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. 1991 Jul;214(1):31–41. doi: 10.1097/00000658-199107000-00006

Management and long-term outcome of aortic dissection.

D D Glower 1, R H Speier 1, W D White 1, L R Smith 1, J S Rankin 1, W G Wolfe 1
PMCID: PMC1358411  PMID: 2064469

Abstract

All 163 patients admitted to one institution between 1975 and 1988 with aortic dissection were reviewed. Type I and type II patients received grafting of the ascending aorta, with an intraoperative mortality rate of 11%. For type III dissection, management was medical in 53 patients, while 19 required surgery for aortic rupture or expansion, with an intraoperative mortality rate of 11%. The 9- or 10-year survival rates were 29%, 46%, and 29% for types I, II, and III respectively. Of 135 patients with primary aortic dissection, 17 (13%) required subsequent aortic surgery. Cause of late death was other cardiovascular disease in 38%, rupture of another aortic segment in 18%, sudden death in 24%, and other medical conditions in 21%. Although operative therapy for types I and II dissections and reserving operation for selected type III dissections provides acceptable long-term survival, careful follow-up is necessary due to concurrent cardiovascular disease and residual aortic disease.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anagnostopoulos C. E., Prabhakar M. J., Kittle C. F. Aortic dissections and dissecting aneurysms. Am J Cardiol. 1972 Aug;30(3):263–273. doi: 10.1016/0002-9149(72)90070-7. [DOI] [PubMed] [Google Scholar]
  2. Appelbaum A., Karp R. B., Kirklin J. W. Ascending vs descending aortic dissections. Ann Surg. 1976 Mar;183(3):296–300. doi: 10.1097/00000658-197603000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bachet J., Teodori G., Goudot B., Diaz F., el Kerdany A., Dubois C., Brodaty D., de Lentdecker P., Guilmet D. Replacement of the transverse aortic arch during emergency operations for type A acute aortic dissection. Report of 26 cases. J Thorac Cardiovasc Surg. 1988 Dec;96(6):878–886. [PubMed] [Google Scholar]
  4. Bentall H., De Bono A. A technique for complete replacement of the ascending aorta. Thorax. 1968 Jul;23(4):338–339. doi: 10.1136/thx.23.4.338. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bergholm U., Hallén A. Dissecting aneurysm of the descending thoracic aorta. Surgical or medical treatment? Scand J Thorac Cardiovasc Surg. 1984;18(1):45–47. doi: 10.3109/14017438409099382. [DOI] [PubMed] [Google Scholar]
  6. Borst H. G., Laas J., Frank G., Haverich A. Surgical decision making in acute aortic dissection type A. Thorac Cardiovasc Surg. 1987 Nov;35(SPEC):134–135. doi: 10.1055/s-2007-1020274. [DOI] [PubMed] [Google Scholar]
  7. Cachera J. P., Vouhé P. R., Loisance D. Y., Menu P., Poulain H., Bloch G., Vasile N., Aubry P., Galey J. J. Surgical management of acute dissections involving the ascending aorta. Early and late results in 38 patients. J Thorac Cardiovasc Surg. 1981 Oct;82(4):576–584. [PubMed] [Google Scholar]
  8. Cambria R. P., Brewster D. C., Gertler J., Moncure A. C., Gusberg R., Tilson M. D., Darling R. C., Hammond G., Mergerman J., Abbott W. M. Vascular complications associated with spontaneous aortic dissection. J Vasc Surg. 1988 Feb;7(2):199–209. [PubMed] [Google Scholar]
  9. Carey J. S., Skow J. R., Scott C. Retrograde aortic dissection during cardiopulmonary bypass: "nonoperative" management. Ann Thorac Surg. 1977 Jul;24(1):44–48. doi: 10.1016/s0003-4975(10)64570-5. [DOI] [PubMed] [Google Scholar]
  10. Carlson D. E., Karp R. B., Kouchoukos N. T. Surgical treatment of aneurysms of the descending thoracic aorta: an analysis of 85 patients. Ann Thorac Surg. 1983 Jan;35(1):58–69. doi: 10.1016/s0003-4975(10)61432-4. [DOI] [PubMed] [Google Scholar]
  11. Cipriano P. R., Griepp R. B. Acute retrograde dissection of the ascending thoracic aorta. Am J Cardiol. 1979 Mar;43(3):520–528. doi: 10.1016/0002-9149(79)90008-0. [DOI] [PubMed] [Google Scholar]
  12. Crawford E. S., Svensson L. G., Coselli J. S., Safi H. J., Hess K. R. Aortic dissection and dissecting aortic aneurysms. Ann Surg. 1988 Sep;208(3):254–273. doi: 10.1097/00000658-198809000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. DE BAKEY M. E., COOLEY D. A., CREECH O., Jr Surgical considerations of dissecting aneurysm of the aorta. Ann Surg. 1955 Oct;142(4):586-610; discussion, 611-2. doi: 10.1097/00000658-195510000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. DEBAKEY M. E., HENLY W. S., COOLEY D. A., MORRIS G. C., Jr, CRAWFORD E. S., BEALL A. C., Jr SURGICAL MANAGEMENT OF DISSECTING ANEURYSM INVOLVING THE ASCENDING AORTA. J Cardiovasc Surg (Torino) 1964 May-Jun;5:200–211. [PubMed] [Google Scholar]
  15. Daily P. O., Trueblood H. W., Stinson E. B., Wuerflein R. D., Shumway N. E. Management of acute aortic dissections. Ann Thorac Surg. 1970 Sep;10(3):237–247. doi: 10.1016/s0003-4975(10)65594-4. [DOI] [PubMed] [Google Scholar]
  16. Dalen J. E., Alpert J. S., Cohn L. H., Black H., Collins J. J. Dissection of the thoracic aorta. Medical or surgical therapy? Am J Cardiol. 1974 Dec;34(7):803–808. doi: 10.1016/0002-9149(74)90700-0. [DOI] [PubMed] [Google Scholar]
  17. DeBakey M. E., McCollum C. H., Crawford E. S., Morris G. C., Jr, Howell J., Noon G. P., Lawrie G. Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery. 1982 Dec;92(6):1118–1134. [PubMed] [Google Scholar]
  18. Doroghazi R. M., Slater E. E., DeSanctis R. W., Buckley M. J., Austen W. G., Rosenthal S. Long-term survival of patients with treated aortic dissection. J Am Coll Cardiol. 1984 Apr;3(4):1026–1034. doi: 10.1016/s0735-1097(84)80363-0. [DOI] [PubMed] [Google Scholar]
  19. Ergin M. A., O'Connor J., Guinto R., Griepp R. B. Experience with profound hypothermia and circulatory arrest in the treatment of aneurysms of the aortic arch. Aortic arch replacement for acute arch dissections. J Thorac Cardiovasc Surg. 1982 Nov;84(5):649–655. [PubMed] [Google Scholar]
  20. HIRST A. E., Jr, JOHNS V. J., Jr, KIME S. W., Jr Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958 Sep;37(3):217–279. doi: 10.1097/00005792-195809000-00003. [DOI] [PubMed] [Google Scholar]
  21. HUME D. M., PORTER R. R. Acute dissecting aortic aneurysms. Surgery. 1963 Jan;53:122–154. [PubMed] [Google Scholar]
  22. Heinemann M., Laas J., Karck M., Borst H. G. Thoracic aortic aneurysms after acute type A aortic dissection: necessity for follow-up. Ann Thorac Surg. 1990 Apr;49(4):580–584. doi: 10.1016/0003-4975(90)90304-o. [DOI] [PubMed] [Google Scholar]
  23. Hoffman J. I. Maximal coronary flow and the concept of coronary vascular reserve. Circulation. 1984 Aug;70(2):153–159. doi: 10.1161/01.cir.70.2.153. [DOI] [PubMed] [Google Scholar]
  24. Inoue T. Dissecting aneurysm of the aorta--classification and proposal of surgical procedures. Jpn Circ J. 1982 Feb;46(2):201–204. doi: 10.1253/jcj.46.201. [DOI] [PubMed] [Google Scholar]
  25. Jex R. K., Schaff H. V., Piehler J. M., King R. M., Orszulak T. A., Danielson G. K., Pairolero P. C., Pluth J. R., Ilstrup D. Early and late results following repair of dissections of the descending thoracic aorta. J Vasc Surg. 1986 Feb;3(2):226–237. doi: 10.1067/mva.1986.avs0030226. [DOI] [PubMed] [Google Scholar]
  26. Jex R. K., Schaff H. V., Piehler J. M., Orszulak T. A., Puga F. J., King R. M., Danielson G. K., Pluth J. R. Repair of ascending aortic dissection. Influence of associated aortic valve insufficiency on early and late results. J Thorac Cardiovasc Surg. 1987 Mar;93(3):375–384. [PubMed] [Google Scholar]
  27. Kouchoukos N. T., Marshall W. G., Jr, Wedige-Stecher T. A. Eleven-year experience with composite graft replacement of the ascending aorta and aortic valve. J Thorac Cardiovasc Surg. 1986 Oct;92(4):691–705. [PubMed] [Google Scholar]
  28. Lansman S. L., Raissi S., Ergin M. A., Griepp R. B. Urgent operation for acute transverse aortic arch dissection. J Thorac Cardiovasc Surg. 1989 Mar;97(3):334–341. [PubMed] [Google Scholar]
  29. Lemole G. M., Strong M. D., Spagna P. M., Karmilowicz N. P. Improved results for dissecting aneurysms. Intraluminal sutureless prosthesis. J Thorac Cardiovasc Surg. 1982 Feb;83(2):249–255. [PubMed] [Google Scholar]
  30. MCKUSICK V. A., LOGUE R. B., BAHNSON H. T. Association of aortic valvular disease and cystic medial necrosis of the ascending aorta; report of four instances. Circulation. 1957 Aug;16(2):188–194. doi: 10.1161/01.cir.16.2.188. [DOI] [PubMed] [Google Scholar]
  31. Marsalese D. L., Moodie D. S., Vacante M., Lytle B. W., Gill C. C., Sterba R., Cosgrove D. M., Passalacqua M., Goormastic M., Kovacs A. Marfan's syndrome: natural history and long-term follow-up of cardiovascular involvement. J Am Coll Cardiol. 1989 Aug;14(2):422–431. doi: 10.1016/0735-1097(89)90197-6. [DOI] [PubMed] [Google Scholar]
  32. Massimo C. G., Presenti L. F., Marranci P., Favi P. P., Poma A. G., Ponzalli M., Viligiardi R. G. Extended and total aortic resection in the surgical treatment of acute type A aortic dissection: experience with 54 patients. Ann Thorac Surg. 1988 Oct;46(4):420–424. doi: 10.1016/s0003-4975(10)64656-5. [DOI] [PubMed] [Google Scholar]
  33. Miller D. C. Replacement of the transverse aortic arch during emergency operations for type A acute aortic dissection. J Thorac Cardiovasc Surg. 1989 Aug;98(2):310–313. [PubMed] [Google Scholar]
  34. Miller D. C., Stinson E. B., Oyer P. E., Rossiter S. J., Reitz B. A., Griepp R. B., Shumway N. E. Operative treatment of aortic dissections. Experience with 125 patients over a sixteen-year period. J Thorac Cardiovasc Surg. 1979 Sep;78(3):365–382. [PubMed] [Google Scholar]
  35. Mills S. E., Teja K., Crosby I. K., Sturgill B. C. Aortic dissection: surgical and nonsurgical treatments compared. An analysis of seventy-four cases at the University of Virginia. Am J Surg. 1979 Feb;137(2):240–243. doi: 10.1016/0002-9610(79)90154-5. [DOI] [PubMed] [Google Scholar]
  36. Mohr-Kahaly S., Erbel R., Rennollet H., Wittlich N., Drexler M., Oelert H., Meyer J. Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography. Circulation. 1989 Jul;80(1):24–33. doi: 10.1161/01.cir.80.1.24. [DOI] [PubMed] [Google Scholar]
  37. Murday A. J., Pillai R., Magee P. G., Walesby R. K., Wright J. E., Sturridge M. F. Results of surgical repair for dissection of the ascending aorta. Br Heart J. 1987 Jun;57(6):548–551. doi: 10.1136/hrt.57.6.548. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Murphy D. A., Craver J. M., Jones E. L., Bone D. K., Guyton R. A., Hatcher C. R., Jr Recognition and management of ascending aortic dissection complicating cardiac surgical operations. J Thorac Cardiovasc Surg. 1983 Feb;85(2):247–256. [PubMed] [Google Scholar]
  39. Najafi H., Dye W. S., Javid H., Hunter J. A., Goldin M. D., Sherry C. Proceedings: Aortic insufficiency secondary to aortic root aneurysm and/or dissection. J Cardiovasc Surg (Torino) 1976 Jan-Feb;17(1):91–91. [PubMed] [Google Scholar]
  40. Olinger G. N., Schweiger J. A., Galbraith T. A. Primary repair of acute ascending aortic dissection. Ann Thorac Surg. 1987 Oct;44(4):389–393. doi: 10.1016/s0003-4975(10)63798-8. [DOI] [PubMed] [Google Scholar]
  41. Orszulak T. A., Pluth J. R., Schaff H. V., Piehler J. M., Smith H. C., McGoon D. C. Results of surgical treatment of ascending aortic dissections occurring late after cardiac operation. J Thorac Cardiovasc Surg. 1982 Apr;83(4):538–545. [PubMed] [Google Scholar]
  42. Pate J. W., Richardson R. L., Eastridge C. E. Acute aortic dissections. Am Surg. 1976 Jun;42(6):395–404. [PubMed] [Google Scholar]
  43. Pinet F., Froment J. C., Guillot M., Gourdol Y., Meyer P., Loire R., Touboul P., Delahaye J. P., Biron A., Messy P. Prognostic factors and indications for surgical treatment of acute aortic dissections: a report based on 191 observations. Cardiovasc Intervent Radiol. 1984;7(6):257–266. doi: 10.1007/BF02625108. [DOI] [PubMed] [Google Scholar]
  44. Reul G. J., Cooley D. A., Hallman G. L., Reddy S. B., Kyger E. R., 3rd, Wukasch D. C. Dissecting aneurysm of the descending aorta. Improved surgical results in 91 patients. Arch Surg. 1975 May;110(5):632–640. doi: 10.1001/archsurg.1975.01360110178030. [DOI] [PubMed] [Google Scholar]
  45. Rizzoli G., Gregio L., Mazzucco A., Stritoni P., Fracasso A., Brumana T., Gallucci V. Determinants of late survival of 105 patients operated for dissection of the aorta. Eur J Cardiothorac Surg. 1988;2(1):18–24. doi: 10.1016/1010-7940(88)90091-7. [DOI] [PubMed] [Google Scholar]
  46. SPENCER F. C., BLAKE H. A report of the successful surgical treatment of aortic regurgitation from a dissecting aortic aneurysm in a patient with the Marfan syndrome. J Thorac Cardiovasc Surg. 1962 Aug;44:238–245. [PubMed] [Google Scholar]
  47. Seybold-Epting W., Meyer J., Hallman G. L., Cooley D. A. Surgical treatment of acute dissecting aneurysm of the ascending aorta. J Cardiovasc Surg (Torino) 1977 Jan-Feb;18(1):43–48. [PubMed] [Google Scholar]
  48. Sutton M. S., Oldershaw P. J., Miller G. A., Paneth M., Williams B., Braimbridge M. Dissection of the thoracic aorta. A comparison between medical and surgical treatment. J Cardiovasc Surg (Torino) 1981 May-Jun;22(3):195–202. [PubMed] [Google Scholar]
  49. Wheat M. W., Jr Acute dissection of the aorta. Cardiovasc Clin. 1987;17(3):241–262. [PubMed] [Google Scholar]
  50. Wolfe W. G. Acute ascending aortic dissection. Ann Surg. 1980 Nov;192(5):658–666. doi: 10.1097/00000658-198011000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Wolfe W. G., Moran J. F. The evolution of medical and surgical management of acute aortic dissection. Circulation. 1977 Oct;56(4 Pt 1):503–505. doi: 10.1161/01.cir.56.4.503. [DOI] [PubMed] [Google Scholar]
  52. Wolfe W. G., Oldham H. N., Rankin J. S., Moran J. F. Surgical treatment of acute ascending aortic dissection. Ann Surg. 1983 Jun;197(6):738–742. doi: 10.1097/00000658-198306000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]

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