title: Aortic wrapping for stanford type A acute aortic dissection: short and midterm outcome.
abstract: BACKGROUND
  Conventional surgical treatment of Stanford type A acute aortic dissection (AAD) is associated with considerable in-hospital mortality. As regards very elderly or high-risk patients with type A AAD, some may meet the criteria for less invasive surgery likely to prevent the complications associated with aortic replacement.
  
  
  METHODS
  We have retrospectively analyzed a cohort of patients admitted to our center for Stanford type A AAD and having undergone surgery between 2008 and 2012. The outcomes of the patients having had an aortic replacement under cardiopulmonary bypass (group A) have been compared with the outcomes of the patients who underwent off-pump wrapping of the ascending aorta (group B).
  
  
  RESULTS
  Among the 54 patients admitted for Stanford type A AAD, 15 with a mean age of 77 years [46 to 94] underwent wrapping of the aorta. Regarding the new standard European system for cardiac operative risk evaluation (EuroSCORE II), the median result in our group B patients was 10.47 [5.02 to 30.07]. In-hospital mortality was 12.80% in group A and 6.6% in group B (p=0.66). For patients who underwent external wrapping of the ascending aorta, follow-up mortality rate was 13.3% with a median follow-up of 15 months [range 0 to 47].
  
  
  CONCLUSIONS
  The gold standard in cases of Stanford type A AAD consists of emergency surgical replacement of the dissected ascending aorta. In some cases in which the aortic root is not affected a less invasive surgical approach consisting of wrapping the dissected ascending aorta can be suggested as an alternative.
authors: Department of Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis-Robinson, France. Electronic address: demondion.pierre@hotmail.fr.
authors: Pierre
authors: P
authors: Demondion
authors: Department of Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis-Robinson, France.
authors: Ramzi
authors: R
authors: Ramadan
authors: Department of Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis-Robinson, France.
authors: Alexandre
authors: A
authors: Azmoun
authors: Department of Cardiology, Marie Lannelongue Hospital, Le Plessis-Robinson, France.
authors: François
authors: F
authors: Raoux
authors: Department of Radiology, Marie Lannelongue Hospital, Le Plessis-Robinson, France.
authors: Claude
authors: C
authors: Angel
authors: Department of Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis-Robinson, France.
authors: Rémi
authors: R
authors: Nottin
authors: Department of Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis-Robinson, France.
authors: Philippe
authors: P
authors: Deleuze
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D000792:Angiography / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods; D002423:Cause of Death; D015331:Cohort Studies; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods / Q000401:mortality; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality