Original articleCardiovascularFate of the Residual Distal and Proximal Aorta After Acute Type A Dissection Repair Using a Contemporary Surgical Reconstruction Algorithm
Section snippets
Patients
This study was approved by the Investigational Review Board of the University of Pennsylvania (#804788), which waived the need for individual patient consent for the study. Patients were included if they had undergone surgical repair for acute type A aortic dissection in the years 1993 to 2004 performed by surgeons of the Thoracic Aortic Disease Center at the University of Pennsylvania who followed a uniform reconstruction algorithm. Patients had to have an open arch reconstruction with the use
Morbidity
Morbidity in the 216 patients was significant, with 59.3% experiencing some adverse event. Excluding the five intraoperative deaths, the reexploration rate for bleeding was 8.3% (18 of 216). Postoperative myocardial infarction occurred in 12 patients (5.6%), sepsis in 14 (6.5%), and sternal wound infection in 4 (1.9%). Cerebral complication included new postoperative strokes in 16 patients (7.4%), transient ischemic attack in 6 (2.8%), unresponsiveness for more than 24 hours in 15 (6.9%), and
Comment
Acute type A dissection remains one of the most challenging diseases facing cardiothoracic surgeons and is associated with high mortality and morbidity. Prevention of disease process progression in the residual dissected aorta is an important aspect of the patient’s long-term outcome. In an attempt to improve overall outcome in these complex patients, our Thoracic Aortic Surgery group established guidelines in the treatment of acute type A aortic dissection. We felt that no single therapeutic
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