Aortic Dissection Stanford Type Research Articles

Acute Aortic Dissection Type A in Younger Patients (< 60 Years Old) - Does Full Arch Replacement Provide Benefits Compared to Limited Approach?

Acute aortic dissection Stanford type A (AADA) is a surgical emergency associated with high morbidity and mortality. Although surgical management has improved, the optimal therapy is a matter of debate. Different surgical strategies have been proposed for patients under 60 years old. This paper evaluates the postoperative outcome and the need for secondary aortic operation after a limited surgical approach (proximal arch replacement) vs. extended arch repair. Between January 2000 and January 2018, 530 patients received surgical treatment for AADA at our hospital; 182 were under 60 years old and were enrolled in this study - Group A (n=68), limited arch repair (proximal arch replacement), and group B (n=114), extended arch repair (> proximal arch replacement). More pericardial tamponade (P=0.005) and preoperative mechanical resuscitation (P=0.014) were seen in Group A. More need for renal replacement therapy (P=0.047) was seen in the full arch group. Mechanical ventilation time (P=0.022) and intensive care unit stay (P<0.001) were shorter in the limited repair group. Thirty-day mortality was comparable (P=0.117). New onset of postoperative stroke was comparable (Group A four patients [5.9%] vs. Group B 15 patients [13.2%]; P=0.120). Long-term follow-up did not differ significantly for secondary aortic surgery. Even though young patients received only limited arch repair, the outcome was comparable. Full-arch replacement was not beneficial in the long-time follow-up. A limited approach is justified in the cohort of young AADA patients. Exemptions, like known Marfan syndrome and the presence of an intimal tear in the arch, should be considered.

Direct open aortic cannulation under temporary retrograde cerebral flush perfusion in acute aortic dissection Stanford type A—a case report

Direct open aortic cannulation under temporary retrograde cerebral flush perfusion in acute aortic dissection Stanford type A—a case report

A Case of Paraplegia Treated with Cerebrospinal Fluid Drainage and Permissive Hypertension after Graft Replacement of the Ascending Aorta and the Total Aortic Arch for Acute Aortic Dissection Stanford Type A.

Paraplegia after an operation for acute aortic dissection Stanford type A (AADA) is fairly uncommon, and there is no consensus about optimal treatment. We present a case in which cerebrospinal fluid drainage (CSFD) and permissive hypertension were used for treatment of paraplegia. When the patient showed complete bilateral paraplegia after operation for AADA, we immediately began CSFD and maintained mean arterial blood pressure at over 90 mmHg. His neurological deficit gradually recovered, and he was eventually able to walk without support. The combination of CSFD and permissive hypertension could be a first-line emergent treatment for postoperative paraplegia after AADA surgery.

Total Aortic Arch Replacements With a 4 Branched Frozen Elephant Trunk (FET) Graft in Acute Aortic Dissection (DeBakey type I)

Total Aortic Arch Replacements With a 4 Branched Frozen Elephant Trunk (FET) Graft in Acute Aortic Dissection (DeBakey type I)

The effect of leisure activities on acute aortic dissection Stanford type A complicated by dementia upon discharge from the hospital:

The effect of leisure activities on acute aortic dissection Stanford type A complicated by dementia upon discharge from the hospital:

Thoracic Endovascular Aortic Repair for Descending Aortic Aneurysm due to Triple-Channeled Chronic Aortic Dissection Stanford Type B in an Elderly Patient with Marfan Syndrome

Thoracic Endovascular Aortic Repair for Descending Aortic Aneurysm due to Triple-Channeled Chronic Aortic Dissection Stanford Type B in an Elderly Patient with Marfan Syndrome

A Mycobacterium chimaera infection after 12 years since cardiac surgery: a case report

Abstract Issues Mycobacterium chimaera bacterium, firstly identified in 2004, is mainly present in drinking water but is generally not harmful for human health. Incubation period ranges from 3 to 72 months, with a median of 17 months. Clinical signs are fever, weakness and weight loss. The infection has a lethality rate of 50%. Invasive infections are associated to the use of Heater-Cooler-Devices (HCD) in cardiovascular surgery. Description of the Problem This work reports on an unexpected Mycobacterium chimaera infection case occurred after a time period much longer than what literature reports for both incubation and surgical infection. In January 2007, a 67-year-old man underwent cardiac surgery for an aortic dissection Stanford type A, with implantation of an ascending aorta prosthesis at Udine Academic Hospital (Italy). After a chronic heart failure relapse occurred in September 2018, he developed fever of unknown origins, sepsis, and then he underwent surgery to substitute the vascular prothesis. In January 2019 the clinical condition of the patient got worse and he died in September 2019. Results The first level bacterial culture turned out to be positive for Mycobacteria, so the second level molecular biology test was carried out with GenoType NTM-DR. This analysis revealed a specific positivity for Mycobacterium chimaera. The confirmation test on the Heater-Cooler-Device (HCD) could not be carried out as this device was scrapped since years. Lessons This case report suggests that Mycobacterium chimaera incubation period can be extremely variable. Therefore, when performing differential diagnosis, it should be considered even for those patients who underwent cardiac surgery more than 5 years prior clinical manifestation. We suggest extending the current ECDC's exposure criteria, assuming that incubation period could cover the entire patient's life. Key messages Mycobacterium chimaera can have an incubation period much longer than what is usually described in literature and ECDC guidelines. This report can be considered a starting point to improve the hospital infection control surveillance system in hospitals performing cardiac surgery.

Acute thoracic aortic dissection: a case report

Introduction: Aortic dissection (AD) is the most common aortic emergency, result in a catastrophic outcome. Patients usually asymptomatic, some of them present with sudden severe, tearing or sharp back or anterior chest pain and haemodynamic disturbance. Early and accurate diagnosis and treatment determine the patient outcome.Case Report: A case of 40 years old man complained of acute, sharp, chest pain since 4 days before admission which worsen instead of medical treatment, with a history of smoking since a few years ago. A vital sign was within normal limit. Laboratory result showed high CKMB, troponin T, LDH result. Occasional ventricular extrasystoles and inferior ischaemic was found in the ECG examination. From echocardiography, the patient suspected to have aortic dissection Stanford type A since an intimal flap on ascending aorta was found, with left ventricle hypertrophy, dilatation of right atrium and right ventricle, severe aortic regurgitation, moderate mitral regurgitation, severe tricuspid regurgitation, moderate pulmonary regurgitation and moderate pulmonary hypertension. From plain radiography, the patient showed mediastinum widening and cardiomegaly, CT angiography showed Stanford type A aortic dissection (DeBakey type I). The patient refused to seek further treatment for operation as suggested.Conclusion: It is still challenging to differentiate aortic dissection (AD) and another acute chest emergency. Since clinical presentation and laboratory result may be similar between those illnesses. Therefore careful history taking and further imaging examination should be considered to increase the patient outcome.

Preliminary results of spot-stent grafting in Stanford type B aortic dissection and intramural haematoma.

Optimal treatment for patients with diseased proximal landing zones in acute/subacute Stanford type B dissection and intramural haematoma remains unclear. This study describes the preliminary outcomes of a localized endovascular treatment [spot-stent grafting (SSG)] of main entries/intramural blood pooling located downstream (aortic zones 4 and 5) using one single short device comprising diseased landing zones, looking particularly at the technical and morphological outcomes. Patients undergoing thoracic endovascular aortic repair (TEVAR) for acute/subacute aortic dissection Stanford type B/intramural haematoma Stanford type B between 1997 and 2018 were identified from a prospectively maintained institutional database. In a total of 183 cases, 22 patients (7 women; median age 62 years; range 35-79 years) received SSG. The primary study end point was technical success. The primary morphological end point was false lumen thrombosis/aortic remodelling. Secondary end points were TEVAR-related mortality/morbidity and reinterventions. The median follow-up was 28.5 months (5 days-15.6 years). The primary technical success rate was 100% (22/22). During follow-up, false lumen thrombosis was seen in 21 patients (95.5%) at a median of 6 days (0 days to 2.7 years) after the index procedure (limited/extended false lumen thrombosis: n = 9 vs 12). Aortic remodelling was achieved in 15 of 22 patients (68.2%) at a median of 360 days (3 days to 7.2 years). Limited/extended remodelling was observed in 8/15 and 7/15, respectively. Retrograde dissection or stent graft-induced new entry was not observed. No stroke or spinal cord injury occurred. Reinterventions were performed in 4/22 cases. The in-hospital mortality and 30-day mortality were 0%. Overall mortality during the follow-up period was 22.7% (5/22). This study shows favourable technical and morphological results for SSG in selected patients with acute/subacute aortic dissection Stanford type B/intramural haematoma Stanford type B. Patient allocation to SSG remains individual. Prospective large-scale long-term data may allow refinement of the application.

Conservative Treatment of Thrombosed Type Acute Aortic Dissection Involving the Ascending Aorta Successfully Leads to Remodeling

Introduction - The preferred treatment for non-thrombosed acute aortic dissection of the ascending aorta is surgical intervention [1-3]. For thrombosed type dissection of the ascending aorta best treatment remains debatable. Studies from Asia have recently shown medical treatment to be a reasonable alternative for this specific subgroup [4-8]. Absence of an intimal tear is thought to be important for a safe conservative treatment strategy. In this case report we present a patient with acute aortic dissection Stanford type A with an entry tear and thrombosis of the false lumen of the ascending aorta who was managed with conservative treatment. Methods - A 69-year-old white female was referred to our center with acute onset of upper abdominal and back pain. She was hemodynamically stable with no signs of shock. The patient had multiple peripheral vascular bypasses in the year before admission and an aortic tube graft seven years earlier for an infrarenal inflammatory aneurysm. Computer tomography angiography (CTA) showed a circular intramural hematoma (maximum diameter 5mm) from the aortic root to the proximal descending aorta where a penetrating atherosclerotic ulceration was visible 7 cm from the origin of the left subclavian artery with asymmetric intramural hematoma blood pools in the descending aorta. There was no sign of pleural effusion, pericardial effusion, or organ ischemia. The echocardiogram showed good left ventricular function without aortic valve regurgitation and a moderately dilated ascending aorta to 4.2 cm with a thickened wall. The combination of an entry tear distal from the left subclavian artery and intramural hematoma of the ascending aorta provided a treatment dilemma, since it is difficult to treat both lesions using a single approach. The upper abdominal and back pain had subsided at presentation to our center and the patient was clinically stable; therefore we opted for a conservative approach with close observation. The patient was admitted to the intensive care unit and antihypertensive therapy aimed at maximum systolic pressure of 100 mmHg was initiated, with re-evaluation multiple times every shift. Follow up CTAs were performed on days 2, 3, 10, 14, 21 and 28. During her hospital stay, the patient occasionally experienced mild pain, which responded well to medication. With systolic blood pressures of 130mmHg, on day 10 the intramural hematoma (IMH) in the ascending aorta had grown to 10mm. With tighter blood pressure control the IMH decreased and no further progression in hematoma thickness or aortic diameter was observed on subsequent CTA scans. Progression of the intramural blood pools in the descending aorta was treated conservatively. Follow up 4 weeks after discharge (day 59) showed remodeling of the ascending aorta with persistent blood pools in the descending aorta and only minimal further dilatation. Results - CT-angiogram on day 10 (left) vs day 59 (right) showing resolution of the intramural hematoma and remodeling of the ascending aorta. Conclusion - Dissection involving the ascending aorta is a life-threatening condition for which operative treatment is recommended in most cases. In thrombosed dissection, conservative therapy with close observation and willingness to convert to immediate surgery may be considered. This approach can lead to complete remodeling of the ascending aorta.

Surgical treatment of acute aortic dissection Stanford type A in the third trimester of pregnancy: A case report.

BackgroundAortic dissection is rare in pregnancy, but it is often life-threatening. Thus, early diagnosis and optimal treatment are crucial. In addition, regular multidisciplinary care plays an important role in improving the therapeutic outcome.CaseA 31-year-old pregnant woman (gravida 2, para 1, abortus 0) was transferred to our centre at 34 weeks of gestation with onset of dyspnoea and serious chest pain radiating to her back. Ultrasonography unexpectedly revealed a dilation of the aortic root with a sign of dissection. Computed tomography confirmed a type A aortic dissection based on the Stanford classification. She was successfully treated by caesarean section prior to open repair of acute type A dissection and received multidisciplinary care. The patient was discharged on the 16th postoperative day, and the baby is still alive without adverse events.ConclusionAortic dissection in pregnancy is relatively rare, but physicians should be on high alert for the condition when a pregnant woman has chest pain. Early diagnosis and adequate treatment in addition to regular multidisciplinary care are crucial to achieve favourable results.

Anesthetic Challenges for Modified Bentall Procedure in a Pregnant Marfan Patient with Acute Stanford Type A Dissection

&lt;p&gt;&lt;em&gt;Aortic dissection is a life-threatening condition which requires immediate surgical intervention. It has been estimated that half of aortic dissection and/or ruptures in women younger than 40 years of age have been associated with pregnancy.&lt;sup&gt;19&lt;/sup&gt; The limited data on the coincidence of Marfan syndrome, pregnancy and aortic dissection makes its anesthetic management a formidable challenge to any anesthesiologist.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;This is a case of a 33-year-old G1P0, 28 weeks age of gestation with Marfan syndrome, who had Aortic Dissection Stanford type A and underwent an emergency Modified Bentall’s surgery with cardiopulmonary bypass and deep hypothermic circulatory arrest.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;This case illustrates the dilemma of managing this case since there are two patients involved, mother and fetus. Wrong decision could result in demise of both. Although the aim is life for both, survival of one without neurologic sequelae is already considered a success.&lt;/em&gt;&lt;/p&gt;

Endovascular Treatment of Acute Aortic Dissection Stanford Type A

A 48-year-old man was admitted to our emergency department in a critical condition with aortic dissection Stanford type A extending from the aortic arch after the ostium of the brachiocephalic trunk to both iliac arteries with severe compression of the true lumen. The supra-aortic arteries were

GW28-e0055 The Management Manner and Reasons Analysis for Stress-induced Hypertension in Adults with Aortic Dissection (Stanford type A) after Bentall or Improved-Cabrol of Cardiac Surgery

GW28-e0055 The Management Manner and Reasons Analysis for Stress-induced Hypertension in Adults with Aortic Dissection (Stanford type A) after Bentall or Improved-Cabrol of Cardiac Surgery

Near-Infrared Spectroscopy Does Not Reliably Detect the Cerebral Status in Adults During Aortic Arch Surgery - A Retrospective Trial

Introduction: To investigate relationship between intraoperative regional oxygen cerebral desaturation (rScO_2) and the incidence of neurological deficit after aortic arch surgery in adult patients. Methods: This study was conducted in a retrospective fashion. 53 patients undergoing aortic arch surgery with antegrade selective cerebral perfusion during deep hypothermic circulatory arrest between 2010 and 2012 were included. ln all patients cerebral monitoring was performed using the near-infrared spectroscopy (NIRS) and a bispectral index electroencephalography (BIS). Cumulative values of rScO_2 decrease ＞ 20% of the baseline level (min%) captured as the area under the curve (rScO_2 AUC) were calculated. Patients were divided in two groups: patients with (N-group) and without (Non-N group) a nonreversible neurological deficit, and patients with (D-group) and without (Non-D group) a reversible neurological deficit. Results: Of 53 patients, 49 (93%) suffered an aortic dissection Stanford Type A/De Bakey Type I and 4 (8%) patients a De Bakey Type II. Six (11%) patients died. Eleven (21%) patients developed a nonreversible (stroke, hemorrhage) and 23 (43%) patients a reversible neurological deficit (postoperative delirium). Postoperative delirium was significantly more frequent in the N-group (91%) compared to the Non-N group (33%). No significant difference was found for absolute rScO_2 values ＜ 50% and for the rScO_2 AUC in both hemispheres between all groups. Conclusion: Regional oxygen cerebral desaturation measured by NIRS appears to be a poor indicator for neurological outcome after aortic arch surgery in adults.

Left Ventricular Intussusception of an Intimal Flap in an Aortic Dissection Stanford Type A.

A 75-year-old woman was admitted to the emergency department with severe and sudden chest pain. Transthoracic echocardiogram showed an unusual case of aortic dissection Stanford Type A with complete circumferential detachment of the ascending aorta intima. An intussusception of the intima flap into the left ventricular outflow tract was also observed. This case presents a very rare surgical treatment involving root repair using tissue adhesives for a left ventricular intimal flap.

Complete Shrinkage of the Obliterated False Lumen After Open and Endovascular Chronic Aortic Dissection Stanford Type A Repair.

A 48-year-old man was admitted to our hospital with chronic aortic dissection Stanford Type A. His diagnosis was confirmed by chest multi-detector computed tomography (CT). The patient underwent combined (i.e., hybrid) open and endovascular repair (frozen elephant trunk) in a one-stage operation with moderate hypothermic circulatory arrest and antegrade cerebral perfusion. His postoperative course was uneventful, and he was discharged home on postoperative day 9. At 2-year follow-up, chest CT angiography revealed complete shrinkage of the obliterated false lumen in the distal aortic arch and descending thoracic aorta.

Acute Myocardial Infarction Secondary to Aortic Dissection

A 50-year-old man with a history of hypertension awakened with acute retrosternal chest pain accompanied by dim consciousness. He was transferred to cardiac catheterization laboratory for emergent percutaneous coronary intervention (PCI) but diagnostic coronary angiography was difficult and unsuccessful. Therefore, he was immediately conducted the thoracoabdominal computed tomography angiography (CTA). The CTA showed aortic dissection (Stanford type A), involving the left main coronary artery (LMCA) and left anterior descending (LAD). Emergency surgery was executed. Unfortunately, this patient eventually died of multiple organ dysfunction syndromes.

Off-Pump Multilayered Sutureless Repair for a Left Ventricular Blowout Rupture after Aortic Dissection Repair

A left ventricular (LV) free wall rupture is a highly lethal condition. A 75-year-old female who experienced chest pain was diagnosed as having an acute aortic dissection Stanford type A and underwent emergent surgery. Under cardiopulmonary bypass with LV venting through the right superior pulmonary vein, a proximal aortic stamp was formed. The patient was cooled, selective antegrade brain perfusion was performed, and a hemiarch repair was performed. After the patient was transferred to the intensive care unit, her blood pressure suddenly fell to 50 mmHg. She had a blowout rupture in the left ventricular anterolateral free wall. Since the bleeding hall was not large and the damage to the surrounding left ventricular tissue was not very wide, an off-pump multilayered sutureless repair was performed by using three layers of collagen fleece squares with fibrinogen-based impregnation (TachoComb; CSL Behring, Tokyo, Japan) and three layers of gelatin-resorcin-formalin glue reinforced by an equine pericardial patch (Xenomedica; Edwards Lifesciences, LLC, Irvine, CA). The blow-out rupture seemed to be caused by perioperative myocardial infarction generated by the compression of the left ventricular vent to the LV lateral wall. The patient was free from re-rupture or aneurysm enlargement. The thickness of the hemostatic material seemed to help control the bulging of the aneurysm and to prevent further LV aneurysm enlargement and re-rupture.

胸部ステントグラフト内挿術中に発症した Stanford A 型急性大動脈解離による広範な脳虚血の診断にBispectral index が有用であった一症例

胸部ステントグラフト内挿術中に発症した Stanford A 型急性大動脈解離による広範な脳虚血の診断にBispectral index が有用であった一症例