Korean J Thorac Cardiovasc Surg.  2004 Jun;37(6):517-523.

Clinical Analysis of the Operative Results of the Type A Aortic Dissection according to the Location of the Intimal Tear

• Kim H
• Chung KC
• Jee HO
• Kang JH
• Chung WS
• Lee CB
• Chon SH
• Kim YH

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.

Keyword

Aortic aneurysm, ascending; Aortic Dissection; Surgical operation; Risk analysis; Mortality

MeSH Terms

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