Aortic Dissection Type Research Articles

Standford type A aortic dissection in a patient with situs inversus totalis, with critical clinical presentation: a case report.

We describe the case of a male Caucasian patient with SIT and aortic dissection type A, who occurred to our Emergency Department with a severe clinical condition of shock. Using the fast diagnostic approach with chest X-Ray and echocardiography followed by computed tomography investigation, a Standford type A acute aortic dissection and the presence of SIT were detected. The patient was subjected to surgical treatment with optimal results in a short time. The event of aortic dissection is an extremely serious condition and the simultaneous presence of a critical clinical presentation with an unusual congenital anomaly could condition a correct and rapid diagnostic process. Only an accurate diagnostic investigation can give a quick diagnosis and useful elements for a correct therapeutic approach.

The Correlation of Age and Extension Length in DeBakey Type I Aortic Dissection: Are older patients over 70 years at a lower risk?

Age-related atherosclerosis has been shown to cause aortic stiffness and wall rigidification. This analysis aimed to correlate age and dissection extension length in a large contemporary multi-centre study. We hypothesize that younger patients suffer more extensive DeBakey Type I dissection due to aortic wall integrity, allowing unhindered extension within the layers. The perioperative data of 3385 patients from the German Registry for Acute Aortic Dissection Type A (GERAADA) were retrospectively analyzed with regard to postoperative outcomes and dissection extension. Patients with DeBakey Type I aortic dissection (n = 2510) were retrospectively identified and divided into two age-groups for comparison: ≤ 69 years (n = 1741) and ≥ 70years (n = 769). Patients with DeBakey type II dissection or connective tissue disease were excluded from the analysis. In younger patients (≤ 69 years), aortic dissection involved the supraaortic vessels significantly more often (52.0% vs. 40.1%; p < 0.001) and extended significantly further downstream the aorta: descending aorta (68.4% vs. 57.1%; p < 0.001), abdominal aorta (54.6% vs. 42.1%; p < 0.001), iliac bifurcation (36.6% vs. 26.0%; p < 0.001). Consequently, younger patients also presented with significantly higher incidences of preoperative cerebral (p < 0.001), spinal (p < 0.001), visceral (p < 0.001), renal (p = 0.013) and peripheral (p < 0.001) malperfusion. In older patients (≥70 years), dissection extent was significantly more often limited to the level of the aortic arch (40.9% vs. 29.2%; p < 0.001). No significant difference was found with regard to 30-day mortality (20.7% vs. 23.6%; p = 0.114). Extensive DeBakey Type I aortic dissection is less frequent in older patients ≥70 years than in younger patients. In contrast, younger patients suffer more often from preoperative organ malperfusion and associated complications. Postoperative mortality remains high irrespective of age-groups.

Onset of pain to surgery time in acute aortic dissections type A: a mandatory factor for evaluating surgical results?

An acute aortic dissection type A (AADA) is a rare but life-threatening event. The mortality rate ranges between 18% to 28% and mortality is often within the first 24 h and up to 1%-2% per hour. Although the onset of pain to surgery time has not been a relevant factor in terms of research in the field of AADA, we hypothesize that a patient's preoperative conditions depend on the length of this time. Between January 2000 and January 2018, 430 patients received surgical treatment for acute aortic dissection DeBakey type I at our tertiary referral hospital. In 11 patients, the exact time point of initial onset of pain was retrospectively not detectable. Accordingly, a total of 419 patients were included in the study. The cohort was categorized into two groups: Group A with an onset of pain to surgery time < 6 h (n = 211) and Group B > 6 h (n = 208), respectively. Median age was 63.5 years (y) ((IQR: 53.3-71.4 y); (67.5% male)). Preoperative conditions differed significantly between the cohorts. Differences were detected in terms of malperfusion (A: 39.3%; B: 23.6%; P: 0.001), neurological symptoms (A: 24.2%; B: 15.4%; P: 0.024), and the dissection of supra-aortic arteries (A: 25.1%; B: 16.8%; P: 0.037). In particular, cerebral malperfusion (A 15.2%: B: 8.2%; P: 0.026) and limb malperfusion (A: 18%, B: 10.1%; P: 0.020) were significantly increased in Group A. Furthermore, Group A showed a decreased median survival time (A: 1,359.0 d; B: 2,247.5 d; P: 0.001), extended ventilation time (A: 53.0 h; B: 44.0 h; P: 0.249) and higher 30-day mortality rate (A: 25.1%; B: 17.3%; P: 0.051). Patients with a short onset of pain to surgery time in cases of AADA present themselves not only with more severe preoperative symptoms but are also the more compromised cohort. Despite early presentation and emergency aortic repair, these patients show increased chances of early mortality. The "onset of pain to surgery time" should become a mandatory factor when making comparable surgical evaluations in the field of AADA.

Outcomes of abdominal false lumen embolization for chronic aortic dissection after prior proximal repair with stent-graft.

Persistent false lumen (FL) perfusion with aneurysmal formation is common after thoracic endovascular aortic repair (TEVAR) for typical extended aortic dissection and is associated with poor outcomes. Endovascular FL embolization (FLE) has recently been tried for treatment of postdissection aortic aneurysm (PDAA). However, most reports address thoracic rather than abdominal FLE. In this study, we present the results of abdominal FLE in patients with residual patent abdominal FL following stent-graft repair for aortic dissection. Between 2015 and 2019, 24 patients (mean age: 56.7 ± 11.8 years, range: 40-84 years, 18 male) received endovascular abdominal FLE using vascular plugs, coils, or candy plugs as the main surgery (5 patients) or auxiliary procedure (19 patients) after earlier stent-graft repair for aortic dissection (Type A: 9, Type B: 15). The medical records were reviewed and aortic remodeling was examined comparing the preembolization computed tomography (CT) and the most recent CT before reintervention. Technical success was achieved without any intraoperative complications, early morbidity, or mortality. Median follow-up was 34.4 months (range: 12-71). Regarding thoracic FL, 15 patients exhibited complete thrombosis before the procedure and did not change status thereafter except for 1 patient with distal stent-graft-induced new entry. In the other 9 patients, 6 exhibited increased thrombosis. With regard to the abdominal aorta, increased FL thrombosis only occurred in 8 patients with 3 (12.5%) achieving complete thrombosis. The maximal thoracic aortic diameter did not change (1.4 ± 5.6 mm) statistically, but the abdominal diameter increased significantly (4.3 ± 3.7 mm, p < 0.005). From our results, abdominal FLE is a safe procedure. However, covering all the re-entry tears is complex and the possibility of complete FL thrombosis is low. The abdominal aortic diameter appears to become enlarged in these patients. Continuous follow-up is necessary after FLE.

Clinical analysis of 11 cases of pregnancy with aortic dissection

Objective: To investigate the treatment and maternal and fetal outcomes of pregnant women with aortic dissection (AD). Methods: The clinical data of 11 pregnant women with AD treated at the First Affiliated Hospital of Air Force Military Medical University from January 1st, 2011 to August 1st, 2022 were collected, and their clinical characteristics, treatment plans and maternal and fetal outcomes were analyzed retrospectively. Results: (1) Clinical characteristics: the age of onset of 11 pregnant women with AD was (30±5) years old, and the week of pregnancy of onset was (31.4±8.0) weeks. Clinical manifestations: the main symptoms were sudden onset of chest and back pain or low back pain. Type of AD: 8 cases of Stanford type A, and 3 cases of type B. The aortic width was (42±11) mm. Diagnostic methods: the diagnosis of AD was confirmed by transthoracic echocardiography (TTE), computed tomography angiography (CTA) or enhanced CT examination, among which 4 cases were confirmed by CTA examination, 4 cases by TTE examination, and 3 cases by enhanced CT examination. Laboratory results: white blood cell count was (15.4±8.7) ×109/L, neutrophil count was (13.5±8.5) ×109/L, the median D-dimer level was 2.7 mg/L (2.1-9.2 mg/L), and the median fibrin degradation products level was 12.0 mg/L (5.4-36.1 mg/L). (2) Treatments: all 11 patients were admitted to hospital in emergency. Before operation, the departments of cardiac surgery, obstetrics, pediatrics and anesthesiology cooperated to develop individualized treatment plan. Aortic surgery was performed in 11 pregnant women with AD. In 6 of them, pregnancy termination was performed at the same time as aortic surgery, and aortic surgery was performed after cesarean section. Four cases of pregnancy termination and aortic operation were performed by stages, including aortic operation after cesarean section in 2 cases, and cesarean section after aortic operation in 2 cases. One case (12+6 weeks of gestation) had spontaneous abortion on the day after aortic surgery. The gestational age of the 11 patients on pregnancy termination was (32.9±7.4) weeks. Aorta surgical methods: 7 patients received under extracorporeal circulation ascending aorta replacement ± aortic valve replacement ± coronary artery transplantation (or coronary artery bypass transplantation)± left and right coronary Cabrol + total arch replacement (or aortic arch replacement)± stent implantation, 1 patient received under extracorporeal circulation aortic root replacement, and 3 patients underwent aortic endoluminal isolation. (3) Maternal and fetal outcomes: among the 11 pregnant women with AD, 9 (9/11) survived, 2 (2/11) died with lower limb ischemia before the onset of the disease. A total of 10 newborns were born in 9 pregnant women after delivery (1 of them was twins), and the 2 cases were spontaneous abortion after aortic surgery in the first trimester (12+6 weeks) and fetal death after hysterotomy in the second trimester (26+3 weeks), respectively. Among the 10 surviving neonates, 3 were full-term infants and 7 were premature infants. The birth weight of newborn was (2 651±784) g. Respiratory distress syndrome was found in 6 cases. The newborns were followed up for (5.6±3.6) years after birth, and the infants developed well during the follow-up period. Conclusions: Pregnancy complicated with AD is dangerous, and chest and back pain is the main clinical manifestation of this disease. With early identification and selection of appropriate diagnostic methods, multidisciplinary diagnosis and treatment, mother and children could obtain good outcomes.

The clinical German Registry for Acute Aortic Dissection Type A (GERAADA) score: go and see your patient!

Journal Article Accepted manuscript The clinical German Registry for Acute Aortic Dissection Type A (GERAADA) score: Go and see your patient! Get access Maximilian Luehr, MD, PhD Maximilian Luehr, MD, PhD Department of Cardiothoracic Surgery, Heart Center of the University Hospital, University of Cologne, Cologne, Germany Corresponding author: Maximilian Luehr, MD, PhD, Department of Cardiothoracic Surgery, Heart Center of the University Hospital, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany Phone: +49 (0)221 478 32405 Fax: +49 (0) 221 478 32509 E-mail: maximilian.luehr@uk-koeln.de Search for other works by this author on: Oxford Academic PubMed Google Scholar European Journal of Cardio-Thoracic Surgery, ezad169, https://doi.org/10.1093/ejcts/ezad169 Published: 22 April 2023 Article history Received: 16 April 2023 Accepted: 21 April 2023 Published: 22 April 2023

Validation of the German Registry for Acute Aortic Dissection Type A Score in predicting 30-day mortality after type A aortic dissection surgery.

No reliable scores are available to predict mortality following surgery for type A acute aortic dissection (TAAAD). Recently, the German Registry of Acute Aortic Dissection Type A (GERAADA) score has been developed. We aim to compare how the GERAADA score performs in predicting operative mortality for TAAAD to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II. We calculated the GERAADA score and EuroSCORE II in patients who underwent TAAAD repair at the Bristol Heart Institute. As there are no precise criteria to calculate the GERAADA score, we used 2 methods: a Clinical-GERAADA score, which evaluated malperfusion with clinical and radiological evidence, and a Radiological-GERAADA score, where malperfusion was assessed by computed tomography scan alone. 207 consecutive patients had surgery for TAAAD, and the observed 30-day mortality was 15%. The Clinical-GERAADA score showed the strongest discriminative power with an area under the curve (AUC) of 0.80 [95% confidence interval (CI) 0.71-0.89], while the Radiological-GERAADA score had an AUC of 0.77 (95% CI 0.67-0.87). EuroSCORE II showed acceptable discriminative power with an AUC of 0.77 (95% CI 0.67-0.87). Clinical GERAADA score performed better than the other scores and it is specific and easy to use in the context of a TAAAD. Further validation of the new criteria for malperfusion is needed.

Clinical Application of Proximal Arch Cannulation in the Surgical Treatment of Acute Type I Aortic Dissection.

Objective The goal is to determine the best location for inserting a catheter into the aortic arch of patients with a certain type of aortic dissection (DeBakey type I) by analyzing images of the patient's aortic arch before surgery. This analysis will take into account the shape and structure of the patient's aortic arch to find the most optimal location for cannulation. Methods A retrospective analysis was conducted on 100 patients with acute DeBakey type I aortic dissection diagnosed between January 2021 and February 2023, utilizing the Carestream medical imaging software Image Suite V4 (New York, USA). The study included 67 cases that underwent surgery and 33 cases that did not. The study aimed to evaluate the optimal intubation position on the patient's aortic arch by analyzing the true and false lumen classification, true and false lumen area, and hematoma thickness on the patient's aortic arch, as observed in the aortic computed tomography angiography (CTA) conducted upon admission. Results The vascular axis analysis showed a significant difference in the true lumen area among the three regions that were examined (P < 0.001). Zone 1 had a larger true lumen area of 6.40 ± 2.71 cm2 compared to zone 2 with 5.75 ± 2.13 cm2 and zone 3 with 4.85 ± 1.70 cm2, as determined by statistical analysis. In addition, the statistical analysis of hematoma thickness in the three regions where cannulation can be performed revealed a significant difference among the three groups (P = 0.027). Further analysis showed that there was no significant difference between zone 1 and zone 2 (P = 1.000), a significant difference between zone 1 and zone 3 (P < 0.046), and no significant difference between zone 2 and zone 3 (P = 0.080). The difference between zone 1 false lumen thickness of 1.55 ± 0.51 cm and zone 3 false lumen thickness of 1.33 ± 0.55 cm was found to be small. Conclusion Cannulation of the aortic arch is a common strategy used in cardiac surgery. Accurate cannulation is critical to the success of the procedure. The use of CTAprovides valuable guidance for the cannulation procedure. A thorough examination of CTA and precise measurement of relevant parameters can help guide the surgeon to determine the optimal cannulation site. The study found that zone 1 of the aortic arch has the largest area and is the most suitable for cannulation, in accordance with the physiological characteristics and surgical practices of a surgeon. Furthermore, cannulation of the aortic arch has been found to be a safe and effective strategy for cannulation. Overall, careful examination of CTA and accurate measurement of relevant parameters can have a significant guiding effect on the cannulation of the aortic arch, which can lead to improved outcomes in cardiac surgery.

A Case Report of Renal Dysgenesis with Isolated Aortic Dissection Type B: Can it be a Chance Association?

Aortic dissection can occur in the hypertensive individual, but its presentation as an isolated autonephrectomy is extremely rare. We, here, present a rare case of hypertension, probably secondary to renal dysgenesis, in a 20-year-old female. She presented with persistent headaches and episodes of hypertensive urgency. Later, we found, on computed tomography, a localized dissection flap in the descending abdominal aorta around the renal artery level. After a diagnostic workup, we reached the final diagnosis of renal dysgenesis with isolated abdominal aortic dissection type B. Isolated abdominal type B aortic dissection can be managed conservatively; however, the patient needs to be followed up regularly so that timely intervention can be done if the need arises.

Single stem visceral debranching for complex aortic disease

What this paper adds Treatment of complex aortic diseases including thoracoabdominal aortic aneurysms and aortic dissection is highly challenging. Hybrid repair may be useful in some situations wherein anatomy, the need of emergent repair or patient comorbidities preclude the use of total endovascular or direct open reconstruction. This paper details an original hybrid repair in which a single branch is used to reroute all visceral vessels. Abstract: Objective: Hybrid treatment of complex aortic disease has been described with various techniques of retrograde visceral bypass. The use of a single branch to revascularize all renal and visceral vessels may be less cumbersome than multiple synthetic branches and may seems to be efficient in terms of patency. Methods: We retrospectively included 15 patients between 2013 and 2021. Indication was aortic dissection (AD) (type A, acute or chronic type B), thoracoabdominal aortic aneurysms (TAA), visceral occlusive disease. Surgery consisted in median laparotomy, visceral vessel debranching from native aorta or from an aortic graft. In case of AD, surgical fenestration was performed. Additional TEVAR completed the treatment when indicated, during the same procedure or later on Results: Mean age was 60 years. 9 (60%) patients were treated for AD, 3 (20%) for TAA, 3 (20%) for occlusive disease. A total of 65 target vessels were debranched through the single stem retrograde vascular graft (SSRVG) technique. Aortic surgical fenestrations were performed in 8 cases and TEVAR in 4 cases. In the postoperative course, 3 TAA patients died,7 patients developed renal insufficiency (47%), 4 patients presented pneumonia (27%) and 3 colonic ischemia (20%). After a mean follow up of 21 months, all vessels (but 2 IMAs) were patent and no endoleak was noted. Conclusion: SSRVG technique offers a feasible and safe solution in various complex aortic diseases. The use of a single graft makes the technique straightforward by reducing the volume of multiple branch assembly in the retroperitoneal space with satisfying patency rates. Further studies with larger patient sample size and longer follow up are needed to elucidated the efficacy and durability of the technique.

Role of Helicopter Transfer and Cloud-Type Imaging for Acute Type A Aortic Dissection.

This study explored if long-distance transfer was safe for patients suffering from acute aortic dissection type A (AADA) and also analyzed the effectiveness of helicopter transfer and cloud-type imaging transfer systems for such patients in northern Hokkaido, Japan. The study included 112 consecutive patients who underwent emergency surgical treatment for AADA from April 2014 to September 2020. The patients were divided into two groups according to the location of referral source hospitals: the Asahikawa city group (group A, n = 49) and the out-of-the-city group (group O, n = 63). Use of helicopter transfer (n = 13) and cloud-type telemedicine (n = 20) in group O were reviewed as subanalyses.Transfer distance differed between groups (4.2 ± 3.5 km in group A vs 107.3 ± 69.2 km in group O; p = 0.0001), but 30-day mortality (10.2% in group A vs 7.9% in group O; p = 0.676) and hospital mortality (12.2% in group A vs 9.5% in group O; p = 0.687) did not differ. Operative outcomes did not differ with or without helicopter and cloud-type telemedicine, but diagnosis-to-operation time was shorter with helicopter (240.0 ± 70.8 vs 320.0 ± 78.5 minutes; p = 0.031) and telemedicine (242.0 ± 75.2 vs 319.0 ± 83.8 minutes; p = 0.007). We found that long-distance transfer did not impair surgical outcomes in AADA patients, and both helicopter transfer and cloud-type telemedicine system could contribute to the reduction of diagnosis-to-operation time in the large Hokkaido area. Further studies are mandatory to investigate if both the systems will improve clinical outcomes.

The relationship between the characteristics of tears and the progression of Stanford type B aortic dissection after endovascular treatment

Endovascular treatment of Stanford type B aortic dissection (type B dissection) has been widely used. There will be complications such as aortic dilatation, which will lead to poor prognosis of some patients. With more in-depth researches, it was found that there was a possible correlation between the prognosis of type B dissection and tears, such as the increasing of aortic diameter would be faster with longer tears, and the location of the tear will affect the thrombosis of the false lumen. Studies on hemodynamics have also found that different characteristics of tears of aortic dissection can cause changes in the pressure, blood flow rate and blood capacity in the true and false lumens recently. The hemodynamic changes can be used to predict the prognosis of type B dissection. The main characteristics of tears included the size, position, number of tears, residual tears and stent graft induced new entry. Describing the effect of tear characteristics on the development of type B dissection, can provide the basis for the clinical treatment and further research of type B dissection.

Combining aortic arch dissection stent implantation and root surgery for aortic dissection type A

BackgroundAcute aortic dissection type A (AADA) is associated with high perioperative morbidity and mortality. A novel non-covered hybrid prosthesis (AMDS, CryoLife, Kennesaw, USA) can be easily implanted to stabilize the true lumen. However, the role of AMDS for patients requiring additional aortic root surgery has not been described.MethodsBetween 2010 and 2020 a total of n = 370 patients underwent surgery for AADA in our department. Of those, n = 120 underwent treatment for aortic root in addition to proximal arch replacement without resection of the aorta beyond the innominate artery (Control, n = 111) and were compared to patients who received additional AMDS implantation (AMDS, n = 9).ResultsAortic valve repair was performed in 48.6% (Control) and in 55.6% of AMDS patients. Cardiopulmonary bypass (Control: 248 ± 76 min, AMDS: 313 ± 53 min, P < 0.01) time as well as circulatory arrest time of the lower body (Control: 30 ± 15 min, AMDS: 52 ± 12 min, P < 0.01) was prolonged in the AMDS group. Nevertheless, postoperative in-hospital morbidity such as dialysis (Control: 22.4%, AMDS: 11.1%, P = 0.68) and stroke (Control: 17.0%, AMDS: 22.2%, P = 0.65) were comparable. In-hospital death (Control: 21.8%, AMDS: 11.1%, P = 0.68) and the compound end-point MACCE (Control: 38.7%, AMDS: 44.4%, P = 0.74) did also not differ.ConclusionsAddressing the arch by implantation of AMDS prolongs cardiopulmonary bypass and circulatory arrest time, however without relevant impairments of short-term outcome. Combining root surgery with replacement of the proximal aortic arch and AMDS implantation seems feasible and safe as it did not impair the early postoperative outcome.

Biomarkers for prediction of neurological complications after acute Stanford type A aortic dissection: A systematic review and meta-analysis.

The predictive value of biomarkers such as neuron specific enolase (NSE), S100B, neurofilament (NFL), interleukin-6 (IL-6), coagulation factor R, and D-Dimer (DD) after acute Stanford A type aortic dissection (AAAD) with neurological complications has recently gained much attention from the research community. However, results from these studies are conflicting. This meta-analysis is conducted to assess the relationship between the biomarkers and the risk of neurological complications after AAAD. Two reviewers performed a systematic literature search across eight databases (CNKI, Wan Fang, VIP, CBM, PubMed, Web of Science, Cochrane Library, and EMBASE). The studies regarding biomarkers in AAAD patients published up to February 2022 were included. These studies were subjected to rigorous scrutiny and data extraction to determine the weighted mean difference (WMD) and the 95% confidence interval (CI), which were analyzed using the RevMan 5.4 and Stata software 14.0. A total of 12 studies including 360 cases with neurological complications and 766 controls were incorporated into our meta-analysis. WMD analysis showed that there was a higher NSE levels in AAAD patients with postoperative neurological complications compared with controls (WMD = 0.640, 95% CI: 0.205 ~ 1.075, P = 0.004 < 0.005), and the level of S100B was related to the 6 h and 24 h postoperative neurological complications (6 h: WMD = 0.64, 95% CI: 0.27 ~ 1.02, P = 0.0007 < 0.001; 24 h: WMD = 0.281, 95% CI: 0.211 ~ 0.351, P < 0.001). Moreover, S100B levels at 6 hours after operation were significantly higher than that at 24 hours (WMD = 0.260, 95% CI: 0.166 ~ 0.354, P < 0.001). NSE and S100B are both candidate biomarkers to predict postoperative neurological complications in patients with AAAD. Other markers are also valuable when used in conjunction with clinical judgement. The findings accentuate the necessity of further research to establish standardized values for these biomarkers in predicting neurological complications.

Total arch replacement with extended branched stented anastomosis frozen elephant trunk repair for type A dissection improves operative outcome.

Emergency surgical repair is the standard treatment for acute aortic dissection type A. However, the surgical risk of total arch replacement remains high. The Viabahn Open Revascularization TEChnique has been used for supra-aortic reconstruction during total arch replacement. This Cleveland Clinic technique is called "branched stented anastomosis frozen elephant trunk repair." Our total arch replacement with reconstructed extended branched stented anastomosis frozen elephant trunk repair requires no unnecessary cervical artery exposure. We compared the outcomes of extended branched stented anastomosis frozen elephant trunk repair and conventional total arch replacement in acute aortic dissection type A. We compared the clinical course of patients undergoing total arch replacement using sutureless direct branch vessel stent grafting with frozen elephant trunk (extended branched stented anastomosis frozen elephant trunk repair) for acute aortic dissection type A with patients undergoing conventional total arch replacement. For the procedure, the aortic arch was transected circumferentially distal to the brachiocephalic artery origin. Frozen elephant trunk was fenestrated by heating with a cautery, and the self-expandable stent graft was delivered into the branch vessels through the fenestration. Of 58 cases, 21 and 37 were classified in the extended branched stented anastomosis frozen elephant trunk repair and conventional total arch replacement groups, respectively. The times (minutes) of selective antegrade cerebral perfusion (75±24, 118±47), total operation (313±83, 470±151), and cardiopulmonary bypass (195±46, 277±96) were significantly better in the extended branched stented anastomosis frozen elephant trunk repair group (P<.001). Six surgical deaths occurred: 2 (9%) in the extended branched stented anastomosis frozen elephant trunk repair group and 4 (10%) in the conventional total arch replacement group. In all cases, only 1 patient (2%) in the conventional total arch replacement group had a branch artery-related complication during the postoperative follow-up period. In the extended branched stented anastomosis frozen elephant trunk repair group, blood product use significantly decreased (P<.05). Extended branched stented anastomosis frozen elephant trunk repair has shown comparable safety and efficacy to conventional total arch replacement and can be used for acute aortic dissection type A emergency repair. It optimizes true lumen perfusion and facilitates supra-aortic artery remodeling.

Treatment of acute type A aortic dissection with the Ascyrus Medical Dissection Stent in a consecutive series of 57 cases.

The Ascyrus Medical Dissection Stent (AMDS) has been recently introduced as an alternative for total arch replacement in acute aortic dissection type A (AADA). The aim of this study was to evaluate the postoperative outcomes after AMDS treatment in a large contemporary cohort of AADA patients. Data acquisition was performed retrospectively at 2 German aortic centres between 2020 and 2022 and comprised the perioperative parameters and postoperative results of all AADA patients. All patients treated with the AMDS for AADA were included in the study. The primary end point was in-hospital mortality. Secondary end points were defined as early postoperative and AMDS-related complications. Fifty-seven AADA patients treated by AMDS were included in the study group. The mean age was 64.6 ± 10.8 years and 59.7% (n = 34) were males. The actual in-hospital mortality was considerably lower than the predicted mortality risk by the German registry for acute aortic dissection type A score (16% vs 22%). The median ICU and in-hospital stay were 5 (interquartile range: 3-13) and 12 (interquartile range: 10-22) days, respectively. Postoperative complications comprised acute renal insufficiency (37%) with need for temporary (16%) or permanent dialysis (5%), delirium (26%), re-exploration for bleeding (14%), tracheostomy (14%) and new stroke (4%). A new AMDS-related complication (central stent collapse) was observed in 9% (n = 5) by postoperative computed tomography and chest X-ray. The incidence of complete central AMDS collapse did not impact 30-day mortality. The AMDS may be successfully used in AADA with acceptable 30-day mortality in accordance with the German registry for acute aortic dissection type A score. However, careful preoperative evaluation of the patient's individual aortic anatomy regarding potential contraindications and proper device implantation are strongly recommended to avoid complete central AMDS collapse.

Asymptomatic Acute Dissection of the Abdominal Aorta as a Rare Complication of Takayasu Disease

The present study describes a case of a 24-year-old who had an asymptomatic acute dissection of the abdominal sub-renal aorta along with an inflammatory syndrome suggestive of Takayasu disease. Aortic dissection is a rare complication of Takayasu's disease that has only been reported a few times in the literature. The type of aortic dissection (type III b, according to the classification of De Bakey and Stanford) confirmed by computed tomography scan of the aorta (CT scan) in our patient. The patient underwent conservative medical treatment.

495 STANFORD TYPE-A ACUTE AORTIC DISSECTION: A LIFE-THREATENING EMERGENCY

Abstract Stanford type A acute aortic dissection is a life-threatening cardiological emergency which occurs when an intimal tear in the ascending aorta creates a false lumen within the media refilled by pulsatile blood flow. Some investigators report the immediate mortality to be as high as 40%. Both congenital and acquired conditions can be the cause of an instability of the aortic wall that can lead to dissection. Diagnosis, which requires a high level of suspicion, is usually made with aortic angio-CT. The case we present involves a 62-years old man with a history of hypertension, parossistic atrial fibrillation and familiarity for type B aortic dissection. He called 911 complaining of sudden onset dorsal pain that then irradiated anteriorly to the chest and upwardly to the neck, associated with profuse sweating. An EKG performed at patient's home showed ST elevation in V1 meaningful of right ventricle infarction. Arrived at the Emergency Ward of our hospital arterial pressure was 80/50 mmHg with an HR of 44 bpm. Rapidly, because of the suspect of aortic dissection, an angio-TC was performed showing a type A aortic dissection starting from Valsalva sinuses and extending till common right iliac artery and external left iliac artery including left subclavian artery ostium. The left renal artery originated from false lumen, but patient had a so-called horseshoe kidney. For this reason, the patient was transferred immediately to the cardiac surgery room with indication for Bentall procedure (aortic valve plus ascending aorta replacement with home-made valved Dacron tubular prosthesis), aortic arch repair with supra-aortic vessels debranching and reimplantation and saphenous graft on right coronary artery. During surgery was evident that intimal tear was located immediately after left common carotid artery and right coronary sinus was involved in the dissection thus explaining why right ventricle free wall was visibly hypokinetic. Surgery went without complication and patient entered ICU with circulation supported by a low dose of epinephrine and norepinephrine; respiratory weaning took place in day 1 post-operation. The following days patient developed circumferential pericardial effusion which needed percutaneous subxiphoid drainage despite not being hemodynamically relevant. Echocardiography before discharge showed aortic valve prosthesis and ascending aorta prosthesis well positioned, bi-ventricular normal dimensions and function and organized residual pericardial effusion with fibrin strands. Stanford type A is the most common type of aortic dissection and requires immediate surgical treatment. The Bentall procedure is considered the gold standard for patients needing ascending aorta plus aortic valve replacement. Even though mortality rates remain high for Stanford type A acute aortic dissection, this case shows how is possible to survive from such a life-threatening condition if a prompt and correct diagnosis is made and thanks to flawless surgical operation.

Guideline for the Treatment of Thoracic Aortic Dissection Type A: Summary of the S2k Guideline.

Guideline for the Treatment of Thoracic Aortic Dissection Type A: Summary of the S2k Guideline.

Early and Late Mortality Predictors in Patients with Acute Aortic Dissection Type B.

Despite technological advances in diagnosis and treatment, in-hospital mortality with acute aortic dissection type B is still about 11%. The purpose of this study was to assess the risk factors for early and long-term adverse outcomes in patients with acute aortic dissection type B treated medically or with conventional open surgery. The present study included 104 consecutive patients with acute aortic dissection type B treated in our Center from January 1st, 1998 to January 1st, 2007. Patient demographic and clinical characteristics as well as in-hospital complications were reviewed. Univariate and multivariate testing was performed to identify the predictors of in-hospital (30-day) and late (within 9 years) mortality. 92 (88.5%) patients were treated medically, while 12 (11.5%) patients with complicated acute aortic dissection type B were treated by open surgical repair. In-hospital complications occurred in 35.7% patients, the most often being acute renal failure (28%), hypotension/shock (24%), mesenteric ischemia (12%), and limb ischemia (8%). The in-hospital mortality rate was 15.7% and the 9-year mortality rate was 51.9%. Independent predictors of early mortality in patients with acute aortic dissection type B were uncontrolled hypertension (HR-20.69) and a dissecting aorta diameter >4.75 cm (HR-6.30). Independent predictors of late mortality were relapsing pain (HR-7.93), uncontrolled hypertension (HR-7.25), and a pathologic difference in arterial blood pressure (>20 mmHg) (HR-5.33). Knowledge of key risk factors may help with a better choice of treatment and mortality reduction in acute aortic dissection type B patients.