Management for Thrombotic Type A Acute Aortic Dissection

DOI
  • Kondo Chiaki
    Department of Cardiovascular Surgery, Mie General Medical Center
  • Maeshiro Ryo
    Department of Cardiovascular Surgery, Mie General Medical Center
  • Inoue Kentarou
    Department of Cardiovascular Surgery, Mie General Medical Center
  • Suzuki Hitoshi
    Department of Cardiovascular Surgery, Mie General Medical Center
  • Fujinaga Kazuya
    Department of Cardiovascular Surgery, Mie General Medical Center
  • Yada Masaki
    Department of Cardiovascular Surgery, Mie General Medical Center

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Other Title
  • 偽腔早期血栓閉塞型の急性A型大動脈解離に対する治療戦略

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Objective: The basics of the treatment for Stanford type A acute aortic dissection are immediate surgical repair of ascending aorta, but emergency operation for the early thrombotic type is not necessarily required. Even if these patients do not have surgical treatment, they heal. In this study, we investigated the results of treatment for the cases of the early thrombotic type A acute aortic dissection, and clarified the validity and the problems of treatment strategies. Methods: Between January 2004 and September 2011, in 75 patients of acute type A aortic dissection that we treated for acute stage, we examined 21 patients in which the false lumen was thrombotic in early phase. Indications of emergency surgery are patients with an ascending aortic diameter of 50 mm or more with a narrowed true lumen. Except for the above patients, we chose conservative treatment. Results: There were 2 cases of emergency aortic surgery, on the other hand, the cases that chose conservative treatment were 19 cases. Pericardiotomy and pericardial drainage was performed in all 10 patients who were accompanied by cardiac tamponade in medical therapy group. All cases survived and were discharged. In the medical therapy group, 12 patients showed complete resolution of the false lumen in the ascending aorta, 4 patients showed decrease in the size of the false lumen, 1 patient showed decrease in the size of the false lumen but the diameter of the ascending aorta increased. One patient showed re-dissections during the follow-up period and the false lumen opened again. One patient dropped out. Conclusion: In patients with Stanford type A acute aortic dissection with the thrombotic false lumen, 2 patients underwent emergency surgical repair of the aorta and remaining 19 patients were treated medically. Because all cases survived, our therapeutic strategy for patients with thrombotic type A acute aortic dissection was suitable and removal of cardiac tamponade is effective lifesaving therapy.

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