title: Comparison of operative techniques in acute type A aortic dissection performing the distal anastomosis.
abstract: OBJECTIVE
  The aim of our retrospective study was to evaluate early and midterm clinical outcomes of two surgical techniques: open anastomosis in deep hypothermic circulatory arrest (DHCA) compared to anastomosis with clamped aorta while continuing on extracorporeal circulation (CECC).
  
  
  METHODS
  Between November 1997 and February 2002, 67 patients were operated for acute type A aortic dissection. Records of 35 patients with isolated replacement of the ascending aorta without intervention on the aortic arch were retrospectively reviewed. The influence of two techniques (DHCA n = 15, CECC n = 20) on clinical outcome and midterm follow up was investigated.
  
  
  RESULTS
  There were no statistically significant differences in preoperative data. Female gender in the DHCA group was coincidentally more frequent. Intraoperative management did not result in different early clinical outcome. 30-day mortality was not statistically different. Mean follow up time was 20.7 +/- 11.1 months in the DHCA group and 28.7 +/- 14.3 months in the CECC group. One-year and 3-year survival estimates in DHCA group were 85%+/- 7% and 79%+/- 9%, respectively. In the CECC group similar survivals were 80%+/- 10% and 73%+/- 11%, respectively. No statistically significant differences between the two groups were obtained in early or midterm outcome.
  
  
  CONCLUSIONS
  While there is no difference in clinical outcome in surgical treatment of acute type A aortic dissection with or without circulatory arrest, there are some practical technical advantages if the distal anastomosis is performed in an open manner. Probably the long-term outcome too is better with this anastomosis technique.
authors.affiliation: Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany. bernhard.danner@dgn.de
authors.forename: Bernhard C
authors.initials: BC
authors.lastname: Danner
authors.forename: Ehsan
authors.initials: E
authors.lastname: Natour
authors.forename: Michael
authors.initials: M
authors.lastname: Horst
authors.forename: Valentin
authors.initials: V
authors.lastname: Dikov
authors.forename: Probal K
authors.initials: PK
authors.lastname: Ghosh
authors.forename: Otto E
authors.initials: OE
authors.lastname: Dapunt
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005112:Extracorporeal Circulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012107:Research Design; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome