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. 1995;22(3):250–254.

Surgical treatment of type A aortic dissections. Results with profound hypothermia and circulatory arrest.

M Ehrlich 1, M Grabenwöger 1, P Simon 1, G Laufer 1, E Wolner 1, M Havel 1
PMCID: PMC337095  PMID: 7580363

Abstract

Type A aortic dissection still presents an emergency situation in cardiac surgery that is associated with high morbidity and mortality rates. There has been a significant improvement in the surgical outcome since the introduction of deep hypothermia and circulatory arrest. In this study, we discuss our results after operative repair of ascending aortic dissections, using deep hypothermia and circulatory arrest. This study presents the results of 67 patients (43 men, 24 women) from 18 through 81 years of age (mean, 54 years) who underwent surgery for type A dissecting aneurysm over a period of 4 years. Type A dissection (52 acute and 15 chronic cases) was due to Marfan syndrome in 12 patients, to atherosclerotic disease of the aorta in 27 patients, and to traumatic injury in 1 patient. Hypertension as the only pathologic finding was observed in 27 patients. Deep hypothermia (confirmed by isoelectric electroencephalogram) and circulatory arrest were induced in all patients. Two patients died intraoperatively due to massive bleeding (intraoperative mortality, 3%). The 30-day mortality rate was 30% (n = 20). Causes of perioperative deaths in order of frequency were multi-organ failure (n = 11), myocardial infarction (n = 2), postoperative bleeding (n = 2), cerebrovascular insult (n = 2), and sepsis (n = 1). The mean intensive care unit stay of the surviving 47 patients (72%) was 8 days, followed by a mean of 21 additional days in the hospital. Our experience with profound hypothermia and circulatory arrest, used in combination with coated grafts, supports our conviction that this is the method of choice for the treatment of type A dissecting aneurysm.

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Selected References

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  1. Bachet J., Gigou F., Laurian C., Bical O., Goudot B., Guilmet D. Four-year clinical experience with the gelatin-resorcine-formol biological glue in acute aortic dissection. J Thorac Cardiovasc Surg. 1982 Feb;83(2):212–217. [PubMed] [Google Scholar]
  2. COOLEY D. A., CREECH O., Jr, DE BAKEY M. E. Surgical treatment of aortic aneurysms. Am Surg. 1956 Nov;22(11):1043–1051. [PubMed] [Google Scholar]
  3. COOLEY D. A., DE BAKEY M. E. Hypothermia in the surgical treatment of aortic aneurysms. Bull Soc Int Chir. 1956 May;15(3):206–215. [PubMed] [Google Scholar]
  4. COOLEY D. A., DE BAKEY M. E. Surgical considerations of excisional therapy for aortic aneurysms. Surgery. 1953 Dec;34(6):1005–1020. [PubMed] [Google Scholar]
  5. COOLEY D. A., DE BAKEY M. E. Surgical considerations of intrathoracic aneurysms of the aorta and great vessels. Ann Surg. 1952 May;135(5):660–680. doi: 10.1097/00000658-195205000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cooley D. A., Livesay J. J. Technique of "open" distal anastomosis for ascending and transverse arch resection. Cardiovasc Dis. 1981 Sep;8(3):421–426. [PMC free article] [PubMed] [Google Scholar]
  7. Cooley Denton A., Romagnoli Alexander, Milam John D., Bossart Mattie I. A method of preparing woven Dacron aortic grafts to prevent interstitial hemorrhage. Cardiovasc Dis. 1981 Mar;8(1):48–52. [PMC free article] [PubMed] [Google Scholar]
  8. DE BAKEY M. E., COOLEY D. A. Excisional therapy of aortic aneurysms. Am Surg. 1953 Jul;19(7):603–612. [PubMed] [Google Scholar]
  9. Diehl J. T., Moon B., LeClerc Y., Wiesel R. D., Salerno T. A., Goldman B. S. Acute type A dissection of the aorta: surgical management with the sutureless intraluminal prosthesis. Ann Thorac Surg. 1987 May;43(5):502–507. doi: 10.1016/s0003-4975(10)60197-x. [DOI] [PubMed] [Google Scholar]
  10. Dietrich W., Mössinger H., Spannagl M., Jochum M., Wendt P., Barankay A., Meisner H., Richter J. A. Hemostatic activation during cardiopulmonary bypass with different aprotinin dosages in pediatric patients having cardiac operations. J Thorac Cardiovasc Surg. 1993 Apr;105(4):712–720. [PubMed] [Google Scholar]
  11. Everts P. A., Berreklouw E., Box H. A., Hessels M. M., Schönberger J. P. Continuous retrograde hypothermic low flow cerebral perfusion during aortic arch surgery. Perfusion. 1994 Mar;9(2):95–99. doi: 10.1177/026765919400900203. [DOI] [PubMed] [Google Scholar]
  12. Griepp R. B., Stinson E. B., Hollingsworth J. F., Buehler D. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg. 1975 Dec;70(6):1051–1063. [PubMed] [Google Scholar]
  13. Havel M., Teufelsbauer H., Knöbl P., Dalmatiner R., Jaksch P., Zwölfer W., Müller M., Vukovich T. Effect of intraoperative aprotinin administration on postoperative bleeding in patients undergoing cardiopulmonary bypass operation. J Thorac Cardiovasc Surg. 1991 Jun;101(6):968–972. [PubMed] [Google Scholar]
  14. 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]
  15. Lenfant C. NHLBI funding policies. Enhancing stability, predictability, and cost control. Circulation. 1994 Jul;90(1):1–1. doi: 10.1161/01.cir.90.1.1. [DOI] [PubMed] [Google Scholar]
  16. McCready R. A., Pluth J. R. Surgical treatment of ascending aortic aneurysms associated with aortic valve insufficiency. Ann Thorac Surg. 1979 Oct;28(4):307–316. doi: 10.1016/s0003-4975(10)63127-x. [DOI] [PubMed] [Google Scholar]
  17. 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]
  18. Raudkivi P. J., Williams J. D., Monro J. L., Ross J. K. Surgical treatment of the ascending aorta. Fourteen years' experience with 83 patients. J Thorac Cardiovasc Surg. 1989 Nov;98(5 Pt 1):675–682. [PubMed] [Google Scholar]
  19. Simon P., Owen A. N., Moidl R., Kupilik N., Anwari A., Grabenwoeger M., Ehrlich M., Mohl W., Wolner E., Havel M. Sinus of Valsalva aneurysm: a late complication after repair of ascending aortic dissection. Thorac Cardiovasc Surg. 1994 Feb;42(1):29–31. doi: 10.1055/s-2007-1016450. [DOI] [PubMed] [Google Scholar]
  20. Sundt T. M., 3rd, Kouchoukos N. T., Saffitz J. E., Murphy S. F., Wareing T. H., Stahl D. J. Renal dysfunction and intravascular coagulation with aprotinin and hypothermic circulatory arrest. Ann Thorac Surg. 1993 Jun;55(6):1418–1424. doi: 10.1016/0003-4975(93)91082-x. [DOI] [PubMed] [Google Scholar]
  21. Svensson L. G., Crawford E. S., Hess K. R., Coselli J. S., Raskin S., Shenaq S. A., Safi H. J. Deep hypothermia with circulatory arrest. Determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg. 1993 Jul;106(1):19–31. [PubMed] [Google Scholar]
  22. Ueda Y., Miki S., Okita Y., Tahata T., Sakai T., Matsuyama K. [The protective effect of continuous retrograde cerebral perfusion on the central nervous system during deep hypothermic systemic circulatory arrest]. Nihon Kyobu Geka Gakkai Zasshi. 1993 Apr;41(4):559–568. [PubMed] [Google Scholar]
  23. Von Oppell U. O., Chimuka D., Brink J. G., Zilla P. Aortic dissection repair with GRF glue complicated by heart block. Ann Thorac Surg. 1995 Mar;59(3):761–763. doi: 10.1016/0003-4975(94)00775-6. [DOI] [PubMed] [Google Scholar]
  24. Westaby S., Forni A., Dunning J., Giannopoulos N., O'Regan D., Drossos G., Pillai R. Aprotinin and bleeding in profoundly hypothermic perfusion. Eur J Cardiothorac Surg. 1994;8(2):82–86. doi: 10.1016/1010-7940(94)90097-3. [DOI] [PubMed] [Google Scholar]
  25. Woloszyn T. T., Marini C. P., Coons M. S., Nathan I. M., Basu S., Acinapura A. J., Cunningham J. N. Cerebrospinal fluid drainage and steroids provide better spinal cord protection during aortic cross-clamping than does either treatment alone. Ann Thorac Surg. 1990 Jan;49(1):78–83. doi: 10.1016/0003-4975(90)90359-e. [DOI] [PubMed] [Google Scholar]
  26. Yoshimura N., Ataka K., Okada M., Yamashita C., Yoshimura K., Kobayashi S. Ophthalmoscopic findings demonstrate reduced cerebral blood flow during retrograde cerebral perfusion. J Thorac Cardiovasc Surg. 1995 Mar;109(3):591–593. doi: 10.1016/S0022-5223(95)70295-4. [DOI] [PubMed] [Google Scholar]

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