[Management of type A acute aortic dissection--results of the cases with thrombosed false lumen].
By reviewing the outcome, we studied the propriety of our principles for the treatment of type A acute aortic dissection in 45 patients, encountered during the 10-year period between 1981 and 1990. We conducted a comparative study of patients with a thrombosed false lumen (type T) and a patent false lumen (type P) to examine the effect of an acutely thrombosed false lumen on the prognosis of this disease. For the 25 patients treated in the first 6 years (1981-1986), operation was performed as soon as exact diagnosis was made, regardless of the presence of complications and the type or severity of the disease. Early death occurred in 9/20 operated cases and in 4/5 unoperated cases, so 13/25 patients died for a 52.0% mortality rate. For the 20 patients who received treatment in the latter period (1987-1990), we gave priority to conservative treatment for type T cases that were free from complications, and adopted a treatment method attaching greater importance to the resection of intimal tears. As a results, early deaths were observed in only 4 type P patients (20.0%) who underwent operation, a significant better result (p < 0.05). For patients in whom we were able to excise the intimal tear (30.0%, early mortality rate), the results were better than in those in whom the intimal tear were left alone (53.8%). The results were particularly good in type T patients (25.0% of them underwent intimal tear resection and 71.4% underwent no operation for the intimal tear).(ABSTRACT TRUNCATED AT 250 WORDS)
Sasaki
K
K
Department of Thoracic Surgery, Nihon Medical School, Tokyo, Japan.
Tanaka
S
S
Ikeshita
M
M
Sugimoto
T
T
Imura
H
H
Shoji
T
T
Takano
T
T
Tanaka
K
K
Kumazaki
T
T
Oya
T
T
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013927:Thrombosis / Q000601:surgery*; D014654:Vascular Patency