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The Journal of Cardiovascular Surgery 1999 February;40(1):111-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Type III dissection according to DeBakey. Comments on 45 cases treated

Zanetti P. P., Sorisio V., Rosa G., Muncinelli M.

From the Department of Surgery Thoracic Aortic Surgery Center General Regional Hospital, Asti, Italy


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Background. There is uncer­tain­ty regard­ing the ­most suit­able ­form of treat­ment for ­both chron­ic and ­even ­more so the ­acute ­forms of DeBakey’s ­type III aor­tic dis­sec­tions. This ret­ro­spec­tive ­study anal­y­ses the indi­ca­tions and meth­ods ­used in 20 ­acute cas­es and 25 chron­ic cas­es of ­type III dis­sec­tion.
Method. The 45 ­patients includ­ed in ­this ­study pre­sent­ed a ­high ­index of oper­abil­ity giv­en ­that ­they ­were select­ed ­from ­more ­than one cor­o­nary ­unit and ­referred to our ser­vice for ­this pur­pose. This ­study ­also con­firmed a ­clear indi­ca­tion for med­i­cal treat­ment in uncom­pli­cat­ed ­acute ­forms, where­as it is nec­es­sary to opt for sur­gery in the ­case of ongo­ing or threat­ened com­pli­ca­tions. In chron­ic ­forms aor­ta diameter and/or throm­bo­sis of the ­false ­lumen are a val­id param­e­ter.
Results. The inci­dence of mor­tal­ity was 33.3% in the 12 ­acute ­forms under­go­ing sur­gery, ­with 4 ­deaths; in the ­case of chron­ic ­forms under­go­ing sur­gery, the inci­dence was 15% ­with 3 ­deaths. Of the 8 ­patients ­with ­acute pathol­o­gy who ­were not oper­at­ed, 87.5% ­died; where­as of the 5 non-oper­at­ed chron­ic ­patients, 60% ­died (3 cas­es). During the ­post-oper­a­tive peri­od rethor­a­cot­o­my was ­only nec­es­sary in 1 ­case fol­low­ing hemo­thor­ax on day 5, where­as at a res­pir­a­to­ry lev­el ­only 50% of ­patients ­were extu­bat­ed with­in 48 ­hours, and in 12 cas­es it was nec­es­sary to con­tin­ue ­until day 5-7, where­as trach­e­os­to­my was per­formed in 5 cas­es.
Conclusions. The mod­ern ten­den­cy in the treat­ment of DeBakey’s ­type III ­acute dis­sec­tions is to opt for sur­gery not ­only in the pres­ence of man­i­fest com­pli­ca­tions, but ­also ­when ­faced ­with threat­ened com­pli­ca­tions or the fail­ure of med­i­cal treat­ment. Chronic ­forms ­present the two key indi­ca­tions for sur­gery, name­ly aneu­rys­mat­ic evo­lu­tion of the ­wall (> 5-6 cm) and ­absent throm­bo­sis of the ­false ­lumen.

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