Optimal Management of Acute Type A Aortic Dissection: Based on Assessment of Short- and Long-term Results.:Based on Assessment of Short-and Long-term Results
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Acute type A aortic dissection requires prompt diagnosis and appropriate primary management. We report short-and long-term results of surgical and medical management of acute type A aortic dissection in our department and discuss optimal management for good results. From 1991 to 2000, 146 patients diagnosed with acute type A aortic dissection were admitted to our department. Of these, 32 (21.9%) died in the emergency room due mainly to cardiac tamponade. It was difficult to resuscitate patients who had suffered cardiopulmonary arrest due to acute aortic dissection. Surgery could be done on 101 patients. Prosthetic vascular graft replacements were done to resect entry sites in 99 patients. Hospital mortality in preoperatively critical patients (n=32) was 40.6% but only 14.5% in others (n=69). Overall actuarial survival at 5 years postoperatively was 68.5%. The extent of replaced aorta, either ascending or total arch, did not influence short-and long-term results. A clotted false lumen in the descending aorta following proxymal aorta replacement significantly reduced dissection-related events. Considering these facts, extended aorta replacement seems to be acceptable for resection of entry site in the aortic arch and ascending aorta replacement seems to be reasonable if the entry site is in the ascending aorta. Of the 38 patients (33.3%) with early thrombosed acute type A aortic dissection, 13 without dissection-related complications were treated nonsurgically and 25 were treated surgically. Excluding critical cases, in-hospital mortality and event-free occurrence in surgically treated cases were significantly better than those in nonsurgically treated cases, indicating that the appropriateness of the widely used nonsurgical treatment for thrombosed cases should be reconsidered.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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