Aortic Dissection Type Research Articles

Surgical treatment of Stanford type A aortic dissection after thoracic endovascular aortic repair

Objective: To examine the surgical treatment of Stanford type A aortic dissection (type A dissection) after thoracic endovascular aortic repair (TEVAR). Methods: The data of 58 patients with reoccurrence of type A dissection after TEVAR admitted into the Department of Cardiovascular Surgery, Henan Chest Hospital from February 2012 to January 2020 were analyzed retrospectively. There were 40 males and 18 females, aged (57.0±6.7) years (range: 31 to 71 years). The time between recurrence of type A dissection and TEVAR (M(QR)) was 37 days (72.8 months) (range: 1 h to 14 years). Forty-eight cases underwent emergency operation, 9 cases underwent sub-emergency operation, and 1 case died of dissection rupture on the way to the operating room. All 57 patients underwent radical treatment. Fifty-four cases underwent the frozen elephant trunk technique under deep hypothermia circulatory arrest and selective cerebral perfusion, and 3 cases (>65 years old) underwent arch debranch anastomosis+ascending aorta replacement+descending arch covered stent implantation under mild hypothermia. Results: The operation time was (445±32) minutes (range: 382 to 485 minutes), the aortic crossclamp time was (103±19) minutes (range: 89 to 133 minutes), the cardiopulmonary bypass time was (189±27) minutes (range: 162 to 221 minutes), and the intraoperative blood loss was (665±343) ml (range: 450 to 1 750 ml). Postoperative ICU stay time was 5 (6) days (range: 2 to 27 days), and postoperative hospital stay was 14.0 (4.5) days (range: 2 to 36 days). Three cases died, including 2 cases with severe brain complications and 1 case with systemic multiple organ failure caused by severe liver insufficiency and gastrointestinal hemorrhage. Postoperative follow-up was 0.5 to 7.0 years, which showed that 1 case had left coronary artery anastomotic stoma fistula 3 months after operation and underwent reoperation, 2 cases underwent thoracoabdominal aortic replacement again, and the rest of patients had no anastomotic stoma fistula and incomplete stent distortion and expansion on CT angiography. Four cases died during follow-up, and 1 case died of sudden cerebral infarction 2 years after operation. Conclusion: The recurrent type A dissection after TEVAR is mostly related to stent graft, and the patients can undergo operation actively with good prognosis.

A transient spinal cord ischemia reveals a silent type A aortic dissection

Aortic dissection is a life-threatening vascular emergency that requires a prompt diagnosis and management. Isolated spinal transient ischemic accident is an extremely rare manifestation of Aortic Dissection (AD) type A. Thus, AD should be on the top of the aetiology list, despite the isolated character of the neurological presentation. A 53-year-old man, previously healthy, presented to the emergency department for a right sided renal colic documented by a uroscan showing a right ureterovesical junction stone (Figure 1). Initial blood tests were normal. While symptomatic treatment was being administered, he presented an acute paraplegia with anaesthesia of both lower limbs in all modalities below T4. Deep tendon reflexes were absent and plantar reflex was indifferent bilaterally. His blood pressure was 200/140 mmHg. His symptoms self-resolved after 20 minutes. He denied any significant thoracic or back pain, and had no signs of limb ischemia.

Effect of High-Flow Nasal Cannula for Hypoxemia Following Sun's Procedure in Acute Aortic Dissection Type a Patients.

Background: Patients with acute aortic dissection type A (AADA) often have hypoxemia (partial pressure of oxygen [PaO2]/fraction of inspired oxygen [FiO2] <300 mmHg) before weaning in the intensive care unit (ICU). This study compared the efficacy of high-flow nasal cannula (HFNC) with that of conventional oxygen therapy (COT) in patients with AADA following Sun's procedure.Methods: The medical records of 87 adult patients with AADA who underwent Sun's procedure and met the inclusion criteria (PaO2/FiO2 <300 mmHg before weaning) were retrospectively analyzed. After surgery, 41 patients were treated with HFNC and 46 were treated with COT. The oxygenation level, FiO2, partial pressure of carbon dioxide, heart rate, respiratory rate, subjective discomfort, and reintubation rate were recorded. The difference in lung volume loss between the HFNC and COT groups was assessed using the radiological atelectasis score (chest radiograph) or calculated from three-dimensional (3D) reconstructed computed tomography (CT) images.Results: From day 1 to day 5 after weaning, there was no significant difference in PaO2/FiO2 between the HFNC and COT groups, although the FiO2 was significantly lower in the HFNC group than in the COT group (P < 0.05). Further studies indicated that the percentage of lung volume loss (pleural effusion and/or pulmonary atelectasis) by 3D reconstruction of CT images at 4–8 days post-operation was significantly lower in the HFNC group (P < 0.05). The subjective experience of breathing discomfort, reintubation rate, and length of stay in the ICU were significantly reduced in the HFNC group (P < 0.05). There was no significant difference in readmission to the ICU and in-hospital mortality between the two groups.Conclusions: HFNC can be used as an effective oxygen therapy for AADA patients with hypoxemia after Sun's procedure.

Aortic dissection during pregnancy and postpartum.

Patients with aortic dissection during pregnancy and postpartum period exhibit a high mortality. At present, a complete overview of aortic dissection during pregnancy and postpartum period is lacking. ​Methods: This systematic review included 80 reports published from 2000 to 2020, comprising a total study population of 103 patients with aortic dissection. ​Results: We found that Stanford Type A aortic dissection was more common in prepartum cases, especially in the third trimester, while postpartum cases of aortic dissection were more common in Stanford Type B. The most common risk factor was connective tissue disease, with no other known risk factors. The mode of delivery had no significant effect on the type of postpartum aortic dissection. Reduced maternal and fetal mortality was observed when patients with Stanford Type A aortic dissection occurring after 28 gestational weeks underwent cesarean section followed by aortic replacement. Patients with Stanford Type B aortic dissection were treated mainly with medication and/or endovascular repair. ​Conclusion: Contemporary management of patients during pregnancy and within 12 weeks postpartum requires multidisciplinary cooperation and includes serial, noninvasive imaging, biomarker testing, and genetic risk profiling for aortopathy. Early diagnosis and accurate treatment are essential to reduce maternal and fetal mortality.

ГИБРИДНЫЕ ВМЕШАТЕЛЬСТВА В НЕОТЛОЖНОЙ АНГИОХИРУРГИИ

Objective. To improve the results of treatment of patients with multilevel atherosclerotic lesions and aortic dissection. Methods. In 2019 year 16 hybrid surgical interventions on arteries of lower extremities and 1 hybrid intervention for aortic dissection type B were made in Brest Regional Hospital. Most of the patients were men (15 out of 16), the average age was 60.2±6.4 (M±σ) years. Disease was staged according to the Fontaine-Pokrovsky classification: 4 patients (25%) - IIb, 8 (25%) - III, 4 (25%) - IV. The type of surgery was determined by the level of occlusion / stenosis (according to Doppler ultrasound and angiographic examination) and the state of the outflow tract. According to the TASC II classification, all patients were class C or D. Four groups of hybrid interventions on the arteries of the lower extremities were identified: hybrid on the ilio-femoral segment (n=9), hybrid on the femoral-popliteal segment (n=4), hybrid on the femoral segment (n=1), hybrid on the aorto-iliac segment (n=2). Results. Technical success was achieved in 100% of cases. In 1 case thrombosis of the superficial femoral artery occurred, which did not require reconstruction due to compensated collateral blood flow, and 1 case of death from acute heart failure. Primary patency was achieved in 93.75% of cases. Duration of hybrid surgery 174.2±67.3 (M±σ) min. Duration of the open stage of the operation - 72.85±30.3 (M±σ) min. The augmentation of the ankle-brachial index (ABI) was 0.26±0.15 (M±σ). Hybrid interventions were performed in the X-ray operating room and always from one vascular access. The amount of iodine-contrasting substance used is 150.8±68 (M±σ) ml. Conclusion. The use of hybrid interventions provides complete revascularization of lower extremities and minimizes risks of perioperative complications during implantation of aortic stent grafts in type B aortic dissection. Hybrid operations should be considered as the most perspective direction in the development of angiosurgery.

The zone 2 concept and distal stent graft positioning in TH 2-3 are associated with high rates of secondary aortic interventions in frozen elephant trunk surgery.

The goal of this study was to investigate the association between the localization of the distal anastomosis (zone 2/3), the stent graft length (100-160 mm), the position of the distal end of the hybrid prosthesis and the need for secondary aortic intervention (SAI) in acute and chronic thoracic aortic disease after the frozen elephant trunk procedure. From 2009 through 2020, a total of 232 patients (137 men; mean age, 61.7 ± 13.8 years) were treated with the frozen elephant trunk procedure. The main indications were acute aortic dissection type A (n = 106, 46%), chronic aortic dissection type A (n = 52, 22%) and degenerative thoracic aortic aneurysm (n = 74, 32%). The rate of SAI was significantly higher when we performed a distal anastomosis in zone 2 rather than in zone 3, whereas the rate of SAI was less frequent if the distal positioning of the hybrid prosthesis was below TH 4-5. Combining the zone 2 concept and the short stent graft length (100 mm) was associated with a significantly higher rate of SAIs. Patients with a distal anastomosis in zone 2 were significantly less likely to have a recurrent laryngeal nerve injury (P < 0.001). However, no association between a specific arch zone of a distal anastomosis and the occurrence of spinal cord injury was observed. Rates of SAIs are highest in patients who were treated with a distal anastomosis in zone 2 and a short stent graft (100 mm) with the distal end of the hybrid prosthesis at vertebral level TH 2-3.

Semi-Percutaneous Short-Term Support of Right Heart Failure in Acute Aortic Dissection

Coronary malperfusion in acute aortic dissection type A is associated with increased mortality. The present case shows the management of a patient with an acute right ventricular infarction due to coronary avulsion, with the coronary bypass performed first, followed by aortic surgery and temporary extracorporeal right ventricular support, which was successfully weaned percutaneously after recovery while maintaining a low anticoagulation strategy.

Epiaortic Ultrasound-Guided True Lumen Cannulation of Ascending Aorta in Acute Aortic Dissection Type A

Background: The choice of arterial inflow for acute Stanford type A aortic dissection repair remains controversial. The axillary artery should be considered as first choice for cannulation, but this technique is time-consuming. The ascending aortic cannulation provides antegrade perfusion and can be performed rapidly but there are several concerns such as aortic rupture, extension of dissection, and false lumen cannulation. Objective: To compare the establishment time of cardiopulmonary bypass (CPB) and postoperative outcomes of the two cannulation techniques that provide antegrade perfusion, which was direct true lumen cannulation on the dissected ascending aorta using epiaortic ultrasound-guided and axillary artery cannulation in Siriraj Hospital. Materials and Methods: The authors retrospectively reviewed all the 30 cases of acute aortic dissection type A using two different cannulation methods performed between February 2011 and May 2017. Direct true lumen ascending aortic cannulation was performed using the epiaortic ultrasound-guide with Seldinger technique in 12 patients, and axillary artery cannulation was performed in 18 patients. Results: The direct true lumen ascending aortic cannulation was safely performed in all patients. None of them had aortic rupture. Skin incision to CPB time was significantly faster in the epiaortic ultrasound-guided ascending aortic cannulation group at 29±8 versus 49±14 minutes (p&lt;0.001). The 30-day mortality and postoperative adverse events, such as ischemic stroke, acute kidney injury, visceral organ and limb malperfusion showed no statistically significant difference from the axillary artery cannulation method. Conclusion: Epiaortic ultrasound-guided true lumen cannulation of ascending aorta in the treatment of acute aortic dissection type A is safe and feasible. Skin incision to CPB time can be performed faster and provided good outcome compared to the axillary artery cannulation technique. Keywords: Acute aortic dissection, Ascending cannulation, Epiaortic ultrasound

Clinical profiles and outcomes of acute type A aortic dissection and intramural hematoma in the current era: lessons from the first registry of aortic dissection in China.

Background:Acute type A aortic dissection (ATAAD) and acute type A intramural hematoma (ATAIMH) are life-threatening diseases with high mortality. To better understand their clinical features in the Chinese population, we analyzed the data from the first Registry of Aortic Dissection in China (Sino-RAD) to promote the understanding and management of the diseases.Methods:All patients with ATAAD and ATAIMH enrolled in Sino-RAD from January 1, 2012 to December 31, 2016 were involved. The data of patients’ selection, history, symptoms, management, outcomes, and postoperation complications were analyzed in the study. The continuous variables were compared using the Student's t test for normal distributions and the Mann-Whitney U test for non-normal distributions. Categorical variables were compared using the Chi-square test or Fisher exact test.Results:A total of 1582 patients with ATAAD and 130 patients with ATAIMH were included. The mean age of all patients was 48.4 years. Patients with ATAAD were significantly younger than patients with ATAIMH (48.9 years vs. 55.6 years, P < 0.001). For the total cohort, males were dominant, but the male ratio of patients with ATAAD was significantly higher compared to those with ATAIMH (P = 0.01). The time range from the onset of symptom to hospitalization was 2.0 days. More patients of ATAIMH had hypertension than that of ATAAD (82.3% vs. 67.6%, P < 0.05). Chest and back pain were the most common clinical symptoms. Computerized tomography (CT) was the most common initial diagnostic imaging modality. 84.7% received surgical treatment and in-hospital mortality was 5.3%. Patients with ATAAD mainly received surgical treatment (89.6%), while most patients with ATAIMH received medical treatment (39.2%) or endovascular repair (35.4%).Conclusions:Our study suggests that doctors should comprehensively use clinical examination and genetic background screening for patients with ATAAD and ATAIMH and further shorten the time range from symptoms onset to intervention, achieving early diagnosis and treatment, thereby reducing the mortality rate of patients with aortic dissection in China. We should standardize the procedures of aortic dissection treatment and improve people's understanding. Meanwhile, the curing and transferring efficiency should also be improved.

Aortic Arch Anatomy in Candidates for Aortic Arch Repair

Detailed knowledge of aortic anatomy is necessary before new prostheses can be developed. Our aim was to provide a thorough analysis of aortic arch anatomy in patients who are potential candidates for arch repair. Patients' charts were screened between 2001 and 2019 for all those with a dissection or aneurysm involving aortic arch. Aortic diameters, segmental lengths, aortic arch type, tortuosity, diameters and length of supraaortic vessels were analyzed via computed tomography angiography. We included 558 patients who underwent thoracic aortic treatment for type A, B, non-A non-B dissection, or aortic arch aneurysm. Incidence of all three arch types was similar in patients with type A dissection. In type B dissection and arch aneurysm patients, arch type III was most commonly observed (47% and 52%, respectively). The left vertebral artery offspring from aortic arch was observed in 6.6%. The mid-ascending aorta and aortic arch were not dilated in type B and non-A non-B dissection patients. The innominate, left common carotid and left subclavian arteries median diameters were 16 (14; 18), 8 (7; 9) and 11 (10; 12) mm, respectively. The median innominate artery length was 37 (30; 44) mm. The median left subclavian artery length was 40 (34; 46) mm. Arch types are distributed differently among patients with various arch pathologies. Patients with aortic dissection type B and non-A non-B have a non-dilated ascending aorta and aortic arch. Aortic arch tortuosity, innominate and left subclavian artery lengths do not differ among aortic pathologies.

虚血性膵炎，脾梗塞を合併したB型急性大動脈解離の1例(Acute aortic dissection type B complicated with ischemic pancreatitis and spleen infarction: a case report)

要旨 急性膵炎の成因として栄養動脈の虚血は稀である。今回我々は，急性大動脈解離に起因すると考えられる虚血性膵炎および脾梗塞を合併した1救命例を経験した。症例は57歳の男性。搬送される2日前から発症した持続性の心窩部痛および背部痛を主訴に救急要請し救急搬送された。胸腹部造影CT検査にてStanford分類B型，DeBakey分類IIIb型の血栓閉塞型急性大動脈解離を認めた。主要腹部動脈分枝は真腔起始していたが，腹腔動脈根部から脾動脈本幹にかけて解離が及んでおり，膵尾部の重症急性膵炎，および脾梗塞を認めた。ICU入室後，鎮痛・降圧治療を中心とした保存的加療により全身状態は徐々に改善し，第13病日にICUを退室した。リハビリテーションを施行しつつ，第49病日に自宅へ独歩退院した。急性大動脈解離では解離の範囲に応じて様々な臓器障害を来す。解離による臓器虚血が臨床症状として出現する時期は必ずしも同じではなく，解離領域を考慮し，経時的に変化する病態に対処しなくてはならない。本症例では，急性大動脈解離の治療と虚血に起因する複数の臓器障害に対し保存的治療のみで良好な転機を得ることができた。

Left Ventricular Concentric Geometric Patterns Are Associated With Worse Prognosis Among Patients With Type-A Aortic Dissection.

BackgroundThis study compared left ventricular (LV) characteristics between patients with type‐A and type‐B aortic dissection (AD) and evaluated the ability of LV remodeling phenotypes (hypertrophy, concentricity, or geometric patterns) to predict mortality in both AD types.Methods and ResultsWe evaluated 236 patients with type A and 120 patients with type B who had echocardiograms within 60 days before or after AD diagnosis (median [25th, 75th percentiles] time difference between echocardiogram and AD diagnosis=1 [0, 6] days) from 3 centers. Patients were stratified according to LV phenotypes, and early (90‐day) and late (1‐year) mortality after AD diagnosis were assessed. In adjusted logistic regression analysis, patients with type A had higher and lower odds of concentric and eccentric hypertrophy (odds ratio [OR], 2.56; 95% CI, 1.50–4.36; P<0.001; and OR, 0.55; 95% CI, 0.31–0.97; P=0.039, respectively) than those with type B. Results of multivariable Cox‐regression analysis showed that LV remodeling phenotypes were not related to mortality in patients with type B. By contrast, LV concentricity was associated with greater early and late mortality (hazard ratio [HR], 2.22; 95% CI, 1.24–3.96; P=0.007 and HR, 2.06; 95% CI, 1.20–3.54; P=0.009, respectively) in type A. In further analysis considering normal LV geometry as reference, LV concentric remodeling and concentric hypertrophy were associated with early mortality (HR, 7.78; 95% CI, 2.35–25.78; P<0.001 and HR, 4.38; 95% CI, 1.47–13.11; P=0.008, respectively), whereas concentric remodeling was associated with late mortality (HR, 5.40; 95% CI, 1.91–15.26; P<0.001) among patients with type A. Assessment of LV geometric patterns and concentricity provided incremental prognostic value in predicting early and late mortality beyond clinical variables in patients with type A based on net reclassification improvement and integrated discrimination improvement.ConclusionsLV geometric patterns derived from LV concentricity were associated with greater mortality among patients with type A and may be markers of adverse prognosis in this population.

Acute aortic dissection type A: Impact of aortic specialists on short and long term outcomes.

Acute aortic dissection type-A (AADA) is a life threatening condition which requires emergency surgery. Surgery is usually performed by cardiac surgeons with various levels of aortic surgical experience. We compared the short-term perioperative outcome and long-term survival of patients operated by specialist aortic surgeons (SASs)and those who were operated by surgeons without specialist expertise. A single center retrospective review of 232 patients who underwent acute surgery for AADA was conducted between 2005 and 2020. The cohort was divided into those operated on by SASs (Group A, n = 186) and those operated on by nonaortic surgeons (Group B, n = 46). Statistical comparison was done using regression modelling and groups were propensity matched. Kaplan-Meier comparison was undertaken using STATA14. Of 232 patients, 186 were operated on by an aortic specialist and 46 were operated by a nonaortic specialist. Overall 30-day mortality was 10% in Group A compared to 26.0% in Group B (unadjusted: p = .01, multivariate: p = .02, and propensity matched p = .05). Long-term mortality at 14 years was 26% in Group A compared to 52.0% in Group B (unadjusted: p = .001, multivariate: p = .001, and propensity matched: p = .01). Aortic surgeons performed a significantly higher number of aortic root procedures (43.0% vs. 17.3%, p = .001). The cross-clamp time and bypass time was significantly shorter in Group A patients (89 vs. 105 min, p < .01 and 153 vs. 185, p = < .001). Postoperative requirement for renal filtration was (19% vs. 37%, unadjusted p = .01, multivariate p = .03 and propensity matched p = .04). Although postoperative bleeding was less in Group A (4.0% vs. 11.0%, unadjusted p = .05) after propensity matching it was not statistically significant. In patients with AADA, surgery performed by aortic specialist's results in improved outcomes. Aortic specialists replaced more of dissected aorta, resulting in an increased number of complex procedures, which may explain improved long-term survival after AADA in this cohort. This study adds further support in establishing a specialist aortic surgical service in cardiac centers.

The Relationship between Blood Groups and Aortic Dissection.

Plenty of diseases have been found having associations with blood types, especially cardiovascular diseases. The purpose of this study was to clarify whether there is a relationship between blood groups and acute aortic dissection. We also further studied the distribution of blood groups in different types of acute aortic dissection. A total of 291 patients diagnosed with acute aortic dissection from 2011 to 2018 were enrolled and analyzed retrospectively in this study. The control group consisted of 582 patients who received plastic surgery at West China hospital from 2011 to 2018. First, we analyzed the distribution of blood groups between the study group and the control group, including the ABO, Rh, O and non-O groups. Then, we further divided the study group into two groups by the type of acute aortic dissection to determine if there was difference in blood groups between the two types of acute aortic dissection. The analysis of the distribution of ABO blood groups (p = 0.302) and Rh blood groups (p = 0.502) did not reveal statistically significant differences. There were no statistically significant differences in the distributions of ABO blood groups and Rh blood groups in different types of acute aortic dissection. Our study did not prove the incidence of acute aortic dissection, or the type of acute aortic dissection had a relationship with common blood groups.

Iatrogenic Acute Aortic Dissection in the Era of Minimally Invasive Cardiac Surgery - Experience of a Center and Review of Literature.

IntroductionIatrogenic acute aortic dissection (IAAD) type A is a rare but potentially fatal complication of cardiac surgery.MethodsThe purpose of this article is to review the literature since the first reports of IAAD in 1978, examining its clinical characteristics and describing operative details and surgical outcomes. Moreover, we reviewed the recent literature to identify current trends and risk factors for IAAD in minimally invasive cardiac surgery procedures, often related to femoral artery cannulation for retrograde perfusion.ResultsWe found that IAAD ranges from 0.04 to 0.29% of cardiac patients in overall trials and ranged from 0.12 to 0.16% between 1978-1990, before the minimally invasive surgical era. And we concluded that since the first cases to the recent reports, the incidence of IAAD has not significantly changed. As minimally invasive procedures are on the rise, some authors think that the incidence of IAAD could increase in the future; we think that using all the precaution - such a strict monitoring of perfusion pressure throughout the intervention, avoiding extremely high jet pressures using vasodilators, repositioning of arterial cannula, or splitting perfusion in both femoral arteries -, this complication can be extremely reduced. Finally, we describe a very singular case occurring during mitral valve replacement followed by spontaneous dissection of left anterior descending artery one month later.ConclusionThe present article adds to the literature a more detailed clinical picture of this entity, including patients' characteristics, the mechanism, timing, and localization of the tear, and mortality details.

Recombinant Factor VIIa for The Management of Uncontrollable Bleeding Following The Repair of Acute Type A Aortic Dissection

Background: Bleeding is a serious complication after surgical repair of acute type A aortic dissection. Recombinant factor VIIa (rFVIIa) could be used for the management of severe bleeding; however, it could lead to thromboembolic events. We aimed to report our experience in using rFVIIa in the management of severe bleeding following the surgical repair of acute type A aortic dissection.&#x0D; Methods: We performed a retrospective study, including patients who had surgery for acute aortic dissection type A and received rFVIIa, in the period between January 2012 and January 2019. We reported the amount of bleeding 4 hours before and after the administration of rFVIIa, the number of blood products transfused before and after the use of rFVIIa, thrombosis of the central venous line, as well as the presence of disseminated intravascular coagulation.&#x0D; Results: There were ten patients (2 females and 8 males) out of 120 patients with acute type A aortic dissection, who required the use of rFVIIa for severe postoperative bleeding. The mean age was 67.7±10.5 years. The amount of drainage decreased from 889±585.6 ml during the 4 hours prior to the infusion, to 165±73.5 ml during the following 4 hours (p&lt;0.001). The patients received 2752±1362.9 ml, and 618±483.3 ml packed RBCs before and after rFVIIa administration, respectively (p&lt; 0.001). The patients received 1601±693.4 and 246±419.6 ml of fresh frozen plasma before and after the use of rFVIIa, respectively (p&lt; 0.001). The prothrombin time decreased after the infusion of rFVIIa (42.7±32 and 17.1±8 seconds, p= 0.001). There were no clinical signs of thromboembolism after its use. Mortality occurred in five patients (50%).&#x0D; Conclusion: In the life-threatening situation of uncontrollable bleeding following surgical repair of type A acute aortic dissection, rFVIIa may have benefits to control bleeding. Furthers studies are recommended.

Aortic root repair in acute aortic dissection type A

<h3></h3> Острое проксимальное расслоение — жизнеугрожающее состояние, связанное с высоким риском летальных осложнений, требующих хирургической коррекции. Смертность при этом заболевании составляет около 50% в первые 48 ч. За последние десятилетия было предложено несколько методик коррекции острого расслоения аорты типа А (ОРАТА) и сопутствующей аортальной недостаточности. При этом одним из важных вопросов является выбор способа коррекции ОРАТА в каждом конкретном случае. Основными целями этого обзора являются анализ преимуществ и недостатков различных методик реконструкции корня аорты при ОРАТА, оценка непосредственных и отдаленных результатов реконструктивных вмешательств на корне аорты.

Factors influencing early surgical outcomes of patients with acute aortic dissection type A

Introduction/Objective. Even with the current treatment, mortality from aortic dissection remains high. The study aimed to evaluate the early postoperative outcome of patients with aortic dissection and identify which factors could influence it. Methods. The study included all consecutive patients who underwent surgery for acute aortic dissection type A from 2012 to 2017. We registered all parameters that could potentially impact the outcome (general data, medical history, clinical and cardiological diagnostic test findings, preoperative complications, type of cannulation and the operation performed, additional surgical procedures, operation duration, etc.). The patients were surgically treated according to the current protocols. The main outcome measures were complications and mortality during a one-month postoperative period. All data collected pre-, intra-, and postoperatively were compared and statistically analyzed. Results. The study included 246 patients, 57.54 ? 12.88 years old on average, and mostly of male sex (74%). Early postoperative mortality occurred in 17% of the patients. Preoperative chronic kidney insufficiency (p = 0.005) and cerebrovascular insult (p = 0.047) and tamponade (p = 0.036) were the major risk factors for postoperative complications and mortality. Long hypothermic cardiac arrest (p = 0.001), cross-clamp (p = 0.017) and cardiopulmonary bypass time (p = 0.036) increased postoperative complications. Postoperative complications started occurring after ? 33.5 minutes hypothermic cardiac arrest and ? 67.5 minutes cross-clamp time. Postoperative complications occurrence increased (p = 0.034), while performing anterograde cerebral perfusion decreased the frequency of lethal outcome (p = 0.001). Conclusion. The majority of patients surgically treated for acute aortic dissection had good postoperative outcome. However, numerous pre-, intra-, and postoperative factors can impact patient survival.

A Case Report of Successful Treatment by Colectomy of Right Hemicolonic Necrosis Complicating Acute DeBakey Ⅲb Type Aortic Dissection

A Case Report of Successful Treatment by Colectomy of Right Hemicolonic Necrosis Complicating Acute DeBakey Ⅲb Type Aortic Dissection

Anatomical variability in the structure of the arch and thoracic aorta and its influence on aorta related pathological conditions

Aim. Assessment of normal and variant aortic arch anatomy in patients with type A aortic dissection and aneurysm of the arch and descending thoracic aorta.Methods. We retrospectively studied computer tomography (CT) data of chest organs with contrast in patients who underwent reconstruction of the aortic arch in type I aortic dissection according to DeBakey classification (n = 61) and resection of the aortic arch and descending thoracic aorta aneurysm (n = 14) at the Meshalkin National Medical Research Center, Novosibirsk, Russian Federation. The control group included patients without aortic arch pathology (n = 52). To identify relationships between the anatomical type of aortic arch and the risk of aortic pathology development, univariate and multivariate binary logistic regression analyses were used.Results. Our analysis revealed four types of aortic arch anatomy. Normal aortic arch anatomy occurred in 66.1 % of patients (n = 84), the proportion of abnormalities of the left common carotid artery was 30 % (bovine aortic arch occurred in 15 %, and the same site of origin of left common carotid artery and brachiocephalic trunk occurred in 15 %). Divergence of the left vertebral artery from the aortic arch between the left common carotid and left subclavian arteries occurred in 3.1 % (n = 4), and the combination of “bovine trunk” and divergence of the left vertebral artery from the aortic arch was detected in 0.8 % patients (n = 1). Logistic regression analyses revealed no statistically significant relationships between variant aortic arch anatomy and the development of type A aortic dissections and aortic arch aneurysms. The presence of the common origin of brachiocephalic trunk and left common carotid artery was associated with a reduced risk of acute aortic dissection type I by 89 %, or an OR of 0.11 (95% CI: 0.03–0.46) (p = 0.002).Conclusion. Our data will help with future planning surgical interventions on the aortic arch and descending thoracic aorta. Received 17 June 2020. Revised 16 July 2020. Accepted 17 July 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and design: A.A. ShadanovData collection and analysis: A.A. Shadanov, T.A. BergenStatistical analysis: D.A. Sirota, A.A. ShadanovDrafting the article: A.A. ShadanovCritical revision of the article: D.A. Sirota, M.M. Lyashenko, A.M. ChernyavskiyFinal approval of the version to be published: A.A. Shadanov, D.A. Sirota, T.A. Bergen, M.M. Lyashenko, A.M. Chernyavskiy