Surgical Therapy of Stanford Type A Acute Aortic Dissection: Dose intimal tear within replaced aortic segment make any differnce in its clinical characteristics

Cho, Gwang Jo; Woo, Jong Su; Sung, Si Chan

Abstract

BACKGROUND: Stanford type A aortic dissection is a sur gical disease which has its intimal tear point somewhere in the aorta. The start ing intimal tear point of the type A aortic dissection has not been a common iss ue in the therapy of the aortic dissection. So we analysed our surgical cases of the type A acute aortic dissection subdivided by the location of intimal tear point. MATERIAL AND METHOD: Between M arch 1991 and July 1999, 40 patients with type A acute aortic dissection underwe nt surgical repair. In 27 patients intimal tear was found within the ascending a orta and aortic arch(Group I), but in 13 patients not found(Group II). All clini cal factors were compared between two groups and analized retrospectively. RESULT: The Group I had more s erious preoperative conditions such as shock, aortic regurgetation, cardiac isch emia and renal failure than the Group II. Group I had more aortic valve abnormal ies. Group II had more hematoma in the false lumen but it had no statistical sig nificance. Group II had more frequent postoperative renal dysfunction than Group I, but Group I had more reoperations from bleeding. The surgical mortality rate was 22.2 % in Group I and 0 % in Group II.
CONCLUSION
The patients with ascending aortic intimal tear point had poor preoperative conditions and more ao rtic valve abnormalities, which resulted in the poor postoperative prognosis. Be sides the patients without ascending aortic intimal tear point developed intraop erative malperfusion of distal organ more frequently. Conclusively the prognosis of the patient without intimal tear in ascending aorta was better than that of the patient with intimal tear in ascending aorta.