Type A aortic aneurysm dissection: causes of development, diagnostic methods and treatment results

  • I. M. Kravchenko National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
  • V. I. Kravchenko National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
  • I. I. Zhekov National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
  • I. A. Osadovska National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
  • I.I. Zinovchyk National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
  • D. V. Gorban National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
DOI: https://doi.org/10.30702/ujcvs/19.3712/077043-047
Keywords: aortic aneurysm, Type A aortic aneurysm dissection

Abstract

Surgical treatment of Type A aortic aneurysm dissection remains one of the most complicated problems in car-diac surgery. The whole surgical treatment experience of such aneurysms by one team is presented in the article. Factors that could have caused the aortic aneurysm (dissection) development are provided. It is shown that experience accumulation, methods improvement of surgical treatment, brain, heart and internal organs protection have allowed to reach the hospital mortality rate of 4.5% over the last 5 years. Data on severe baseline of the operated patients are presented in the paper. It is represented that in the Institute’s experience type A aneurysm dissection accounts for 28.9% of all aneurysms. The vast majority (79.6%) of patients were operated on for acute or subacute type A dissection; 69.2% of patients had type I dissec-tion. All operations were performed under conditions of bypass, moderate hypothermia (30–32 °C) and during the aortic arch replacement (42.4%) – under conditions of deep hypothermia (13–20 °C) and retrograde cerebral perfusion. Surgical correction methods are presented with valve-saving surgeries performed in 63.7% of patients. The surgical treatment results have been shown to be highly dependent on the time of the surgery. Thus, at the initial stage of surgical experience, hospital mortality was 24.1% with a decrease to 16.1% and with a decrease to 4.6% over the last 8 years.

References

  1. Zerbino DD, Kuzyk JuI. [Dissecting aortic aneurysm: clinical masks, features of differential diagnosis]. Klinicheskaja medicina. 2002;5:58–61. Russian.
  2. Sitar LL, Kravchenko ІM, Kravchenko VІ, Maksymenko VB, Zakharova V. P, Popov VV, et al. [Acute type A aortic dissection – problems of diagnosis and organization of emergency care]. Sertsevo-sudynna khirurhiia: shchorichnyk naukovykh prats Asotsiatsii sertsevo-sudynnykh khirurhiv Ukrainy. 2009;17:413–5. Ukrainian.
  3. Aalberts JJJ, Boonstra PW, van den Berg MP, WaterbolkTW.In-hospital mortality and three-year survival after repaired acute type A aortic dissection. Neth Heart J. 2009;17(6):226–31. https://doi.org/10.1007/bf03086252
  4. Amano J, Kuwano H, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2011: Annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg.2013Oct;61(10):578–607. https://doi.org/10.1007/s11748-013-0289-2
  5. Anagnostopoulos CE, Prabhakar MJ, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol.1972Aug;30(3):263–73. https://doi.org/10.1016/0002-9149(72)90070-7
  6. Bachet JE, Termignon JL, Dreyfus G, Goudot B, Martinelli L, Piquois A, Brodaty D, Dubois C, Delentdecker P, Guilmet D. Aortic dissection. Prevalence, cause, and results of late reoperations. J Thorac Cardiovasc Surg. 1994 Aug;108(2):199–205; discussion 205–6.
  7. Bekkers JA, Raap GB, Takkenberg JJ, Bogers AJ. Acute type A aortic dissection: long-term results and reoperations. Eur J Cardiothorac Surg. 2013 Feb;43(2):389–96. https://doi.org/10.1093/ejcts/ezs342
  8. Conway BD, Stamou SC, Kouchoukos NT, Lobdell KW, Khabbaz KR, Murphy E, Hagberg RC. Improved clinical outcomes and survival following repair of acute type A aortic dissection in the current era. Interact Cardiovasc Thorac Surg. 2014 Dec;19(6):971–6. https://doi.org/10.1093/icvts/ivu268
  9. Goda M, Imoto K, Suzuki S, Uchida K, Yanagi H, Yasuda S, Masuda M. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg. 2010 Oct;90(4):1246–50. https://doi.org/10.1016/j.athoracsur.2010.05.069
  10. Inoue Y, Matsuda H, Omura A, Seike Y, Uehara K, Sasaki H, Kobayashi J. What is the optimal surgical strategy for Stanford Type A acute aortic dissection in patients with a patent false lumen at the descending aorta? Eur J Cardiothorac Surg. 2018 Nov 1;54(5):933–9. https://doi.org/10.1093/ejcts/ezy125
  11. Januzzi JL, Isselbacher EM, Fattori R, Cooper JV, Smith DE, Fang J, Eagle KA, Mehta RH, Nienaber CA, Pape LA. Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J Am Coll Cardiol. 2004 Feb 18;43(4):665–9.
  12. Kallenbach K, Kojic D, Oezsoez M, Bruckner T, Sandrio S, Arif R, Beller CJ, Weymann A, Karck M. Treatment of ascending aortic aneurysms using different surgical techniques: a single-centre experience with 548 patients. Eur J Cardiothorac Surg. 2013 Aug;44(2):337–45. https://doi.org/10.1093/ejcts/ezs661
  13. LeMaire SA, Russell L. Epidemiology of thoracic aortic dissection. Nat Rev Cardiol. 2011 Feb;8(2):103–13. https://doi.org/10.1038/nrcardio.2010.187
  14. Michelena HI, Khanna AD, Mahoney D, Margaryan E, Topilsky Y, Suri RM, Eidem B, Edwards WD, Sundt TM 3rd, Enriquez-Sarano M. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA. 2011 Sep 14;306(10):1104–12. https://doi.org/10.1001/jama.2011.1286
  15. Nienaber CA, Fattori R, Mehta RH, Richartz BM, Evangelista A, Petzsch M, Cooper JV, Januzzi JL, Ince H, Sechtem U, Bossone E, Fang J, Smith DE, Isselbacher EM, Pape LA, Eagle KA. Gender-related differences in acute aortic dissection. Circulation. 2004 Jun 22;109(24):3014–21. https://doi.org/10.1161/01.CIR.0000130644.78677.2C
  16. Piccardo A, Regesta T, Pansini S, Concistrè G, Dell’Aquila A, Scarano F, Martinelli L, Passerone G. Should octogenarians be denied access to surgery for acute type A aortic dissection? J Cardiovasc Surg (Torino).2009 Apr;50(2):205–12.
  17. Rylski B, Hoffmann I, Beyersdorf F, Suedkamp M, Siepe M, Nitsch B, Blettner M, Borger MA, Weigang E. Iatrogenic acute aortic dissection type A: insight from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg. 2013 Aug;44(2):353–9; discussion 359. https://doi.org/10.1093/ejcts/ezt055
  18. Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Dissection of the aorta and dissecting aortic aneurysms. Improving early and long-term surgical results. Circulation.1990 Nov;82(5 Suppl):IV24–38.
  19. Wang Y, Wu B, Dong L, Wang C, Shu X. Type A aortic dissection in patients with bicuspid or tricuspid aortic valves: a retrospective comparative study in 288 Chinese patients. Eur J Cardiothorac Surg. 2013 Jul;44(1):172–7. https://doi.org/10.1093/ejcts/ezs613
  20. Yan Y, Xu L, Zhang H, Xu ZY, Ding XY, Wang SW,Xue X, Tan MW. Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic dissection: a meta-analysis. Eur J Cardiothorac Surg. 2016 May;49(5):1392–401. https://doi.org/10.1093/ejcts/ezv351
Published
2020-01-07
How to Cite
1.
Kravchenko IM, Kravchenko VI, Zhekov II, Osadovska IA, Zinovchyk I, Gorban DV. Type A aortic aneurysm dissection: causes of development, diagnostic methods and treatment results. ujcvs [Internet]. 2019Nov.20 [cited 2024Dec.22];(4 (37):43-7. Available from: https://cvs.org.ua/index.php/ujcvs/article/view/316
Issue
Ukrainian Journal of Cardiovascular Surgery No 4 (37) 2019
Section
PATHOLOGY OF AORTA