Two-Step Aortic Cross-Clamping Technique for Acute Type-A Aortic Dissection in Octogenarians

Introduction

Controversy still persists over the treatment of acute type-A aortic dissection in octogenarians, due to the high rates of mortality and the associated morbidity. The International Registry of Acute Aortic Dissection database has identified an age of 70 years and older as one predictor of death in type-A dissection procedures [[1]]. Nevertheless, recent technical surgical improvements in emergency surgery for acute type-A aortic dissection have resulted in a marked decline in hospital mortality.

We report two cases of octogenarians with acute type-A aortic dissection treated with surgery using a two-step aortic cross-clamping technique (see [Fig. 1]).

Fig. 1 A to F First Step of aortic cross-clamping and application of Bioglue inside the aortic wall (A); replacement of the ascending aorta by a Dacron tube (B); the innominate artery is clamped, the aorta is unclamped, the Dacron tube is transversally opened, the Djumbodis is introduced inside the aortic arch (C); the Djumbodis is opened and adapted to the shape of aortic arch (D); Second Step with Dacron tube cross-clamping and suture of prosthesis with running 4/0 propylene suture (E); final result (F).

References

• 1 Hagan P G, Nienaber C A, Isselbacher E M. et al . The International Registry of Acute Aortic Dissection (IRAD). New insights into an old disease.  JAMA. 2000;  283 897-903
• 2 Saccani S, Busi M, Fragnito C. et al . Surgical repair and stent positioning for type A acute aortic: a step forward?.  Ann Thorac Surg. 2005;  79 1761-1763
• 3 Imamaki M, Nakajima N, Masuda M, Ishida A, Shimura H, Miyazaki M. Is it safe to initiate selective cerebral perfusion with normothermia?.  J Card Surg. 2005;  20 408-411
• 4 Roux D, Brouchet L, Concina P, Elghobary T, Glock Y, Fourmal G. Type-A acute aortic dissection: combined operation plus stent management.  Ann Thorac Surg. 2002;  73 1616-1618
• 5 Zimpfer D, Czerny M, Kettenbach J. et al . Treatment of acute type A dissection by percutaneous endovascular stent-graft placement.  Ann Thorac Surg. 2006;  82 747-749