Clinical Analysis of the Operative Results of the Type A Aortic Dissection according to the Location of the Intimal Tear.
- Author:
Hyuck KIM
1
;
Ki Chun CHUNG
;
Heng Ok JEE
;
Jung Ho KANG
;
Won Sang CHUNG
;
Chul Bum LEE
;
Soon Ho CHON
;
Young Hak KIM
Author Information
1. Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University, Korea. yhkim@hanyang.ac.kr
- Publication Type:Original Article
- Keywords:
Aortic aneurysm, ascending;
Aortic Dissection;
Surgical operation;
Risk analysis;
Mortality
- MeSH:
Aorta;
Aorta, Abdominal;
Aorta, Thoracic;
Cardiopulmonary Bypass;
Cause of Death;
Hematoma;
Hemorrhage;
Hospital Mortality;
Humans;
Mortality;
Multiple Organ Failure;
Operative Time;
Retrospective Studies;
Rupture;
Surgical Procedures, Operative
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2004;37(6):517-523
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: The location of intimal tear can vary in type A acute aortic dissection. The aim of this study was to assess the operative result according to the intimal tear site. MATERIAL AND METHOD: From January, 1995 to May, 2003, 18 patients underwent surgery for acute type A aortic dissection. The patients were classified according to the intimal tear site. In Group I (n=11), the intimal tear site was located within the ascending aorta, in Group II (n=7), the intimal tear site was located in the aortic arch, descending aorta, or intramural hematoma only. All clinical data were analyzed retrospectively. RESULT: In Group I, the operative time, cardiopulmonary bypass time, aorta cross clamp time and circulatory arrest time were 381.5+/-81.0 min, 223.5+/-42.5 min, 146.4+/-34.8 min and 36.5+/-17.4 min, respectively; and in group II, 461.7+/-54.0 min, 252.5+/-45.3 min, 162.5+/-45.3 min and 47.0+/-14.4 min respectively. All of those were greater in group II. The overall hospital mortality rate was 27.8% (5/18) and was significantly higher in Group II (57.1%)(p=0.003) compared to that in Group I (9.1%). The causes of death were hemorrhage (n=1) in group I and hemorrhage (n=2), multiple organ failure (n=1), and rupture of abdominal aorta (n=1) in group II. CONCLUSION: Surgical treatment of acute type A aortic dissection with intimal tear in the ascending aorta results in an acceptable mortality rate, but in patients with intimal tear in the aortic arch or descending aorta, the operative mortality still remains high when only ascending aorta replacement was performed. In these circumstances, in order to improve surgical results, efforts to include the intimal tear site in the operative procedure will be needed.
