Efficacy of limited proximal arch replacement for type A acute aortic dissection with critical complications

• Published in: General thoracic and cardiovascular surgery 2016-11, Vol.64 (11), p.651-656
• Main Authors: Hata, Mitsumasa, Orime, Yukihiko, Wakui, Shinji, Nakamura, Tetsuya, Hinoura, Rei, Akiyama, Kenji
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - surgery; Aortic dissection; Brain - blood supply; Brain damage; Brain Ischemia - etiology; Cardiac Surgery; Cardiology; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary resuscitation; Cerebrovascular Circulation; Circulatory Arrest, Deep Hypothermia Induced - adverse effects; Coronary vessels; CPR; Female; Heart attacks; Humans; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Mortality; Operative Time; Original Article; Ostomy; Patients; Pneumonia; Postoperative Complications; Reoperation; Stroke; Subclavian Artery - surgery; Surgery; Surgical Oncology; Survival Rate; Thoracic Surgery; Tracheotomy; Vascular Grafting - adverse effects; Vascular Grafting - methods; Veins & arteries
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-016-0688-2

Objective We assessed the efficacy of limited proximal arch replacement for type A acute aortic dissection (AAD) with critical complications. Methods Sixty-four patients with average age of 64.5 ± 13.0 years, who were intubated prior to arriving at hospital due to cardiopulmonary arrest, cardiac tamponade, or vital organ mal-perfusion, were divided into two groups: group PA consisted of 52 patients undergoing proximal arch repair with mild hypothermic circulatory arrest; group TA consisted of 12 patients who underwent total arch replacement with moderate hypothermia and selective cerebral perfusion. Results The intimal tear on the distal side of the left subclavian artery was not excised in 11 patients (21.2 %) of group PA. The intimal tear was excised in all patients in group TA. The durations of cerebral protection (PA, 18.7; TA, 70.3 min), cardiopulmonary bypass (PA, 121.5; TA, 206 min), and overall operation (PA, 181.8; TA, 403.8 min) were significantly shorter in group PA. The incidence of postoperative brain damage was significantly lower in group PA (9.6 %) than in group TA (33.3 %). The mortality rate was significantly lower in group PA (5.8 %) than in group TA (58.3 %). Distal arch to descending aortic replacement was required in four patients of group PA during follow-up period. There were no complications or mortality during the reoperation. The actuarial survival rate at 10 years was significantly better in group PA (66.5 %) than in group TA (25 %). Conclusion Limited proximal arch repair is suitable for high-risk patients with AAD, despite no excision of the intimal tear.