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The Journal of Cardiovascular Surgery 2000 April;41(2):227-32

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Surgical results of Stanford type B aortic dissection. Comparisons between partial and subtotal replacement of the dissected aorta

Sasaki S., Yasuda K., Kunihara T., Shiiya N., Murashita T., Matsui Y., Sakuma M.

From the Department of Cardiovascular Surgery Hokkaido University, Sapporo, Japan


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Back­ground. Sur­gical ­results for Stan­ford ­type B ­aortic dis­sec­tion ­were ret­ro­spec­tively com­pared ­between the sub­total pros­thetic replace­ment of the thor­a­coab­dom­inal dis­sected ­aorta (STR) and par­tial replace­ment of the ­descending ­aorta at the ­intimal ­tear (PR).
­Methods. ­Twenty-two ­patients (11 ­males and 11 ­females ­with ­mean age of 56.9±2.6 ­years) under­going ­repair of aneu­rysms ­were ana­lyzed. All oper­a­tions ­were per­formed ­with the aid of fem­o­rof­e­moral par­tial car­di­o­pul­mo­nary ­bypass. Recon­struc­tion of the crit­ical ­artery for ­spinal ­cord ­blood ­supply was deter­mined by ­evoked ­spinal ­cord poten­tial (ESP) mon­i­toring in non-­urgent ­cases. Oper­a­tive mor­tality and inci­dence of com­pli­ca­tions ­were com­pared ­between the PR ­group (­Group I; n=15) and the STR ­group (­Group II; n=7).
­Results. ­There ­were one oper­a­tive ­death and one ­late ­death in ­Group I. No ­early or ­late ­deaths ­occurred in ­Group II. Post­op­er­a­tive par­a­plegia ­occurred in 1 ­patient in ­Group I and 2 ­patients in ­Group II. ­Among ­patients under­going selec­tive recon­struc­tion of the crit­ical inter­costal ­arteries, par­a­plegia ­occurred in ­only one ­patient. Inci­dence of post­op­er­a­tive com­pli­ca­tions was not sig­nif­i­cantly dif­ferent ­between ­Group I and ­Group II. Pres­ence of rup­ture (p<0.001) and devel­op­ment of ­acute ­renal ­failure (p<0.05) ­revealed sig­nif­i­cant deter­mi­nants of post­op­er­a­tive mor­tality by mul­ti­var­iate anal­ysis. Oper­a­tive pro­ce­dure did not influ­ence post­op­er­a­tive mor­tality or occur­rence of par­a­plegia.
Con­clu­sions. Oper­a­tive ­results of STR ­with selec­tive recon­struc­tion of the crit­ical ­arteries and PR for ­aortic dis­sec­tion ­were com­par­able. Sub­total replace­ment of the thor­a­coab­dom­inal dis­sected ­aorta is encour­aged to ­apply for ­patients ­with dif­fuse, ­large post­dis­sec­tion aneu­rysms or ­those ­with a ­high ­risk of ­future enlarge­ment of ­remaining ­false chan­nels ­such as ­Marfan syn­drome, ­under ade­quate recon­struc­tion of the crit­ical seg­mental ­arteries.

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