Aortic Dissection Type Research Articles

Stanford B型大動脈解離に対してステントグラフト内挿術を選択し良好な転帰をたどった2症例(Endovascular aortic repair for Stanford type B aortic dissection in two cases with good outcomes)

要旨Stanford B型大動脈解離（B型解離）へのステントグラフト内挿術（thoracic endovascular aortic repair: TEVAR）は安全，有効とされる。症例1は72歳の男性。偽腔閉塞型急性B型解離と診断し，内科治療を行ったがulcer like projection（ULP）を認めTEVARを行った。症例2は慢性偽腔開存型B型解離の50歳の男性。既存解離腔に加え，新規解離腔が出現，三腔解離を呈した。内科治療を行ったが，偽腔拡大による真腔圧迫を認めたため，第20病日にTEVARを行った。B型解離は内科治療が原則だが，近年，TEVARを選択する例が増加し，良好な結果が報告されている。また三腔解離例は稀で，本邦でのTEVAR施行例は少ない。

IP017. Performance of Current Claims-Based Approaches to Identify Aortic Dissection Hospitalizations

Methods that use claims data to identify patients with aortic dissection (AD) for study are not well validated. We aimed to evaluate the accuracy of previously reported diagnosis and procedural coding mechanisms to identify AD admissions and treatment types for patients with acute AD at our institution. All inpatient hospitalizations at a single center between 2000 and 2015 were retrospectively reviewed for an AD diagnosis code (International Classification of Diseases, Ninth Revision and Tenth Revision) through institutional billing databases. Diagnoses were verified using medical records and imaging studies. Characteristics of the aortic disease, treatment modalities, and procedural codes were abstracted. Sensitivity and specificity analyses were performed to test the ability of diagnosis and procedural codes to correctly identify the anatomic involvement of the aorta and treatment type for acute AD (TASR, type A open surgery repair; TBSR, type B open surgery repair; TEVAR, thoracic endovascular repair; MM, medical management). Diagnosis codes identified 1697 hospitalizations among 1312 patients. AD was present in 1295 (76%) visits. In 281 (17%) visits, no aortic disease was present, and 121 (7%) were for intramural hematoma or penetrating aortic ulcer without AD. Among visits with AD, 438 (34%) were first-time visits for acute AD, 11 (<1%) were readmissions for acute AD, 112 (9%) were for subacute AD, 620 (48%) were for chronic AD, and 114 (9%) were for AD of unknown age. There were 223 (51%) acute AD visits that ranked AD among the top three discharge diagnoses, and 202 (46%) did not rank AD at all. Stanford type A AD was present for 260 (59%) acute visits and Stanford type B for 178 (41%). Acute AD management included 229 (52%) open surgery, 28 (6%) endovascular surgery, 10 (2%) open and endovascular surgery, and 171 (39%) medical. Diagnosis coding demonstrated sensitivities and specificities for aortic involvement as follows: thoracic (sensitivity, 46%; specificity, 75%), thoracoabdominal (sensitivity, 22%; specificity, 98%), and abdominal (sensitivity, 65%; specificity, 98%). Procedural coding had low sensitivities: TASR (sensitivity, 29%; specificity, 98%), TBSR (sensitivity, 0%; specificity, 100%), TEVAR (sensitivity, 9%; specificity, 100%), MM (sensitivity, 46%; specificity, 97%). After exclusion of cases with diagnosis of aneurysm, sensitivities and specificities were minimally changed: TASR (sensitivity, 25%; specificity, 99%), TBSR (sensitivity, 0%; specificity, 100%), TEVAR (sensitivity, 9%; specificity, 100%), and MM (sensitivity, 45%; specificity, 98%). At our institution, one in four inpatient hospitalizations coded for AD demonstrated no evidence of dissection. Current billing stratification methods to determine type of acute AD and treatment modality have poor sensitivities but are highly specific. To more effectively use claims data to study AD, more sensitive methods are necessary.

Direct Cannulation of Ascending Aorta versus Standard Femoral Artery Cannulation in Acute Aortic Dissection Type A.

During surgery for ascending aortic dissection, the dissected ascending aorta itself has traditionally been rejected as a cannulation option. The purpose of this study is to prove that direct cannulation of the ascending aorta in patients operated for acute aortic dissection type A (AADA) is at least as effective and safe as classic femoral cannulation. Between September 2008 and January 2015, we operated on 117 patients with AADA through median sternotomy. Cannulation was accomplished in 32 cases (27%) through the femoral artery (group A), and in 85 patients (73%) through the dissected ascending aorta (group B). Moderate hypothermic circulatory arrest with bilateral antegrade cerebral perfusion was used in 108 patients (92%). The mean time of circulatory arrest was 17 minutes (range: 9-52 minutes). The 30-day mortality rate was 22% (7 patients) in group A, and 18% (15 patients) in group B (P = not significant). Temporary neurologic dysfunction (TND) including postoperative confusion, delirium, or agitation occurred in four patients (13%) in group A, and four patients (5%) in group B (P = not significant). The incidence of permanent neurologic dysfunction (stroke) was 9% (3 patients) in group A and 3% (3 patients) in group B. The direct cannulation of the ascending aorta is a safe alternative for patients with AADA, offering the opportunity for antegrade cerebral perfusion. It is easy to perform, reliable, and associated with acceptable early results.

Outcome After Operation for Aortic Dissection Type A in Morbidly Obese Patients

The number of obese patients is increasing, and more obese patients are likely to present for surgical repair of aortic dissection type A (ADA). We evaluated the effect of this procedure on the postoperative outcome of patients based on their body mass index (BMI; calculated as kg/m2). A total of 667 patients who underwent surgical repair of ADA between 2003 and 2017 were retrospectively analyzed. Patients were divided into four groups according to BMI: normal weight (BMI: 18 to <25, n= 186), overweight (BMI: 25 to <30, n= 238), obese (BMI: 30 to <35, n= 144), and morbidly obese (BMI ≥35, n= 99). We compared clinical features and outcomes. No statistical difference was found regarding clinical presentation or proximal or distal aortic repair. Postoperative complications were similar among all groups. Although the rate for reintubation, tracheotomy, and the length of stay in the intensive care unit tended to be similar, the time to extubation (p= 0.010) and the total length of hospital stay (p= 0.017) were significantly longer in morbidly obese patients. Significantly more blood was transfused and replaced in the normal weight patients compared with the obese patients: in median 69% of the calculated blood volume was replaced in the normal weight patients compared with 32% in the morbidly obese patients (p < 0.001). In-hospital mortality and late survival were similar among all weight groups. Despite the comorbidities that are associated with obesity, obese patients undergoing surgical repair of ADA are not at greater risk of death or other adverse outcomes. An immediate surgical approach should be considered in all patients independent of weight.

A case of ruptured aneurysm of coronary-pulmonary artery fistula diagnosed after emergency thoracotomy

BackgroundCoronary fistulae are occasionally detected using echocardiography or coronary angiography. We report a patient with cardiac tamponade because of a ruptured aneurysm of a coronary artery fistula.Case presentationA 60-year-old man was referred to our hospital with sudden onset of chest pain and unconsciousness. He was initially diagnosed with cardiac tamponade for type A acute aortic dissection, and an emergency operation was performed. A large amount of bleeding was seen in the pericardium, but aortic dissection around the arch was not observed. Instead, a ruptured aneurysm of a coronary-pulmonary fistula was identified on the pulmonary artery root. The aneurysm was resected, and the fistula was closed by ligation. The patient’s postoperative progress was good, and he was discharged on postoperative day 12 without any abnormalities on the coronary arteriogram.ConclusionsPreoperative diagnosis of the rupture of the small coronary artery aneurysm is difficult in such an emergency case, and this possibility should be considered in differential diagnosis when the CT image does not show typical aortic dissection.

Risk of Mortality After Resolution of Spinal Malperfusion in Acute Dissection

Spinal cord ischemia (SCI) may develop in patients presenting with acute aortic dissection. We sought to determine how SCI and its recovery affect outcomes. We reviewed patients with SCI in acute type A aortic dissection (ATAAD) and acute type B aortic dissection (ATBAD) from September 1999 to May 2014. SCI was defined as paraplegia or paraparesis present on admission. Monoparesis/plegia, paraesthesia, or numbness was defined as ischemic neuropathy. All ATBAD patients were managed with antiimpulse therapy, with selective intervention for rupture, rapid aortic expansion, malperfusion, or intractable pain. ATAAD patients were managed with urgent proximal aortic replacement. Neurologic symptoms were present in 178 (18.2%) of 978 acute dissections (482 ATAAD and 496 ATBAD). Of these 178 patients, SCI presented in 52 patients (29.2%; 80.1% male; mean age, 57 years). On admission paraplegia was present in 24 (46.2%), paraparesis in 10 (19.2%), paresthesia/numbness in 27 (51.9%), and leg ischemia in 25 (48.1%). Aortic operations were performed in 27 SCI patients (51.9%). Symptom resolution was seen in 30 (57.7%). The 30-day mortality was 19.2% and was significantly less in those with resolution of SCI (6.7% vs 36.4%, p= 0.012). When surgical intervention was required in ATBAD with SCI, mortality was 50% (p= 0.039). SCI and symptom resolution significantly affected overall survival. SCI is associated with significantly increased risk of overall mortality (hazard ratio, 2.9; p < 0.001), and SCI resolution completely offsets this risk (hazard ratio, 0.28; p= 0.003). These effects were consistent between ATAAD and ATBAD (p= 0.554). SCI in acute aortic dissection portends a poor prognosis. However, reversal of deficits is associated with a long-term survival outcome comparable to patients unaffected with SCI.

Epidemiology and management of thoracic aortic dissections and thoracic aortic aneurysms in Ontario, Canada: A population-based study

ObjectivesTo determine hospital incidence, mortality, and management for thoracic aortic dissections and aneurysms. MethodsA population-based retrospective cohort study of anonymously linked data for residents of Ontario, Canada, was carried out. Incident cases of thoracic aortic dissections and aneurysms were identified between 2002 and 2014. Treatment and mortality trends were assessed. ResultsThere were 5966 aortic dissections (Type A n = 2289 [38%] and Type B n = 3632 [61%]). Overall incidence proportion for aortic dissections was 4.6 per 100,000. There were 9392 thoracic aortic aneurysms with an overall incidence proportion of 7.6 per 100,000. The incidence for both dissections and aneurysms significantly increased over the 12-year study. Only 53% (1204 out of 2289) of Type A dissections underwent surgery. Type B dissection treatment was 83% (3000 out of 3632) medical, 10% (370 out of 3632) surgery, and 7% (262 out of 3632) endovascular. Thoracic aortic aneurysm treatment was 53% (4940 out of 9392) surgery, 44% (4129 out of 9392) medical, and 3% (323 out of 9392) endovascular. Thirty-five percent of known descending thoracic aortic aneurysms (323 out of 924) received a stent graft. Cardiac surgeons performed 87% of the open surgical repairs. Vascular surgeons performed 91% of the endovascular procedures. All-cause 3-year mortality significantly decreased for both aortic dissections (44% to 40%) and aneurysms (30% to 22%). All-cause hospital mortality also decreased. Women had worse outcomes than men. ConclusionsThe incidence of thoracic aortic dissections and aneurysms increased over time but all-cause hospital and late outcomes improved. Gender differences exist. Men incur more disease but women have higher hospital mortality. Surgery was primarily referred to cardiac surgeons. Endovascular therapy was primarily referred to vascular surgeons.

Outcome of Valve-sparing vs Bentall Procedure in Acute Type A Aortic Dissection

Objectives: Valve-sparing aortic surgery is increasingly used in contrast to the Bentall procedure in patients with an enlarged aortic root and normal aortic leaflets, despite the more complex operative technique in valve sparing root remodeling. To what extend complex valve sparing aortic surgery is feasible in acute aortic dissection type A (AADA) is not quite clear. In this study we analyze the long-term outcome after different valve sparing and Bentall procedures in AADA patients.

Predictors of Outcomes after Correction of Acute Type A Aortic Dissection under Moderate Hypothermic Circulatory Arrest and Antegrade Cerebral Perfusion.

IntroductionHypothermic circulatory arrest is widely used for correction of acute type A aortic dissection pathology. We present our experience of 45 consecutive patients operated in our unit with bilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest.MethodsBetween January 2011 and April 2015, 45 consecutive patients were admitted for acute type A aortic dissection and operated emergently under moderate hypothermic circulatory arrest and bilateral antegrade cerebral perfusion. ResultsMean age was 58±11.4 years old. Median circulatory arrest time was 41.5 (30-54) minutes while the 30-day mortality and postoperative permanent neurological deficits rates were 6.7% and 13.3%, respectively. Unadjusted analysis revealed that the factors associated with 30-day mortality were: preoperative hemodynamic instability (OR: 14.8, 95% CI: 2.41, 90.6, P=0.004); and postoperative requirement for open sternum management (OR: 5.0, 95% CI: 1.041, 24.02, P=0.044) while preoperative hemodynamic instability (OR: 8.8, 95% CI: 1.41, 54.9, P=0.02) and postoperative sepsis or multiple organ dysfunction (OR: 13.6, 95% CI: 2.1, 89.9, P=0.007) were correlated with neurological dysfunction. By multivariable logistic regression analysis, postoperative sepsis and multiple organ dysfunction independently predicted (OR: 15.9, 95% CI: 1.05, 96.4, P=0.045) the incidence of severe postoperative neurological complication. During median follow-up of 6 (2-12) months, the survival rate was 86.7%.ConclusionBilateral antegrade cerebral perfusion and direct carotid perfusion for cardiopulmonary bypass, in the surgical treatment for correction of acute aortic dissection type A, is a valuable technique with low 30-day mortality rate. However, postoperative severe neurological dysfunctions remain an issue that warrants further research.

Aortic Root Surgery in Acute Aortic Dissection Type A: Comparison of Aortic Valve-sparing Repair versus Composite Grafting

Aortic Root Surgery in Acute Aortic Dissection Type A: Comparison of Aortic Valve-sparing Repair versus Composite Grafting

Unusual Case of Giant Ascending Aortic Aneurysm Evolution of an Acute Aortic Dissection Type A Unoperated: A Case Report

Survival after an acute aortic dissection type A unoperated is exceptional. We present the case of a 74-years-old male patient with multiple cardiovascular risk factors, presented mainly with severe dyspnoea of increasing intensity. Echocardiography and computer tomography angiography showed a large ascending aortic aneurysm (with a diameter of 10.8 cm) without aortic valve insufficiency, which started at 7 cm above the sinotubular junction, with a parietal thrombus occupying more than 30% of the circumference and its distal end at 5 cm after the aortic arch. This aneurysm was due to the evolution of an acute aortic dissection type A that was diagnosed five years prior to the current admission, which was not operated because the patient refused the surgical procedure at that time. Also, severe mediastinum displacement to the right with compression effect on the lung was revealed on the computer tomography. There are just a few cases in the literature diagnosed after acute aortic dissection type A unoperated who survived so long. In this context, he underwent surgical ascending aortic replacement with a prosthetic graft. The patient’s postoperative evolution was uneventful.

Surgical treatment of acute aortic dissection type A

Surgical treatment of acute aortic dissection type A

Left Anterior Trap-Door Thoracostomy Approach for Modified Bentall’s Operation in a Patient with Severe Pectus Excavatum and Acute Aortic Dissection Type A: A Case Report

Acute aortic dissection type A is an urgent condition that requires a surgical treatment. Especially in patientswith Marfan syndrome and severe Pectus excavatum, the surgery could be more complicated and life-threatening. Among these, we reported a successful left anterior trap-door thoracostomy approach for urgency modified Bentall’s operation without operation for Pectus excavatum and no complication was found.

Successful use of deep hypothermic circulatory arrest (DHCA) during mid-term pregnancy

Introduction Ascending aortic dissection (Type A) often requires deep hypothermic circulatory arrest (DHCA) for proper repair. It involves the use of cardiopulmonary bypass to achieve whole body cooling to a temperature of 18 degrees Celsius prior to the cessation of all circulation. This circulatory arrest then allows for repair of the aortic arch and/or cerebral vessels without cross-clamp. This technique is well described and has become standard practice in the treatment of Type A dissection. The use of DHCA during pregnancy, however, has seldom been described. Case description A 31-year-old female at 21 weeks gestation presented acutely to the emergency department with a Type A aortic dissection. She was taken emergently to the operating room and cardiopulmonary bypass was initiated via femoral arterial and central venous cannulation. Aortic repair was accomplished during a 25 minute period of DHCA. Destruction of her aortic root by the dissection included the right coronary ostium and required composite tissue valve and conduit replacement (Bio–Bentall) with right coronary saphenous vein bypass. Fetal ultrasound imaging obtained preoperatively and postoperatively demonstrated no changes in fetal heart tones or obvious evidence of fetal injury. She was subsequently discharged on postoperative day 4. Evaluation by obstetrics 8 weeks postoperatively (29 weeks gestation) revealed normal fetal growth. 4 months post operatively she delivered a full-term infant without any noticeable deficits. Conclusions The use of DHCA for type A aortic dissection is standard practice but its use during pregnancy has rarely been described. This case illustrates the use of DHCA during midterm pregnancy that resulted in an excellent outcome. Take home message DHCA can successfully be used during midterm pregnancy.

How does descending aorta geometry change when it dissects?

Thoracic endovascular aortic repair is the treatment of choice in complicated acute type B aortic dissection. How to infer predissection aortic diameter is not well understood. Our aim was to delineate changes in descending aortic geometry due to dissection. Five tertiary centres reviewed their acute aortic dissection type B databases containing 802 patients. All patients who had undergone computed tomography angiography less than 2 years before and immediately after aortic dissection onset were included. We compared the aortic geometry before and after the dissection onset. Altogether 25 patients were included [median age 60 (first quartile 52, third quartile 72) years; 60% men]. In all except 1 patient, the maximum descending aortic diameter was less than 45 mm before aortic dissection onset. The largest increase in diameter induced by the dissection was observed in the proximal descending aorta 28.2 (25.1, 32.1) vs 34.6 (31.3, 39.1) mm (+6.4 mm; +23%; P < 0.001). The thoracic descending aortic length increased after the dissection onset [253.3 (229.3, 271.9) vs 261.3 (247.9, 285.4) mm; P = 0.003]. The predissection aortic diameter of the proximal thoracic descending aorta was 7.9 (5.2, 10.7) mm larger (P < 0.001) than the post-dissection area-derived true-lumen diameter and 2.5 (1.3, 6.1) mm larger than the maximum true-lumen diameter (P < 0.001). Type B aortic dissection increases the diameter, length and volume of the descending thoracic aorta. The predissection aortic diameter most closely resembles the post-dissection maximum diameter of the true lumen.

In DeBakey Type I Aortic Dissection, Bovine Aortic Arch Is Associated With Arch Tears and Stroke

The study sought to evaluate if a bovine aortic arch (BAA) influences the location of the entry site in acute aortic dissection type A (AADA) and to identify the impact of BAA on postoperative outcome, especially stroke. A total of 315 patients underwent surgery due to AADA DeBakey type I (72.1% men, mean age 59.5 ± 13.4 years) between 2002 and 2015. Imaging studies and operative reports were screened for presence of BAA and location of the entry site. Patients were divided into 2 groups based on presence (BAA+) and absence (BAA-) of BAA (BAA+ n= 49, BAA- n= 264). Dissection patterns, surgical treatment, risk factors for postoperative complications, and long-term outcome were analyzed. Prevalence of BAA in patients with AADA was 15.6%. Location of the entry site was more commonly in the aortic arch in patients with BAA (BAA+ 46.8% versus BAA- 14.3%; p < 0.001). Multivariable analysis identified BAA (odds ratio [OR], 5.9; 95% confidence interval [CI], 2.89 to 12.04; p < 0.001) and preoperative competent aortic valve (OR, 2.26; 95% CI, 1.19 to 4.31; p= 0.013) as independent predictors for an arch tear. Thirty-nine patients (12.4%) suffered from stroke. Patients with BAA had higher stroke rates (BAA+ 24.5% versus BAA- 10.2%; p= 0.009). BAA emerged as one risk factor for stroke in the setting of AADA (OR, 2.69; 95% CI, 1.2 to 6.0; p= 0.016). Long-term survival was comparable for patients with BAA and patients without congenital arch anomalies. BAA is an independent predictor for the distinctive location of the entry site in the aortic arch and risk factor for stroke.

Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years†

Our goal was to present our 15-year experience (2001-2015) with the frozen elephant trunk (FET) technique. A total of 251 patients (82 with aortic aneurysms, 96 with acute aortic dissection type A, 4 with acute type B dissections, 52 with chronic aortic dissection type A, 17 with chronic type B dissection and 67 redo cases) underwent FET implantation with either the custom-made Chavan-Haverich (n = 66), the Jotec E-vita (n = 31) or the Vascutek Thoraflex hybrid (n = 154) prosthesis. The cases were assigned to an early period (2001-2011) and a contemporary period (2012-present). Mean cardiopulmonary bypass time, aortic cross-clamp time, circulatory arrest time and selective antegrade cerebral perfusion time were 241 ± 72, 125 ± 59, 56 ± 30 and 81 ± 34 min, respectively. Incidence of rethoracotomy for bleeding, stroke, spinal cord injury, prolonged ventilatory support (>96 h) and long-term dialysis were 18, 14, 2, 24 and 2%, respectively. The in-hospital mortality rate was 11% (in acute aortic dissection type A, 12%). Of the 2 patients with graft infections, 1 died and the other had a protracted hospital stay. There were 49 second-stage procedures in the downstream aorta: either open surgical [n = 25 (thoraco-abdominal, n = 15; descending, n = 6; infrarenal, n = 4)] or transfemoral endovascular (n = 23). Elective thoracic endovascular aneurysm repair R implantation was successful in all 23 cases. FET results are comparable with those of the published results of the conventional elephant trunk technique. FET is an ideal landing zone for subsequent transfemoral endovascular completion. Patients with graft infections may have dismal results.

Validation and Adjustment of the Leipzig-Halifax Acute Aortic Dissection Type A Scorecard

The novel Leipzig-Halifax (LH) scorecard for acute aortic dissection type A (AADA) stratifies risk of in-hospital death based on age, malperfusion syndromes, critical preoperative state, and coronary disease. The study aim was to externally validate the LH scorecard performance and, if adequate, propose adjustments. All consecutive AADA patients operated on from 1996 to 2016 (n= 509) were included to generate an external validation cohort. Variables related to in-hospital death were analyzed using univariable and multivariable analysis. The LH scorecard was applied to the validation cohort, compared with the original study, and variable selection was adjusted using validation measures for discrimination and calibration. In-hospital mortality rate was 17.7% (LH cohort 18.7%). Critical preoperative state and Penn class non-Aa were independent predictors (odds ratio [OR] 2.42 and 2.45, respectively) of in-hospital death. The LH scorecard was adjusted to include Penn class non-Aa, critical preoperative state, and coronary disease. Assessing discrimination, area under receiver operator characteristic curve for the LH scorecard was 0.61 versus 0.66 for the new scorecard (p= 0.086). In-hospital mortality rates in low-, medium-, and high-risk groups were 14%, 15%, and 48%, respectively (LH scorecard) versus 11%, 23%, and 43%, respectively (new scorecard), and goodness-of-fit p value was 0.01 versus 0.86, indicating better calibration by the new scorecard. A lower Akaike information criterion value, 464 versus 448, favored the new scorecard. Through adjustment of the LH scorecard after external validation, prognostic performance improved. Further validated, the LH scorecard could be a valuable risk prediction tool.

Valve-sparing David I procedure in acute aortic type A dissection: a 20-year experience with more than 100 patients.

The aortic valve-sparing David procedure has been applied to the elective treatment of patients with aortic aneurysms with excellent results. The use of this technique in patients with acute aortic dissection type A (AADA) is still a matter of debate. We present our long-term experience with 109 patients with AADA who had the valve-sparing David I procedure. Between July 1993 and October 2015, 109 patients with AADA had the valve-sparing David I procedure at our centre. We conducted a retrospective review with follow-up. The mean age was 54 ± 12 years; 78 (72%) patients were men. Marfan syndrome was present in 6 (5%) patients and bicuspid aortic valve in 3 (3%). Only 4 (4%) patients received the isolated David procedure; 50 (46%) underwent additional proximal, 13 (12%) subtotal and 42 (39%) total aortic arch replacement. The in-hospital mortality rate was 11% ( n = 12). Intraoperative/discharge echocardiography showed aortic insufficiency ≤ I° in 93 of 97 patients (96%). Mean follow-up time was 8.3 ± 5.7 years. The survival rate after discharge at 1, 5 and 10 years was 94%, 90% and 78%, respectively. Thirteen percent ( n = 13) of patients underwent valve-related reoperation. Freedom from valve-related reoperation at 1, 5 and 10 years was 96%, 88% and 85%, respectively. Compared to patients who underwent the David I procedure for any reason other than AADA, there were no significant differences in long-term survival rates ( P = 0.29) and freedom from a valve-related reoperation ( P = 0.39). The valve-sparing David I procedure has acceptable long-term results even in emergent operations for AADA and is not inferior when performed in elective settings.

Frozen elephant trunk en la disección aórtica aguda tipo i: ¿ha llegado su momento?

Acute aortic dissection type i, involving the ascending aorta and aortic arch and extending downstream into the descending thoracic or thoracoabdominal aorta, is still associated with a significant operative and medium-term mortality, as well as a high incidence of complications, despite the development in surgical techniques and perioperative management. In this scenario, the frozen elephant trunk technique is probably the latest to be introduced into the armamentarium of the cardiac surgeon to treat extensive lesions of the thoracic aorta.In the following review article, an analysis is presented on the advantages and drawbacks of this technique in the treatment of acute aortic dissection type i, from clinical and practical perspectives.