Surgical Treatment of Proximal Aortic Dissection in Patients with Stanford Type A Acute Aortic Dissection

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  • Uchida Tetsuro
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Kim Cholsu
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Maekawa Yoshiyuki
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Oba Eiichi
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Nakamura Ken
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Hayashi Jun
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Yoshimura Yukihiro
    Second Department of Surgery, Yamagata University Faculty of Medicine
  • Sadahiro Mitsuaki
    Second Department of Surgery, Yamagata University Faculty of Medicine

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Other Title
  • Stanford A 型急性大動脈解離における基部進展様式と至適修復法の検討

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Objective : Although dissection extending to the aortic root is a common finding, it is potentially fatal in patients with acute type A aortic dissection. The purpose of this study was to evaluate surgical results of acute type A aortic dissection with proximal involvement. The proximal extension of dissection, types of aortic root procedure and its feasibility were investigated. Methods : Between 1997 and 2011, 80 patients with acute type A aortic dissection underwent emergent operation. Results : Dissection reaching around the coronary artery orifice was observed in 28 patients. In 11 patients, both left and right coronary arteries were involved with aortic dissection. Aortic root replacement was performed in 4 patients. In 7 patients, the dissected aortic root was reinforced by GRF glue and proximal aorta was replaced with a graft. Among these patients, postoperative aortic root redissection with severe aortic regurgitation was observed in 5 patients during postoperative long-term periods. All of them required surgical re-intervention of the aortic root. In 17 patients, dissection was extended to the right coronary artery. Aortic root reconstruction was performed in 2 patients due to pre-existing annulo-aortic ectasia. The remaining 15 patients underwent proximal reinforcement with GRF glue. No patient showed dissection extending to the left coronary artery alone. Operative mortality was 11% and other types of complications concerning the aortic root was not observed. Conclusion : An acceptable outcome was demonstrated with our surgical strategy of proximal aortic dissection. For patients, in particular, with proximal involvement to both the left and right coronary arteries, redissection of the aortic root should be noticed as a late complication with considerable frequency. Special care should be taken for precise recognition of the proximal extension of dissection and appropriate surgical procedure including simultaneous aortic root replacement.

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