| Treatment of Patients with Acute
Type A Dissection with Malperfusion |
(Department of Cardiovascular Surgery, Tokushima
Red Cross Hospital, Tokushima, Japan)
| Yoshiaki Fukumura |
Masaaki Bando |
Yasushi Shimoe |
| Kazuhisa Katayama |
Homare Yoshida |
Yoshihiko Kataoka |
|
Although the results of surgical
treatment for acute type A dissection have improved because of
progress in surgical techniques, the prognosis is still very
poor and optimal therapeutic approach is still not clearly established
for cases of acute dissection complicated with malperfusion.
Of 134 patients who presented with acute aortic dissection between
January 1986 and June 1999, 57 had acute type A dissection and
10 had acute type A dissection with malperfusion. Patient age
ranged from 53 to 78 (average, 64.6) years. There were 6 men
and 4 women. There was accompanying cerebral ischemia in 3 cases,
coronary ischemia in 1, visceral ischemia in 5, renal ischemia
in 2, ischemia of the extremities in 7, and multiple organ ischemia
in 5. One patient died before surgery, and another patient died
after sternotomy due to aortic rupture. The other 8 patients
underwent surgical operations. The following surgical procedures
were performed: bypass grafting to the superior mesenteric artery
was performed in 1 patient, stent implantation to the right coronary
artery followed by ascending aortic replacement (19th day after
onset) was performed in 1, and aortic repair (5 ascending aortic
replacements and 1 hemiarch replacement) in the acute phase was
performed in 6. The mortality rates were 66.7%(2/3)in patients
with cerebral ischemia, 0%(0/1) in the patient with coronary
ischemia, 80%(4/5) in those with visceral ischemia, 100%(2/2)
in those with renal ischemia, 42.9%（3/7) in those with ischemia
of the extremities, 80%(4/5) in those with multiple organ ischemia,
and 50%(5/10) in all cases. All patients whose base excess (B.E.)
was less than －10mEq/l on admission died (4/4). We conclude that
in order to improve surgical results in patients with acute type
A dissection with malperfusion, different approaches may be required
for each patient. The combination of aortic repair and percutaneous
reperfusion are important. Arterial blood gas analyses were simple,
and the values of B. E. at admission were useful to determine
the surgical strategy in these patients and to predict their
prognosis.
Jpn. J. Cardiovasc. Surg. 30: 182-186 (2001) |
|
