title: Acute type B aortic dissection: surgical therapy.
abstract: BACKGROUND
  Surgery for acute type B aortic dissection is associated with significant mortality. We report the results for 34 consecutive patients who underwent urgent surgery because they met criteria for operation during the acute phase (< 14 days) of acute type B dissection.
  
  
  METHODS
  The average patient age was 64 (32 to 88) years. Indications for surgery were persistent pain (12), threatened exsanguination (18), malperfusion (renal [3], limb [3]), rapid aortic enlargement (4), and uncontrolled hypertension (1). The mean interval from onset of pain to operation was 7 (1 to 14) days. Resection included the proximal descending aorta in 32, the distal aortic arch in 10, extension to the diaphragm in 10, and involved a thoracoabdominal procedure in 3. Surgical techniques included hypothermic circulatory arrest (16 [47%]), distal bypass, monitoring of somatosensory-evoked potentials, sequential intercostal sacrifice (average, 5.6 pairs), cerebrospinal fluid drainage, and steroid administration.
  
  
  RESULTS
  There was no hospital mortality. Important complications occurred in 16 patients (47%): 10 respiratory requiring tracheostomy, six infectious, four dialysis, two myocardial infarctions, and two neurologic (one transient stroke, one paraplegia). Mean intensive care unit and hospital stays were 10 (3 to 32) and 35 (7 to 107) days. Survival at 5 and 10 years was 80% and 57%, respectively (mean follow-up, 5.8 years).
  
  
  CONCLUSIONS
  Patients meeting criteria for urgent surgery have a low perioperative risk for mortality and paraplegia, and are relatively free from long-term aorta-related complications. These findings warrant consideration of earlier surgery for appropriate patients with acute type B aortic dissection.
authors.affiliation: Department of Cardiothoracic Surgery, The Mount Sinai School of Medicine, New York, New York 10029, USA. sllhttxmd@msn.com
authors.forename: Steven L
authors.initials: SL
authors.lastname: Lansman
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.forename: Daniel
authors.initials: D
authors.lastname: Fink
authors.forename: Jan D
authors.initials: JD
authors.lastname: Galla
authors.forename: David
authors.initials: D
authors.lastname: Spielvogel
authors.forename: M Arisan
authors.initials: MA
authors.lastname: Ergin
authors.forename: Randall B
authors.initials: RB
authors.lastname: Griep
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D015996:Survival Rate