Cor Vasa 2010, 52(3):145-148 | DOI: 10.33678/cor.2010.040

The Essen concept of surgical management of patients with acute aortic dissection

Jaroslav Benedík^1,*, Konstantinos Tsagakis¹, Markus Kamer¹, Adam Jarowit Piotrowski¹, Parwis Massoudy¹, Brigitte Osswald¹, Paschalis Tossios¹, Mathias Thielmann¹, Holger Egebrecht², Thomas Konorza², Raimund Erbel², Hainz Jakob¹

¹ Klinik für Thorax- und Kardiovaskuläre Chirurgie, Universitätsklinikum Essen

² Klinik für Kardiologie, Universitätsklinikum Essen, Deutschland

Aim of study: To present the concept of management of patients with acute aortic dissection, developed at the Department of Thoracic and Cardiovascular Surgery of University Hospital Essen, Germany.

Methods: The concept is based on four main principles, i.e., minimization of time from diagnosis to actual surgery, optimal selection of arterial cannulation based on preoperative assessment performed right on the operating table of a hybrid operating room, termination of severe visceral malperfusion using fenestration or stenting in the abdominal aorta region, and use of intraoperative angioscopy to examine the aortic arch and descending aorta to determine the necessary extent of actual surgery.

Results: A total of 71 patients with acute aortic dissection, with a mean age of 61±13 years, were operated on from January 2004 through December 2008 in Essen, Germany. Patients were predominantly men (44; 62%) and those with DeBakey Type I dissection (59%). Thirty-six (51%) hemodynamically stable patients had preoperative angiography while the remaining (those with cardiogenic shock or severe hemodynamic instability) had emergency surgery without previous angiography. An endovascular intervention procedure (fe-nestration or stenting) was performed in seven patients (10%) preoperatively. Intraoperative angioscopy, undertaken during hypothermic circulatory arrest, served to determine the extent of surgery in the area of the aortic arch and descending aorta. The procedure involved the ascending aorta in all patients, aortic arch in 67, and descending aorta in 30 patients. There were nine in-hospital deaths (13%) while seven patients (10%) developed stroke, and five (7%) required surgical revision for bleeding.

Conclusions: The Essen algorithm of care of patients with acute aortic dissection shortens the time from diagnosis to surgery, minimizes the risk of long-term intraoperative malperfusion, and sets clear rules for the rational use of a combined prosthesis or an extensive procedure in aortic arch and descending aorta.

Keywords: Acute aortic dissection; Hybrid surgery; Intraoperative angioscopy

Published: March 1, 2010  Show citation