VỊ TRÍ LỖ VÀO VÀ PHẪU THUẬT LÓC ĐỘNG MẠCH CHỦ LOẠI A CẤP TÍNH: KINH NGHIỆM TỪ MỘT TRUNG TÂM

Abstract

Background: The location of entry tear not only affects prognosis but also the treatment strategy of aortic dissection. However, the relationship between the entry tear and surgical outcomes for acute type A aortic dissection remains unclear. Methods and results: We retrospectively reviewed all patients with acute type A aortic dissection who underwent surgery on at Viet Duc University Hospital in the period of 2021-2022. Of 89 patients, the entry tear at the ascending aorta had the highest rate, accounting for 43.8% and the proportions of the other two groups were quite equal. The group without the entry tear at the ascending aorta or aortic arch presented false lumen thrombosis most frequently. The position of entry tear influenced the extent of surgery, in which the majority of patients with entry tear at the aortic arch had the hemiarch or total arch replacement. Postoperatively, the early mortality rate and early reoperation rate were 11.2% and 5.6%, respectively. The most common cause of early death was multiorgan failure and that of reoperation was bleeding. After surgery, the early mortality rate tended to be higher in the group with lesions at the aortic arch (p=0.08), while those with entry tear at the ascending aorta showed more bleeding complications (p=0.07). Conclusion: Acute type A aortic dissection is a lethal condition with a high mortality rate. The location of entry tear plays an important role in planning surgical treatment and predicting the initial outcomes of surgery as well as the long-term progression of this disease after surgery.