[Acute type A aortic dissection].
BACKGROUND
Current surgical results for acute type A aortic dissection has been getting better, though the mortality rate still remains high, up to 10-15% in Japan. Our strategy consists of #1 make the most use of echography for better understanding of hemodynamics; #2 the extent of replacement depends on the site of initial entry; #3 deep hypothermic circulatory arrest and retrograde cerebral perfusion for brain protection.


METHODS
Between January 2000 and December 2003, 45 consecutive patients were treated. Twelve of them had extended replacement of the arch, and 3 had simultaneous root replacement by means of a composite graft.


RESULTS
In hospital mortality was 11% (5 patients). The cause of death was serious organ malperfusion, which had been developed preoperatively, in all patients but 1 who suffered from thoracic aortic obstruction due to newly developed type B aortic dissection.


CONCLUSIONS
The determinant of surgical mortality in patients with acute type A aortic dissection is the presence of serious organ malperfusion. Rapid diagnosis and less invasive treatment for malperfusion is the key to improve the results.
Morota
Tetsuro
T
Department of Cardiothoracic Surgery, University of Tokyo, Faculty of Medicine, Tokyo, Japan.
Takamoto
Shinichi
S
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D015996:Survival Rate