Clinical significance of anastomotic leak in ascending aortic replacement for acute aortic dissection.
'Anastomotic leak' after ascending aortic replacement for acute aortic dissection, which is determined as direct forward blood flow into the false lumen at the distal anastomosis, prevents the false lumen from being thrombosed. The aim of this study is to determine whether the leak influences on residual aortic growth. Between October 1999 and May 2006, 100 patients presenting for acute type A aortic dissection underwent surgery at our institution. Among the population, 34 patients who underwent ascending aortic replacement and have been followed by computed tomography (CT) for over 6 months were reviewed. On the follow-up CT, maximum diameter of aortic arch and descending aorta were measured and the presence of anastomotic leak was determined. The growth rates of aortic arch and descending aorta in patients diagnosed as having anastomotic leak were greater than patients not having leak (P=0.003, P<0.001, respectively). Initial maximum diameter just after ascending aortic replacement was greater in patients with anastomotic leak than without anastomotic leak in aortic arch and descending aorta (P=0.013, P=0.06). Anastomotic leak after ascending aortic replacement for acute type A aortic dissection contributed to remnant aortic growth. More sophisticated method for reapproximation of dissected aorta should be dictated.
Tanaka
Hiroshi
H
Department of Cardiovascular, Thoracic, and Pediatric Surgery, Kobe University Hospital, Kobe, Japan. hirtanak@hsp.ncvc.go.jp
Okada
Kenji
K
Kawanishi
Yujiro
Y
Matsumori
Masamichi
M
Okita
Yutaka
Y
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013536:Suture Techniques; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D055815:Young Adult