Strategy of Surgical Procedure for Stanford A Type Acute Aortic Dissection

DOI 11 References
  • Shioguchi Soichi
    Department of Cardiovascular Surgery, Koshigaya Hospital Dokkyo University School of Medicine
  • Kato Ippei
    Department of Cardiovascular Surgery, Shinkatushika Hospital
  • Yoshida Shigehiko
    Department of Cardiovascular Surgery, Shinkatushika Hospital

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Other Title
  • Stanford A型急性大動脈解離に対する治療戦略

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Abstract

We reviewed our therapeutic strategies and experience for acute type A aortic dissection. The subjects were 38 patients who underwent the emergency surgery for type A aortic dissection during the period from November 2000 to January 2004. Their mean age was 63.2±11.4 years(range 40∼87 years). The subjects were classified into the following three groups according to surgical procedures: replacement of the ascending aorta (n=11), replacement of the hemiarch aorta(n=25) and replacement of the total arch of aorta(n=2). As a rule, the subclavian artery was selected for blood transmission. The target rectal temperature at the time of circulatory arrest was 20°C. Unilateral anterograde brain perfusion was performed perfusion through the right subclavian artery, while retrograde brain perfusion was performed through the superior vena cava. The femoral artery was simultaneously ensured. Four of those who underwent replacement of the hemiarch aorta died. The 34 patients who had no major complications before surgery were discharged from the hospital and 33 of them succeeded in social rehabilitation. There was no significant difference in surgical factors and incidence of cerebral infarction between replacement of the heimiarch aorta and the ascending aorta. As acute emergency surgery for type A aortic dissection, replacement of the hemiarch aorta including isolated brain perfusion seems to be less invasive than replacement of the total arch aorta.

Journal

  • CIRCULATION CONTROL

    CIRCULATION CONTROL 28 (1), 64-68, 2007

    Japan Society of Circulation Control in Medicine

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