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Efficacy of limited proximal arch replacement for type A acute aortic dissection with critical complications

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Abstract

Objective

We assessed the efficacy of limited proximal arch replacement for type A acute aortic dissection (AAD) with critical complications.

Methods

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.

Results

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 %).

Conclusion

Limited proximal arch repair is suitable for high-risk patients with AAD, despite no excision of the intimal tear.

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Abbreviations

AAD:

Type A acute aortic dissection

CPA:

Cardiopulmonary arrest

CT:

Computed tomography

AR:

Aortic valve regurgitation

AMI:

Acute myocardial infarction

PCI:

Percutaneous coronary intervention

LMT:

Left main trunk

CPR:

Cardiopulmonary resuscitation

SD:

Standard deviation

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Nihon University Hospital, 1-6 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan

    Mitsumasa Hata, Yukihiko Orime, Shinji Wakui, Tetsuya Nakamura, Rei Hinoura & Kenji Akiyama

Authors
  1. Mitsumasa Hata
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  2. Yukihiko Orime
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  3. Shinji Wakui
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  4. Tetsuya Nakamura
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  5. Rei Hinoura
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  6. Kenji Akiyama
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Correspondence to Mitsumasa Hata.

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Mitsumasa Hata and other coauthors have no conflicts of interest to declare.

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Hata, M., Orime, Y., Wakui, S. et al. Efficacy of limited proximal arch replacement for type A acute aortic dissection with critical complications. Gen Thorac Cardiovasc Surg 64, 651–656 (2016). https://doi.org/10.1007/s11748-016-0688-2

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  • DOI: https://doi.org/10.1007/s11748-016-0688-2

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