title: Surgical treatment of acute arch dissection.
abstract: OBJECTIVE
  Acute type A arch dissections are rare and no consensus has been reached on their surgical treatment. We studied perioperative risk factors for mortality in arch dissection patients.
  
  
  METHODS
  Between October 1995 and October 2001, 108 patients with acute type A dissection were operated on, of whom 16 had acute arch dissections. Their mean age was 58 +/- 9 (44-77). Surgery involved total arch replacement in 4, hemiarch replacement in 10, and intimal tear repair with pledgeted sutures and ascending aortic replacement in 2.
  
  
  RESULTS
  One patient who underwent total arch replacement died intraoperatively due to bleeding. Both patients who underwent ascending aortic replacement and primary repair of arch tears died 2 days postoperatively, 1 due to bleeding, and the other due to multiorgan failure. In-hospital mortality was thus 18.75%, or 3 of 16. All 3 had cardiac tamponade preoperatively. The 13 survivors were discharged after a mean hospital stay of 11 +/- 6 days. Mean follow-up was 38 +/- 25 months, from 3 months to 6 years. One patient died due to graft infection 3 months postoperatively, but the remaining 12 remain in good condition. Univariate predictors of in-hospital mortality were the type of surgery (primary intimal tear repair) (p = 0.027) and preoperative cardiac tamponade (p = 0.007).
  
  
  CONCLUSIONS
  Surgical treatment of acute type A-arch dissections can be done with reasonable mortality and mid-term survival comparable with those of other subgroups with acute type A dissection. As with series of arch dissections, our patient population is too small to draw specific conclusions, but our experience leads us to conclude that the sites of intimal tears should be resected in acute type A arch dissection.
authors.affiliation: Department of Cardiovascular Surgery, Ege University Medical School, Izmir 35100, Turkey.
authors.forename: Anil Z
authors.initials: AZ
authors.lastname: Apaydin
authors.forename: Fatih
authors.initials: F
authors.lastname: Islamoglu
authors.forename: Hakan
authors.initials: H
authors.lastname: Posacioglu
authors.forename: Tanzer
authors.initials: T
authors.lastname: Calkavur
authors.forename: Tahir
authors.initials: T
authors.lastname: Yagdi
authors.forename: Yuksel
authors.initials: Y
authors.lastname: Atay
authors.forename: Suat
authors.initials: S
authors.lastname: Buket
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome