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- Title
Acute type A aortic dissection. A single center experience.
- Authors
Stiru, Ovidiu; Dorobanțu, Lucian F.; Pasare, Alexandra; Bubenek, Șerban; Filipescu, Daniela; Moldovan, Horațiu; Iliescu, Vlad. A.
- Abstract
Objective - Acute aortic dissection (AAD) is the most frequent and catastrophic manifestation of the so-called acute aortic syndrome (along with intramural hematoma, penetrating aortic ulcer, and ruptured thoracic aortic aneurysm)3. Th e objective of this study was evaluating the cases of acute type A aortic dissection treated in "Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases over the last nine years, creating a more comprehensive image of this pathology. Material and method - 290 patients (174 male, 116 female, mean age: 55.88±12.13 years) were admitted for acute type A aortic dissection (ATAAD) in our Institute between January 2005 and May 2013, in all cases transesophageal echocardiography being performed for diagnostic confirmation. The main demographic, clinical and perioperative characteristics of these patients were followed and the identification of several factors capable of increasing morbidity and mortality rates associated with acute type A aortic dissection was attempted. Results - The distribution of cases was uniform over time, with a slight decrease of 30-day mortality (p=0.985) and intraoperative mortality rates (p=0.119). Mean age was 55.88±12.13 years and men were more oft en affected than women (3:2 gender rate). Ascending aorta replacement was the operation performed with the highest frequency (29.71%) and the lowest mortality rate (16.05%) while the highest one associated with ascending, arch and descending aorta replacement (83.3%). 29.10% patients were extubated in the first postoperative day. The most frequent complications were: acute renal failure (61.62%), low ejection fraction ⩽30% (57.20%), multiple system organ failure (MSOF) (39.48%), neurologic dysfunction (23.62%). Prolonged cardiopulmonary bypass (CPB) time (over 400 minutes, p=0.001) as well as replacement of the descending aorta (p=0.023) or the aortic arch (p=0.009) associated mortality rates of 80% and 50%, respectively. Conclusion - Type A acute aortic dissection is a frequent pathology in the cardiovascular surgical area. Moreover, it can prove to be a surgical challenge, with increased morbidity and mortality, but in experienced centers the results are more than satisfying. In our experience prolonged CPB time (over 400 minutes) as well as aortic arch and descending aorta replacement significantly increased the.
- Subjects
AORTIC dissection; AORTA surgery; TRANSESOPHAGEAL echocardiography; ACUTE kidney failure; CARDIOPULMONARY bypass
- Publication
Romanian Journal of Cardiology, 2014, Vol 24, Issue 4, p251
- ISSN
1220-658X
- Publication type
Article