When is total aortic arch replacement indicated in patients with acute aortic dissection?
BACKGROUND
The purpose of this preliminary study was to evaluate the effectiveness of our surgical strategy for acute aortic dissection with special emphasis on curative resection of the dissected segments of the aorta.


METHODS
Between January 1995 and April 1999, 29 patients underwent surgery for acute aortic dissection. In 16 patients (Group 1) the dissection was limited to the ascending aorta (8 patients - Group 1a) or involved the ascending aorta and the entire aortic arch (8 patients - Group 1b). Complete resection of all dissected aortic segments (ascending aorta or ascending aorta with complete aortic arch) was performed in these cases, extending to the healthy tissue border. 13 patients (Group 2) presented with dissection of the entire aorta). These patients underwent replacement of the proximal part only of the dissected aorta.


RESULTS
Early mortality (within 30 days) and the incidence of perioperative cerebrovascular events was 3.4% and 10.3% respectively. These events all occurred in Group 2. During the follow-up period of up to six years, there were no significant differences between the surviving patients in regards to long-term mortality and morbidity, although a persisting patent false lumen was observed in seven patients from Group 2.


CONCLUSIONS
Extension of ascending aorta replacement to include the complete aortic arch can be accomplished in patients amenable to complete resection of the dissected aorta without increasing operative risk and with good mid-term results. We believe that total aortic arch replacement is indicated in these cases.
Urbanski
Paul P
PP
Clinic of Cardiosurgery, Bad Neustadt, Germany. urbanski@kardiochirurg.de
D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D016019:Survival Analysis