This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Alberto Forteza Enrique Pérez Permission Requests Google Scholar Articles by Forteza, A. Articles by Cortina, J. PubMed PubMed Citation Articles by Forteza, A. Articles by Cortina, J.

Acute type A aortic dissection: 18 years of experience in one center (Hospital 12 de Octubre)

^a Department of Cardiac Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
^b Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain

*Corresponding author. C/Agastia n° 45 3° C, 28041, Madrid, Spain. Tel.: +34 91636275497; fax: +34 913908396.

E-mail address: apforteza{at}yahoo.es (A. Forteza).

Here, we review our experience in acute type A aortic dissection analyzing the role of antegrade brain protection. A total of 105 patients underwent surgery for acute type A aortic dissection between March 1990 and October 2008. An open technique with deep hypothermia was used in 81 patients. Deep hypothermia alone was induced in 32 patients; in combination with retrograde cerebral perfusion in 26 patients and in combination with antegrade cerebral perfusion (ACP) in the final 23 patients. The overall hospital mortality rate was 15%. Hospital mortality risk factors were age 70 years and preoperative shock (P<0.05). Hospital mortality was reduced to 9% in the last 23 consecutive patients in whom ACP was accomplished (P=0.05). Survival rate after 1, 5, 10 and 15 years of follow-up was 97.6±1.7%, 84.3±4.4%, 60.7±7.5% and 57.1±7.8%, respectively. The only late death risk predictor was the non-use of ACP (P<0.05). Surgery for acute aortic dissection provides excellent results. ACP via the axillary artery improves the prognosis for these patients and should be the brain protection method of choice.

Key Words: Aorta; Aortic dissection; Cerebral protection; Surgery complication; Neurologic injury