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• W132361125 abstract "SUMMARY 1. Experience with surgical management of 179 patients with dissecting aneurysms of the aorta during the past decade has allowed development of certain conceptual changes and new methods of operative treatment based on a better understanding of the anatomic and pathologic patterns of the disease. On the basis of these conceptual developments, dissecting aneurysms may be classified into three basic types: Type I, in which the dissecting process along with its intimal tear arises in the ascending aorta and not infrequently extends into its major terminal branches; Type II, in which the dissecting process is limited to the ascending aorta; and Type III, in which the dissecting process arises in the descending thoracic aorta, usually at or just distal to the origin of the left subclavian artery, and extends distally for a varying distance. Not infrequently, the first two types of dissection are associated with aortic valve regurgitation, due either to annular dilatation or to loss of support for the valve commissural attachments. 2. Also based upon these conceptual developments, specific and definitive surgical approaches have evolved for each type of dissecting process. Type I dissections are managed by transection of the ascending aorta with the use of temporary cardiopulmonary bypass and obliteration of the false lumen by approximation of the inner and outer walls of the dissecting process by continuous suture both proximally and distally, followed by end-to-end anastomosis of the transected aorta. Surgical treatment of Type II dissections consists essentially in resection and graft replacement of the entire ascending aorta using cardiopulmonary bypass. When present in these two types of dissection, aortic valve regurgitation is corrected concomitantly by annuloplasty, including annular constriction, bicuspidization or resupport of the valve, or by prosthetic replacement of the valve. Type III dissections are managed by excision with graft replacement of the segment of descending thoracic aorta in which the dissection arises, using pump bypass from the left atrium to the femoral artery. 3. These procedures have been found applicable to both acute and chronic forms of the disease, and results have been increasingly gratifying in altering the generally grave prognosis of these patients. This is reflected by the fact that the operative mortality has been steadily reduced from 41 per cent in the first 4 years of this surgical experience to only 12 per cent in a series of 97 patients operated upon during the last 4 years. This is further reflected in the long-term survival rates based upon follow-up observations on all patients in the series extending up to 10 years. Thus, the 5-year survival rate of 50 per cent in this surgically treated series of patients, most of whom have resumed normal activities, is in sharp contrast to the less than 1 per cent figure previously reported for nonoperative cases. On the basis of this experience, surgical intervention is now considered the treatment of choice in all instances, and emergency operation is often indicated." @default.
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• W132361125 title "SURGICAL MANAGEMENT OF DISSECTING ANEURYSMS OF THE AORTA" @default.
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• W132361125 doi "https://doi.org/10.1016/s0022-5223(19)33323-9" @default.
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