title: Disadvantages of local repair in acute type A aortic dissection.
abstract: BACKGROUND
  In acute type A dissection of the aorta, local repair with glue-aortoplasty was compared with aortic replacement.
  
  
  METHODS
  Between 1992 and 1996, 106 consecutive patients (mean age, 59 years; 84 men) were operated on average 14.5 hours after onset of dissection. A local repair (gelatin-resorcine-formaldehyde/glutaraldehyde glue, Trigon AG, Monchengladbach, Germany) without graft replacement was performed in 21 patients. Graft replacement and reinforcement of aortic stumps with gelatin-resorcine-formaldehyde/glutaraldehyde glue was performed in 85 patients (supracoronary graft, 68; aortic root replacement, 17).
  
  
  RESULTS
  Survival was 79% after 30 days and 69% after 2 years. There was no difference in early mortality (p = 0.2240) and survival (p = 0.07649). Risk factors for early mortality were preoperative shock, neurologic disorder, duration of crossclamp, and extracorporeal circulation. The rate of reoperation on the proximal aorta was 31.6% (6 of 19) after local repair and 9% (6 of 64) after aortic replacement (p = 0.0157). Local repair was a significant predictor for reoperation (p = 0.0087), with decreased reoperation-free survival (p = 0.01164). In all reinterventions (four supracoronary grafts, including two valve replacements; two composite grafts; two arch replacements) breakdown of the aortoplasty was confirmed.
  
  
  CONCLUSIONS
  Local repair has satisfactory early results but an increased incidence of reoperations due to a breakdown of the glue-aortoplasty. Indications for local repair should be restricted to high-risk patients requiring a minimal emergency surgical procedure.
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zürich and City Hospital Triemli, Switzerland.
authors.forename: U
authors.initials: U
authors.lastname: Niederhäuser
authors.forename: Z
authors.initials: Z
authors.lastname: Kaplan
authors.forename: A
authors.initials: A
authors.lastname: Künzli
authors.forename: M
authors.initials: M
authors.lastname: Genoni
authors.forename: G
authors.initials: G
authors.lastname: Zünd
authors.forename: M L
authors.initials: ML
authors.lastname: Lachat
authors.forename: P R
authors.initials: PR
authors.lastname: Vogt
authors.forename: M I
authors.initials: MI
authors.lastname: Turina
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D012086:Reoperation; D015996:Survival Rate