Surgical repair of type A aortic dissection by the circulatory arrest- graft inclusion technique in sixty-six patients

A. C. Galloway, S. B. Colvin, E. A. Grossi, M. A. Parish, A. T. Culliford, T. Asai, N. M. Rofsky, J. C. Weinreb, S. Shapiro, F. G. Baumann, F. C. Spencer, D. C. Miller, W. W. Angell, W. Wolfe

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Abstract

During an 8-year period (1984 to 1991) 66 patients (mean age 59 years, range 26 to 84 years) with type A aortic dissection (60 ascending aorta tears, 6 arch tears; 35 acute, 31 chronic) had surgical repair by a continuous suture-graft inclusion technique. Hypothermic circulatory arrest (16° C) was used in 58 patients (35/35 acute, 23/31 chronic; mean arrest time 26 minutes, range 10 to 55 minutes). Fifty-two patients had hemiarch repair and 6 had total arch replacement. Aortic valve disease necessitated treatment in 38 patients (1 valved conduit, 20 valve replacements, 17 valve repairs). Recently 11 patients had valve repair by reconstruction of the native aortic root, by means of techniques similar to those used for homograft valve insertion. Operative mortality was 9% (14% acute, 3% chronic). Stroke occurred in 2 patients (3%) and was fatal in both. Variables suggestive of increased operative risk by univariate analysis were acuteness (p = 0.12), visceral ischemia (p = 0.12), and preoperative shock (p = 0.13). No variable was significant by multivariate analysis. Overall actuarial survival at 48 months was 77%, with 3 late deaths from a ruptured distal aneurysm. Late computed tomography or magnetic resonance imaging scan was done in 28 patients at a mean interval of 33 months. These studies identified 1 patient with a pseudoaneurysm requiring reoperation and 3 patients with contained flow between the graft and the wrap. Three patients required late operation: 1 for pseudoaneurysm, 1 for arch dissection, and 1 for repair of a distal aneurysm.

Original languageEnglish (US)
Pages (from-to)781-790
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume105
Issue number5
StatePublished - 1993

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Dissection
Transplants
False Aneurysm
Aortic Diseases
Ruptured Aneurysm
Tears
Aortic Valve
Reoperation
Sutures
Aneurysm
Allografts
Aorta
Shock
Multivariate Analysis
Ischemia
Stroke
Tomography
Magnetic Resonance Imaging
Survival
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Galloway, A. C., Colvin, S. B., Grossi, E. A., Parish, M. A., Culliford, A. T., Asai, T., ... Wolfe, W. (1993). Surgical repair of type A aortic dissection by the circulatory arrest- graft inclusion technique in sixty-six patients. Journal of Thoracic and Cardiovascular Surgery, 105(5), 781-790.

Surgical repair of type A aortic dissection by the circulatory arrest- graft inclusion technique in sixty-six patients. / Galloway, A. C.; Colvin, S. B.; Grossi, E. A.; Parish, M. A.; Culliford, A. T.; Asai, T.; Rofsky, N. M.; Weinreb, J. C.; Shapiro, S.; Baumann, F. G.; Spencer, F. C.; Miller, D. C.; Angell, W. W.; Wolfe, W.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 105, No. 5, 1993, p. 781-790.

Research output: Contribution to journalArticle

Galloway, AC, Colvin, SB, Grossi, EA, Parish, MA, Culliford, AT, Asai, T, Rofsky, NM, Weinreb, JC, Shapiro, S, Baumann, FG, Spencer, FC, Miller, DC, Angell, WW & Wolfe, W 1993, 'Surgical repair of type A aortic dissection by the circulatory arrest- graft inclusion technique in sixty-six patients', Journal of Thoracic and Cardiovascular Surgery, vol. 105, no. 5, pp. 781-790.
Galloway, A. C. ; Colvin, S. B. ; Grossi, E. A. ; Parish, M. A. ; Culliford, A. T. ; Asai, T. ; Rofsky, N. M. ; Weinreb, J. C. ; Shapiro, S. ; Baumann, F. G. ; Spencer, F. C. ; Miller, D. C. ; Angell, W. W. ; Wolfe, W. / Surgical repair of type A aortic dissection by the circulatory arrest- graft inclusion technique in sixty-six patients. In: Journal of Thoracic and Cardiovascular Surgery. 1993 ; Vol. 105, No. 5. pp. 781-790.
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abstract = "During an 8-year period (1984 to 1991) 66 patients (mean age 59 years, range 26 to 84 years) with type A aortic dissection (60 ascending aorta tears, 6 arch tears; 35 acute, 31 chronic) had surgical repair by a continuous suture-graft inclusion technique. Hypothermic circulatory arrest (16° C) was used in 58 patients (35/35 acute, 23/31 chronic; mean arrest time 26 minutes, range 10 to 55 minutes). Fifty-two patients had hemiarch repair and 6 had total arch replacement. Aortic valve disease necessitated treatment in 38 patients (1 valved conduit, 20 valve replacements, 17 valve repairs). Recently 11 patients had valve repair by reconstruction of the native aortic root, by means of techniques similar to those used for homograft valve insertion. Operative mortality was 9{\%} (14{\%} acute, 3{\%} chronic). Stroke occurred in 2 patients (3{\%}) and was fatal in both. Variables suggestive of increased operative risk by univariate analysis were acuteness (p = 0.12), visceral ischemia (p = 0.12), and preoperative shock (p = 0.13). No variable was significant by multivariate analysis. Overall actuarial survival at 48 months was 77{\%}, with 3 late deaths from a ruptured distal aneurysm. Late computed tomography or magnetic resonance imaging scan was done in 28 patients at a mean interval of 33 months. These studies identified 1 patient with a pseudoaneurysm requiring reoperation and 3 patients with contained flow between the graft and the wrap. Three patients required late operation: 1 for pseudoaneurysm, 1 for arch dissection, and 1 for repair of a distal aneurysm.",
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AU - Galloway, A. C.

AU - Colvin, S. B.

AU - Grossi, E. A.

AU - Parish, M. A.

AU - Culliford, A. T.

AU - Asai, T.

AU - Rofsky, N. M.

AU - Weinreb, J. C.

AU - Shapiro, S.

AU - Baumann, F. G.

AU - Spencer, F. C.

AU - Miller, D. C.

AU - Angell, W. W.

AU - Wolfe, W.

PY - 1993

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N2 - During an 8-year period (1984 to 1991) 66 patients (mean age 59 years, range 26 to 84 years) with type A aortic dissection (60 ascending aorta tears, 6 arch tears; 35 acute, 31 chronic) had surgical repair by a continuous suture-graft inclusion technique. Hypothermic circulatory arrest (16° C) was used in 58 patients (35/35 acute, 23/31 chronic; mean arrest time 26 minutes, range 10 to 55 minutes). Fifty-two patients had hemiarch repair and 6 had total arch replacement. Aortic valve disease necessitated treatment in 38 patients (1 valved conduit, 20 valve replacements, 17 valve repairs). Recently 11 patients had valve repair by reconstruction of the native aortic root, by means of techniques similar to those used for homograft valve insertion. Operative mortality was 9% (14% acute, 3% chronic). Stroke occurred in 2 patients (3%) and was fatal in both. Variables suggestive of increased operative risk by univariate analysis were acuteness (p = 0.12), visceral ischemia (p = 0.12), and preoperative shock (p = 0.13). No variable was significant by multivariate analysis. Overall actuarial survival at 48 months was 77%, with 3 late deaths from a ruptured distal aneurysm. Late computed tomography or magnetic resonance imaging scan was done in 28 patients at a mean interval of 33 months. These studies identified 1 patient with a pseudoaneurysm requiring reoperation and 3 patients with contained flow between the graft and the wrap. Three patients required late operation: 1 for pseudoaneurysm, 1 for arch dissection, and 1 for repair of a distal aneurysm.

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