Surgical Treatment Of Acute Dissection Research Articles

<![CDATA[<B>Cerebral retrograde perfusion alternating with carotid artery anterograde perfusion in the surgical treatment of acute dissection of ascending aorta dissection</B>]]>

<![CDATA[<B>Cerebral retrograde perfusion alternating with carotid artery anterograde perfusion in the surgical treatment of acute dissection of ascending aorta dissection</B>]]>

Progress in treatment of ascending aortic aneurysms due to dissection, arteriosclerosis, or cystic medial degeneration.

AbstractThe recent results of surgical treatment of ascending aortic aneurysms caused by dissection, arteriosclerosis, or cystic medial degeneration are reviewed. Important technical advances and the various techniques currently employed are examined. Recent improvements in the results of surgical treatment of acute dissections have resulted in a more aggressive surgical approach with early operative intervention. For patients with cystic medial degeneration treated by supracoronary graft replacement of the ascending aorta and aortic valve replacement, late development of aneuryms of the sinuses of Valsalva suggests that composite graft replacement to exclude the aortic sinuses may be the preferred method of treatment.

Surgical treatment of acute dissection of the ascending aorta (author's transl)

Since 1959, 51 patients underwent open heart surgery for correction of acute dissection of the ascending aorta. Upon admission 33 patients were severely hypotensive or in porgressive heart failure. Acute aortic insufficiency was found in 24 patients, and hemiplegia or hemiparesis in 4. In 45 patients the ascending aorta was reconstructed with a woven graft. After excision of the dissected part of the aorta primary anastomosis or patch aortoplasty was performed in 6 patients. The aortic valve remained intact in 26 cases, and resuspension of the commissures restored competence of the aortic valve in another 9 patients. Sixteen patients required aortic valve replacement because of disrupture of the commissures. Dissection extended into the coronary ostia in 5 cases. Reconstruction of the coronary system was accomplished by reimplantation of the ostia, interposition of a vein graft or aorto-coronary bypass. Nine patients died within the early postoperative course from uncontrollable hemorrhage (4), further dissection (3) and myocardial infarction (2). Within the first year after surgery another 5 patients died from acute aortic dissection (2), pseudomonas-infection causing rupture of the proximal graft anastomosis (1), and myocardial infarction (2). The contraindications of antihypertensive treatment of actue dissection of the ascending aorta are discussed. We recommend prompt surgical intervention in acute dissecting aneurysm of the ascending aorta.