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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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

CARDIAC PAPERS 

 ORIGINAL ARTICLES

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

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.

lingua: Inglese


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