aortic dissection type A. Ann Thorac Surg. 2000;70:1460–5.

    Article  CAS  PubMed  Google Scholar 

  27. Halstead JC, Meier M, Etz C, Spielvogel D, Bodian C, Wurm M, Shahani R, Griepp RB. The fate of the distal aorta after repair of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2007;133:127–35.

    Article  PubMed  Google Scholar 

  28. Bachet J, Teodori G, Goudot B, Diaz F, el Kerdany A, Dubois C, Brodaty D, de Lentdecker P, Guilmet D. Replacement of the transverse aortic arch during emergency operations for type A acute aortic dissection. Report of 26 cases. J Thorac Cardiovasc Surg. 1988;96:878–86.

    CAS  PubMed  Google Scholar 

  29. Yeh CH, Chen MC, Wu YC, Wang YC, Chu JJ, Lin PJ. Risk factors for descending aortic aneurysm formation in medium-term follow-up of patients with type A aortic dissection. Chest. 2003;124:989–95.

    Article  PubMed  Google Scholar 

  30. Fattori R, Bacchi-Reggiani L, Bertaccini P, Napoli G, Fusco F, Longo M, Pierangeli A, Gavelli G. Evolution of aortic dissection after surgical repair. Am J Cardiol. 2000;86:868–72.

    Article  CAS  PubMed  Google Scholar 

  31. Fattouch K, Sampognaro R, Navarra E, Caruso M, Pisano C, Coppola G, Speziale G, Ruvolo G. Long-term results after repair of type a acute aortic dissection according to false lumen patency. Ann Thorac Surg. 2009;88:1244–50.

    Article  PubMed  Google Scholar 

  32. Kazui T, Washiyama N, Muhammad BA, Terada H, Yamashita K, Takinami M, Tamiya Y. Extended total arch replacement for acute type A aortic dissection: experience with seventy patients. J Thorac Cardiovasc Surg. 2000;119:558–65.

    Article  CAS  PubMed  Google Scholar 

  33. Borst HG, Walterbusch G, Schaps D. Extensive aortic replacement using “elephant trunk” prosthesis. Thorac Cardiovasc Surg. 1983;31:37–40.

    Article  CAS  PubMed  Google Scholar 

  34. Schepens MA, Dossche KM, Morshuis WJ, van den Barselaar PJ, Heijmen RH, Vermeulen FE. The elephant trunk technique: operative results in 100 consecutive patients. Eur J Cardiothorac Surg. 2002;21:276–81.

    Article  PubMed  Google Scholar 

  35. Svensson LG, Kim KH, Blackstone EH, Alster JM, McCarthy PM, Greenberg RK, Sabik JF, D’Agostino RS, Lytle BW, Cosgrove DM. Elephant trunk procedure: newer indications and uses. Ann Thorac Surg. 2004;78:109–16; discussion 109–16.

    Article  PubMed  Google Scholar 

  36. Karck M, Chavan A, Hagl C, Friedrich H, Galanski M, Haverich A. The frozen elephant trunk: a new treatment for thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 2003;125:1550–3.

    Article  PubMed  Google Scholar 

  37. Di Bartolomeo R, Pacini D, Savini C, Pilato E, Martin-Suarez S, Di Marco L, Di Eusanio M. Complex thoracic aortic disease: single-stage procedure with the frozen elephant trunk technique. J Thorac Cardiovasc Surg. 2010;140:S81–5; discussion S86–91.

    Article  PubMed  Google Scholar 

  38. Sun LZ, Qi RD, Chang Q, Zhu JM, Liu YM, Yu CT, Lv B, Zheng J, Tian LX, Lu JG. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation: experience with 107 patients. J Thorac Cardiovasc Surg. 2009;138:1358–62.

    Article  PubMed  Google Scholar 

  39. Gorlitzer M, Weiss G, Meinhart J, Waldenberger F, Thalmann M, Folkmann S, Moidl R, Grabenwoeger M. Fate of the false lumen after combined surgical and endovascular repair treating Stanford type A aortic dissections. Ann Thorac Surg. 2010;89:794–9.

    Article  PubMed  Google Scholar 

  40. Di Eusanio M, Petridis FD, Pacini D, Di Bartolomeo R. Facilitated aortic arch repair with the frozen elephant trunk technique. Eur J Cardiothorac Surg. 2011;40:1261.

    PubMed  Google Scholar 

  41. Ius F, Hagl C, Haverich A, Pichlmaier M. Elephant trunk procedure 27 years after Borst: what remains and what is new? Eur J Cardiothorac Surg. 2011;40:1–11.

    Article  PubMed  Google Scholar 

  42. Di Eusanio M, Armaro A, Di Marco L, Pacini D, Savini C, Martin Suarez S, Pilato E, Di Bartolomeo R. Short- and midterm results after hybrid treatment of chronic aortic dissection with the frozen elephant trunk technique. Eur J Cardiothorac Surg. 2011;40:875.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Cardiovascular Department, Cardiac Surgery, Policlinico S. Orsola-Malphghi Hospital, Alma Mater Studiorum Università di Bologna, Via Massarenti, 9, Bologna, 40138, Italy

    Roberto Di Bartolomeo MD & Marco Di Eusanio MD, PhD

  2. Cardiac Surgery Department, Policlinico Sant’Orsola-Malpighi, University of Bologna, Bologna, Italy

    Marco Di Eusanio MD, PhD

Authors
  1. Roberto Di Bartolomeo MD
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  2. Marco Di Eusanio MD, PhD
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Corresponding author

Correspondence to Marco Di Eusanio MD, PhD .

Editor information

Editors and Affiliations

  1. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Robert S. Bonser

  2. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Domenico Pagano

  3. Thoracic and Cardiovascular Surgery Depts., Hannover Medical School, Hannover, Germany

    Axel Haverich

  4. University Hospitals Birmingham, Queen Elizabeth Hospital & Centre, Birmingham, United Kingdom

    Jorge Mascaro

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Di Bartolomeo, R., Di Eusanio, M. (2014). Surgical Management of Acute Type A Dissection. In: Bonser, R., Pagano, D., Haverich, A., Mascaro, J. (eds) Controversies in Aortic Dissection and Aneurysmal Disease. Springer, London. https://doi.org/10.1007/978-1-4471-5622-2_19

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  • DOI: https://doi.org/10.1007/978-1-4471-5622-2_19

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  • Online ISBN: 978-1-4471-5622-2

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