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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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

lingua: Inglese

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


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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