초록접수 현황
| 20F-016 | 구연 발표 |
Acute type I aortic dissection accompanied by true lumen compression in the descending aorta – does it need a different strategy?
Joon Chul Jung, Bongyeon Sohn, Hyoung Woo Chang, Jae Hang Lee, Dong Jung Kim, Jun Sung Kim, Cheong Lim, and Kay-Hyun Park
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
Purpose : Severe compression of the true lumen (TL) in acute aortic dissection is a predisposing factor to malperfusion. This study aimed to investigate the prevalence, impact on the surgical outcome and postoperative morphological change of the compressed TL of the descending aorta in the patients undergoing surgical repair of acute type I dissection.
Methods : In 172 patients with acute type I aortic dissection, aortic dimension at 4 levels of descending aorta was mesrued in preoperative, early postoperative, and latest follow up after 6 months after surgery.
Results : 74 patients (30.5%) had severe TL compression at somewhere in the descending aorta. Those with severe TL compression (group I) had younger age (median 49.5 vs. 59.0), more Marfan syndrome (25.7% vs. 9.5%), and more frequent preoperative renovisceral malperfusion (17.5% vs. 4.7%). Postoperatively, group I more frequently had severe non-cardiocerebral ischemic events (23.5% vs. 10.3%, P<0.05). However, the in-hospital mortality rate was not different between groups (8.8% vs. 7.1%, P=0.784). No patient had <100mm2 postoperative TL area or late malperfusion event. Preoperative compressed TL negatively affected post-surgical remodeling of descending FL, especially after less extensive replacement.
Conclusion : Although severe TL compression carries a higher risk of perioperative ischemic insult to major organs, early surgical outcome does not seem to be improved by more extensive replacement as long as the entry tear is resected. On the contrary to the early outcome, long-term benefit of total arch replacement with elephant trunk was more remarkable for remodeling of descending thoracic aorta when its true lumen is compressed preoperatively.
Methods : In 172 patients with acute type I aortic dissection, aortic dimension at 4 levels of descending aorta was mesrued in preoperative, early postoperative, and latest follow up after 6 months after surgery.
Results : 74 patients (30.5%) had severe TL compression at somewhere in the descending aorta. Those with severe TL compression (group I) had younger age (median 49.5 vs. 59.0), more Marfan syndrome (25.7% vs. 9.5%), and more frequent preoperative renovisceral malperfusion (17.5% vs. 4.7%). Postoperatively, group I more frequently had severe non-cardiocerebral ischemic events (23.5% vs. 10.3%, P<0.05). However, the in-hospital mortality rate was not different between groups (8.8% vs. 7.1%, P=0.784). No patient had <100mm2 postoperative TL area or late malperfusion event. Preoperative compressed TL negatively affected post-surgical remodeling of descending FL, especially after less extensive replacement.
Conclusion : Although severe TL compression carries a higher risk of perioperative ischemic insult to major organs, early surgical outcome does not seem to be improved by more extensive replacement as long as the entry tear is resected. On the contrary to the early outcome, long-term benefit of total arch replacement with elephant trunk was more remarkable for remodeling of descending thoracic aorta when its true lumen is compressed preoperatively.
책임저자: Kay-Hyun Park
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
발표자: Joon Chul Jung, E-mail : junbare3@hanmail.net