Aortic dissections type A. Last nine years experience

Objective: Evaluating the patients operated for type A acute aortic dissection between January 2005 and May 2013. Material and method: Two hundred and ninety patients (174 male, 116 female; mean age 55.88years) were admitted for acute aortic dissection type A. In all cases, a transesophageal echography in ICU or on the table was performed to confirm the diagnosis. Among the associated comorbidities, we have followed the prevalence of Marfan syndrome, thoracic aortic aneurysms, prior surgery involving the thoracic aorta and a history of acute myocardial infarction, hypertension and diabetes mellitus. Results: We operated on 290 patients (174 male, 116 female, mean age: 55.88 years), replacing the aortic segment that contained the entry point: the ascending aorta (91 cases), ascending aorta and aortic root (61 cases), ascending aorta and aortic root and arch (14 cases), ascending aorta and hemiarch (65 cases), ascending aorta, aortic root and hemiarch (33 cases), ascending aorta and aortic arch (25 cases), aortic root, ascending aorta, arch and descending aorta (1 cases), arch (1 case). The aortic valve was involved in 129 cases, and we performed valve resuspension, the Bentall procedure, the Yacoub procedure, the Tirone David procedure and valve replacement. Deep hypothermic arrest longer than 10 minutes was performed in all cases. Surgical reexploration was necessary in 26.57% cases, the most common cause being postoperative bleeding. The most frequent complications were cardiovascular dysfunction ( 57.20%), acute renal failure (61.62%), MSOF (39.48%), neurologic disfunction (23.62%) The average patients was intubated for 23.65 hours and he spent 13.6 days in the ICU ward. 29.10% patients was detubated in fi rst day, the average mortality rate was 31.37% (91 patients). Conclusions: Type A acute aortic dissection can prove to be a surgical challenge, requiring many medical resources and thorough knowledge of aortic surgery. However, in experienced centers, the results are more than satisfying.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)