[Outcome of emergency surgery for Stanford type A aneurysms: selection of operative procedures and supported systems of cerebral protection].
Fourteen surgical cases of acute dissecting aneurysms of Stanford type A were reported. Clinical symptoms, operative methods, pathophysiology, cerebral protection, supported systems, and prognosis were examined. All patients underwent surgery within 5 days of symptom onset. The patient population consisted 8 males and 6 females with a mean age of 56.6 years. Ascending aortic replacement was performed using a vascular graft 12 patients. ECC was performed under deep hypothermia. Femoral artery cannulation and retrograde cerebral perfusions was performed in all cases. The ascending aorta was the site of entry in 13 of the 14 cases. Whenever feasible, enhanced CT and aortography were performed to confirm the entry lesion. Two patients expired. One patient died intraoperatively due to massive bleeding. The other patient, while hospitalized, experienced a cerebrovascular accident and died due to pneumonia. All other patients ran an uneventful post-operative course without cerebrovascular accident. In conclusion we think that although ascending aorta replacement using prosthetic grafts is not ideal for patients with Stanford type A dissecting aneurysms, it is a viable option for emergency cases. We found retrograde circulatory cerebroplegia (RCCP) to be satisfactory for brain protection during these emergency procedures.
Ichihara
T
T
Department of Cardiovascular Surgery, Tosei General Hospital, Seto, Japan.
Ishida
H
H
Asakura
T
T
Sakai
Y
Y
Yasuura
K
K
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D004630:Emergencies; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome