title: Evolving strategies for treatment of acute aortic dissection type A.
abstract: OBJECTIVE
  To assess the outcome of 3 different surgical approaches for treatment of acute aortic dissection type A (AADA).
  
  
  RESULTS
  Between October 1990 and October 2003, we operated on 295 patients (pts) for AADA. Follow-up was complete for 257 pts (87%). Supracommissural replacement (SCR) of the ascending aorta was applied to 145 pts, 64 pts received a composite replacement (comp), and 48 pts were treated with the aorta valve-sparing (AVS) reimplantation technique. Pts in SCR were older compared with AVS and comp (P=0.002), gender (overall 65% male, P=0.143) and presence of Marfan syndrome (overall 5%, P=0.109) were comparable. Cannulation of the aorta was performed more often in AVS (58%) than in comp (19%) or SCR (22%; P<0.001). Mean operation time, extracorporeal circulation time, and aortic cross-clamp time differ significantly between groups (P<0.001, respectively). Stay in the intensive care unit (P=0.12) and time of hospitalization (P=0.32) were comparable. Overall perioperative mortality was 24% and did not show significant differences between groups (AVS 10.4% versus comp 28% versus SCR 26%; P=0.053). Incidence of neurological complications was similar between groups (P=0.95). Mean time of follow-up was shorter for AVS (19+/-20 months) compared with comp (48+/-48 months) and SCR (46+/-45 months). Survival at 5 years was comparable with 89% for AVS, 85% for comp, and 80% for SCR (P=0.61). Two patients from AVS (4.1%) required reoperation for failure of the reconstructed valve. Pts in comp required less aortic reoperations than pts in SCR (comp 6.3% versus SCR 22%; P=0.005).
  
  
  CONCLUSIONS
  In acute aortic dissection type A, the reimplantation technique leads to results comparable to established techniques. Complete removal of diseased tissue, low incidence of reoperation, and lack of anticoagulation may favor this approach in selected patients.
authors.affiliation: Hannover Medical School, Department of Thoracic and Cardiovascular Surgery, Hannover, Germany. kallenbach@thg.mh-hannover.de
authors.forename: Klaus
authors.initials: K
authors.lastname: Kallenbach
authors.forename: Timm
authors.initials: T
authors.lastname: Oelze
authors.forename: Rolf
authors.initials: R
authors.lastname: Salcher
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.forename: Matthias
authors.initials: M
authors.lastname: Karck
authors.forename: Rainer G
authors.initials: RG
authors.lastname: Leyh
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D019090:Case Management / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012092:Replantation; D012189:Retrospective Studies; D016896:Treatment Outcome