[Surgical treatment of acute type A aortic dissection].
The objective of this study was to evaluate the short-term results of surgical treatment in patients with acute aortic dissection.


METHODS
A retrospective analysis of 38 patients with acute type A aortic dissection who were surgically treated at the Clinic of Cardiac, Thoracic, and Vascular Surgery, Hospital of Kaunas University of Medicine, from January 2004 to December 2007 was conducted. The diagnosis of aortic dissection was confirmed by employing special techniques. Two-dimensional transthoracic echocardiography was performed in 34 (89.5%) patients; transesophageal echocardiography, in 24 (63.1%); computed tomography, in 29 (76.3%); coronagraphy and angiography, in 20 (52.6%). Preoperative shock was reported in 3 (7.9%) and cardiac tamponade in 18 (47.4%) cases. More than half (57.9%) of patients were operated on within the first 24 hours after admission. In the majority of cases (73.7%), the diameter of the aorta exceeded 4 cm. In the presence of type A aortic dissection, all patients underwent surgery on cardiopulmonary bypass; its duration varied from 20 to 485 min, with a mean of 214.6+/-102.9 min. The mean aortic cross-clamp time was 114.5+/-62.7 min. Complete circulatory arrest was needed in the majority of cases (86.8%), and it lasted 2 to 97 min (mean, 27.4+/-18.6 min). During cardiopulmonary bypass, body temperature was decreased to 17-28 degrees C (mean, 18.9+/-1.95 degrees C). The duration of surgery ranged from 1 to 14 hours, with a mean of 6.1+/-2.49 hours. During the early postoperative period, 12 (31.6%) patients died. Postoperative bleeding was seen in 16 (42.1%) patients, and 6 of them died later. Due to prolonged bleeding, 4 (10.5%) patients were left with an open sternum after surgery. Resternotomy was performed in 9 patients; 3 of them died due to multiorgan injury. During postoperative period, cardiogenic shock of various degrees was seen in 7 (18.4%) patients. Central nervous system injury occurred in 9 (23.7%) patients.


CONCLUSIONS
The main risk factor for acute aortic dissection is the diameter of the aorta exceeding 4 cm (diagnosed in 73.7% of cases). The main postoperative complications are bleeding (42.1%), injuries of central nervous system (23.7%), and cardiogenic shock (18.4%).
Department of Cardiac, Thoracic, and Vascular Surgery, Kaunas University of Medicine, Eiveniu 2, Kaunas, Lithuania. sakalauskas_j@hotmail.com
Juozas
J
Sakalauskas
Sarūnas
S
Kinduris
Rimas
R
Benetis
Saulius
S
Giedraitis
Povilas
P
Jakuska
Vladas
V
Tamosiūnas
Ina
I
Aleksoniene
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D000792:Angiography; D001014:Aortic Aneurysm / Q000145:classification / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D003627:Data Interpretation, Statistical; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed