Surgical management for type A aortic dissection: 38 cases experience in King Chulalongkorn Memorial Hospital: early result and longterm follow-up.

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dc.contributor.authorSatdhabudha, Opasen_US
dc.contributor.authorLuengtaviboon, Kittichaien_US
dc.date.accessioned2009-05-27T18:39:48Z
dc.date.available2009-05-27T18:39:48Z
dc.date.issued2002-06-22en_US
dc.descriptionChotmaihet Thangphaet.en_US
dc.description.abstractOBJECTIVE: The objective of the present study was to evaluate the outcome of operative treatment for type A aortic dissection during the past 8 year period. PATIENTS AND METHOD: From January 1992 to March 2000, 38 patients (24 men and 14 women) underwent operations for acute (n = 26) and chronic (n = 12) type A aortic dissection. Patient's age ranged from 24 to 82 years (mean age 56 years). Surgical procedures included supracoronary ascending aortic graft for normal sinuses and valve (n = 34) with valve resuspension for commissural detatchment (n = 2), composite valve and ascending aortic graft for abnormal sinuses and valve (n = 1), and valve replacement and supracoronary ascending aortic graft for normal sinuses and abnormal valve (n = 1). Resection was extended into the arch and descending aorta in chronic dissection if there was excessive dilatation of the arch and descending aorta (n = 3). In 28 patients, aortic graft replacement was accomplished by proximal and distal anastomoses during aortic cross-clamping just proximal to the innominate artery. In 10 patients, deep hypothermia and circulatory arrest was used for open distal anastomosis or for arch replacement. Simultaneous coronary artery bypass grafting was performed in 4 patients. Pre-operative risk factors and the condition of the patients were defined and post-operative morbidity and mortality were followed in the early and long term period. RESULTS: There were 2 post-operative deaths (5.2%); one patient died of acute renal failure, the other patient had intra-operative rupture of the heart chamber; both were operated on in the acute phase of dissection. Complications included sternal wound infection in one case, neurological complication in two cases, respiratory problems in three cases, pericardial effusion in one case and post-operative bleeding that required re-operation in five cases. There was no hospital mortality in the group that were operated on in the chronic phase of dissection. Patient follow-up ranged 2 months to 8 years, there were two late mortalities, both, from acute myocardial infarction (at 33 days and 2 years after surgery). Survival rate was 92 per cent and 86 per cent at 30 days and 2 years, respectively. CONCLUSION: The result of repair of type A dissection in both phases was good in our center. The operative mortality was 5.2 per cent. Predictive factors of mortality were pre-operative shock (p=0.021), tamponade (p=0.021) and operation in the acute phase of dissection (p=0.042). In chronic type A dissection, the operative mortality was zero. Coronary artery disease was the most common cause of late deaths. Intermediate term survival in the present series was satisfactory.en_US
dc.description.affiliationDepartment of Surgery, Faculty of Medicine, Chulalongkorn University Bangkok, Thailand.en_US
dc.identifier.citationSatdhabudha O, Luengtaviboon K. Surgical management for type A aortic dissection: 38 cases experience in King Chulalongkorn Memorial Hospital: early result and longterm follow-up. Journal of the Medical Association of Thailand. 2002 Jun; 85 Suppl 1(): S156-62en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/39599
dc.language.isoengen_US
dc.source.urihttps://www.mat.or.th/journal/all.phpen_US
dc.subject.meshAcute Diseaseen_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAged, 80 and overen_US
dc.subject.meshAneurysm, Dissecting --mortalityen_US
dc.subject.meshAortic Aneurysm, Thoracic --mortalityen_US
dc.subject.meshAortic Valve --surgeryen_US
dc.subject.meshAortographyen_US
dc.subject.meshBlood Vessel Prosthesis Implantation --methodsen_US
dc.subject.meshChi-Square Distributionen_US
dc.subject.meshCohort Studiesen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshHeart Valve Prosthesis Implantation --methodsen_US
dc.subject.meshHospitals, Urbanen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshProbabilityen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshSeverity of Illness Indexen_US
dc.subject.meshSurvival Rateen_US
dc.subject.meshThailanden_US
dc.subject.meshTime Factorsen_US
dc.subject.meshTreatment Outcomeen_US
dc.subject.meshVascular Surgical Procedures --methodsen_US
dc.titleSurgical management for type A aortic dissection: 38 cases experience in King Chulalongkorn Memorial Hospital: early result and longterm follow-up.en_US
dc.typeJournal Articleen_US
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