Original ArticlesSurgical Treatment of Acute Type B Aortic Dissection Using an Endoprosthesis (Elephant Trunk)
Section snippets
Patients and Methods
From May 1988 to December 1995, 70 consecutive patients with an acute type B aortic dissection underwent an elephant trunk procedure performed through a me- dian sternotomy during deep hypothermic circulatory arrest. There were 57 male and 13 female patients ranging in age from 31 to 80 years. Diagnosis was confirmed in all patients by aortography, contrast-enhanced computed tomographic scanning, and transthoracic or transesophageal echocardiography. Ten patients had retrograde arch
Results
The mean duration of deep hypothermic circulatory arrest was 31.4 ± 8.7 minutes (maximum, 51 minutes). The total cardiopulmonary bypass time was 99 ± 22 minutes. Associated procedures included replacement of the ascending aorta or arch (11 cases) and myocardial revascularization (2 cases). Fourteen patients (20%) died during their hospital stay. Death was due primarily to neurologic events (2 patients), pulmonary insufficiency (2 patients), acute renal failure (3 patients), multiorgan failure
Comment
Since the mid-1960s and early 1970s when Wheat [[1]] and Daily [[7]] and their colleagues recommended that patients with a type B dissection be treated with medical therapy, surgical treatment has been reserved for patients with complications of the dissection, such as rupture, an aneurysm, or organ ischemia. However, medical therapy is associated with a high incidence of complications stemming from expansion of the false lumen and ischemic injury to different organs, with a 5-year mortality
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