[Acute type A aortic dissection].

Background: Current surgical results for acute type A aortic dissection has been getting better, though the mortality rate still remains high, up to 10-15% in Japan. Our strategy consists of #1 make the most use of echography for better understanding of hemodynamics; #2 the extent of replacement depends on the site of initial entry; #3 deep hypothermic circulatory arrest and retrograde cerebral perfusion for brain protection.

Patients And Methods: Between January 2000 and December 2003, 45 consecutive patients were treated. Twelve of them had extended replacement of the arch, and 3 had simultaneous root replacement by means of a composite graft.

Results: In hospital mortality was 11% (5 patients). The cause of death was serious organ malperfusion, which had been developed preoperatively, in all patients but 1 who suffered from thoracic aortic obstruction due to newly developed type B aortic dissection.

Conclusions: The determinant of surgical mortality in patients with acute type A aortic dissection is the presence of serious organ malperfusion. Rapid diagnosis and less invasive treatment for malperfusion is the key to improve the results.