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Retrograde type A aortic dissection: a different evil
Retrograde type A aortic dissection (RTAAD) can be spontaneous or secondary to the instrumentation of the descending and thoraco-abdominal aorta. It has anatomical differences compared to antegrade type A aortic dissection that impact the management and prognosis. Treatment is not standardized. We r...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9642331/ https://www.ncbi.nlm.nih.gov/pubmed/36271851 http://dx.doi.org/10.1093/icvts/ivac264 |
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author | Lopez-Marco, Ana Adams, Benjamin Oo, Aung Ye |
author_facet | Lopez-Marco, Ana Adams, Benjamin Oo, Aung Ye |
author_sort | Lopez-Marco, Ana |
collection | PubMed |
description | Retrograde type A aortic dissection (RTAAD) can be spontaneous or secondary to the instrumentation of the descending and thoraco-abdominal aorta. It has anatomical differences compared to antegrade type A aortic dissection that impact the management and prognosis. Treatment is not standardized. We report our approach to spontaneous RTAAD in our institution between 2018 and 2022 (n = 15). The mean age was 60.1 years and 93% were male. Aortic valve, coronary arteries and supra-aortic trunks were spared by the dissection in 80% of the cases; distal extension to iliacs was common and lower limb malperfusion was present in 4 cases (27%). The ascending aorta was dilated at presentation in 60% of the cases. Emergency surgery with arch/FET replacement was offered to 11 patients (73%); 3 patients (20%) received a limited proximal aortic repair; 1 patient was treated conservatively. Overall mortality was 47% (100% for limited proximal repair and 22% for those who received arch/FET). We advocate for aggressive treatment of RTAAD excluding the primary entry tear to prevent immediate- and mid-term complications. |
format | Online Article Text |
id | pubmed-9642331 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-96423312022-11-14 Retrograde type A aortic dissection: a different evil Lopez-Marco, Ana Adams, Benjamin Oo, Aung Ye Interact Cardiovasc Thorac Surg Vascular Retrograde type A aortic dissection (RTAAD) can be spontaneous or secondary to the instrumentation of the descending and thoraco-abdominal aorta. It has anatomical differences compared to antegrade type A aortic dissection that impact the management and prognosis. Treatment is not standardized. We report our approach to spontaneous RTAAD in our institution between 2018 and 2022 (n = 15). The mean age was 60.1 years and 93% were male. Aortic valve, coronary arteries and supra-aortic trunks were spared by the dissection in 80% of the cases; distal extension to iliacs was common and lower limb malperfusion was present in 4 cases (27%). The ascending aorta was dilated at presentation in 60% of the cases. Emergency surgery with arch/FET replacement was offered to 11 patients (73%); 3 patients (20%) received a limited proximal aortic repair; 1 patient was treated conservatively. Overall mortality was 47% (100% for limited proximal repair and 22% for those who received arch/FET). We advocate for aggressive treatment of RTAAD excluding the primary entry tear to prevent immediate- and mid-term complications. Oxford University Press 2022-10-22 /pmc/articles/PMC9642331/ /pubmed/36271851 http://dx.doi.org/10.1093/icvts/ivac264 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Vascular Lopez-Marco, Ana Adams, Benjamin Oo, Aung Ye Retrograde type A aortic dissection: a different evil |
title | Retrograde type A aortic dissection: a different evil |
title_full | Retrograde type A aortic dissection: a different evil |
title_fullStr | Retrograde type A aortic dissection: a different evil |
title_full_unstemmed | Retrograde type A aortic dissection: a different evil |
title_short | Retrograde type A aortic dissection: a different evil |
title_sort | retrograde type a aortic dissection: a different evil |
topic | Vascular |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9642331/ https://www.ncbi.nlm.nih.gov/pubmed/36271851 http://dx.doi.org/10.1093/icvts/ivac264 |
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