Operative survival remains the priority in operations for acute aortic dissection type A. It depends on the promptness of diagnostic and treatment but also on the perioperative surgical management: the refinement in surgical techniques, better myocardial and cerebral protection, and control of hemostatic factors.
Between l/95 and 12/98, forty-six patients (mean age 62 years) were operated on for acute aortic dissection type A. One patient had cannulation-related dissection, 3 patients had
Marfan disease and 3 patients had had a previous cardiac operation. Aortic regurgitation was found in 39 patients, hemopericardium in 42. Fifteen patients presented with neurological events (2 comas) at admission, and 3 were in cardiogenic shock.
Deep hypothermic circulatory arrest with temperature determined by somatosensory evoked potentials monitoring was used in all patients: the arch was systematically checked and an open-distal anastomosis reinforced by GRF was performed. For the proximal anastomosis, 34 patients benefited from preservation of the native valve (12 remodelling, 15 reconstructed with GRF and 7 intact aortic root) and 2 had a replacement of the aortic root with a composite graft. Fifteen patients had a total or partial arch replacement.
Results : The operative mortality was 4.7 % (2/46), and the overall hospital mortality 16 % (7 patients). Six patients had to be reopened for hemostasis. Two patients experienced new neurological events. At follow-up (mean 25 months), there were 5 late deaths. On the 34 survivors, 23 are asymptomatic, 2 had recurrent dissection and underwent reoperation.
Conclusion : The current surgical management of this disorder has contributed to enhanced immediate results. Preservation of the native valve may improve the long-term results inasmuch it prevent prosthesis-related complications and anticoagulation in this subject of patients with regard to the distal false lumen.