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The Journal of Cardiovascular Surgery 2021 Feb 10

DOI: 10.23736/S0021-9509.21.11607-6


language: English

A decade of surgical therapy in an all-comer cohort with type A aortic dissection

Jing LI 1 , Matthaeus ZERDZITZKI 1, Daniele CAMBONI 1, Bernhard FLOERCHINGER 1, Christoph UNTERBUCHNER 2, Christof SCHMID 1, Leopold RUPPRECHT 1

1 Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany; 2 Department of Anesthesia, University Medical Center Regensburg, Regensburg, Germany


BACKGROUND: We report on a decade of aortic surgery for type A aortic dissection to assess surgical techniques employed and outcomes over time in an all-comer analysis of a mid-size university cardiosurgical center.
METHODS: 283 patients (189 males and 94 females, mean age 62 years, range 30-85 years), who underwent surgical therapy for type A aortic dissection from 2009 to 2018 in our institution were included in a retrospective statistical analysis.
RESULTS: 55.5 % of patients were hemodynamically stable, 10.3 % came in intubated. A neurological deficit was present in 18.9 % of cases, extremity malperfusion was noted in 17.4 %, and abdominal malperfusion detected in 8.2 %. The extent of the aortic dissection corresponded to DeBakey type I in 88 % of cases, a thoracoabdominal involvement was seen in 64 %. In 51.9 % of patients, only the ascending aorta replaced, another 40.6 % of patients had proximal arch replacement too. A separate stent placement into the descending aorta was achieved in 13.4 % of patients, during surgery (5.7 %) or thereafter (7.7 %). Overall survival to discharge was 79.5 %. Most frequent complications were stroke and paralysis (15.2 %), but only visceral malperfusion (OR 9.0) and heart failure mandating ECMO therapy (OR 29.5) were associated with significantly increased mortality.
CONCLUSIONS: Surgery for type A aortic dissection is still challenging. Along with the refinement of surgical techniques, the indication for the various procedures has moved from a simplified general strategy to a more individualized concept.

KEY WORDS: Type A aortic dissection; Aortic stent; Frozen elephant trunk

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