Repair of acute type A dissection: our experiences and results

Abstract

Background: Significant advances in the diagnosis and therapy have greatly improved surgical outcomes of acute type A dissection. However, surgical management of acute type A dissection still poses formidable challenges, particularly in "developing" countries. We present our surgical management strategy of acute type A dissection in a single center in China.

Methods: On the basis of Stanford classification, acute type A dissection was subclassified at our center. Aortic root lesions were divided into three subtypes (A(1), A(2), and A(3)) and distal aortic lesions into two subtypes (C and S) according to lesion severity. The corresponding surgical procedure was scheduled according to each subtype. According to this subclassification, 257 patients (67 females, 190 males) with acute type A dissection underwent surgical treatment from January 2003 to March 2008.

Results: The overall prevalence of in-hospital death was 4.67% (12 of 257) and deaths at follow-up were 3.27% (8 of 245) during a follow-up of 35 months. Stroke occurred in five patients, paraplegia in two patients, paraparesis in two patients, respiratory failure in 15 patients, renal failure in two patients, hepatic failure in one patient, and multiple-organ failure in one patient. Injury to the spinal cord and visceral organ ischemia were not observed in patients who underwent stented elephant trunk implantation during follow-up. Six patients underwent late distal aortic reoperation.

Conclusions: The encouraging and satisfactory surgical outcomes and postoperative results demonstrating a low prevalence of morbidity and mortality showed the substantial improvement in surgery for acute type A dissection using our surgical strategy at a center in China.