Paradigm change in the management of patients with acute type A aortic dissection who had prior cardiac surgery.
BACKGROUND
Acute type A aortic dissection (ATAAD) is a life-threatening disease entity. Untreated, it usually results in death due to rupture of the proximal aorta into the pericardial cavity, leading to cardiac tamponade. Should patients who have had prior cardiac surgery presenting with ATAAD be treated emergently with surgery, or should they be managed medically? We herein present preliminary evidence that suggests that medical treatment, at least initially, is the best option for these patients. Surgery is indicated in the follow-up, depending on increased size of the dissection or aorta, or to prevent or treat complications.


METHODS
From January 2004 to November 2009, ten consecutive male patients with prior cardiac surgery were admitted to hospital with the diagnosis of ATAAD. Mean age was 61.90 +/- 14.68 years (range, 36 to 79 years), with nine (90%) males and one (10%) female. All were treated medically as the definitive form of management.


RESULTS
Mean follow-up duration was 14.62 +/- 11.12 months (range, 1 to 31 months). Overall mortality during follow-up was 20% (two patients). Eight patients (80%) are alive and well.


CONCLUSIONS
This initial experience with a small, consecutive series of patients, suggests that medical treatment is an option in the initial management of patients with ATAAD who had prior cardiac surgery. It appears that emergency surgery is seldom needed. A larger series of patients and longer follow-up period are needed prior to recommending this treatment approach for such patients.
Division of Cardiothoracic Surgery, Department of Anesthesiology, University of Miami Miller School of Medicine, and Jackson Memorial Hospital, Miami, Florida 33136, USA.
Mohammed
M
Hassan
Enisa M F
EM
Carvalho
Francisco Igor B
FI
Macedo
Edward
E
Gologorsky
Tomas A
TA
Salerno
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D002305:Cardiac Tamponade / Q000209:etiology; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors