J Thorac Cardiovasc Surg 2009;138:123-124
© 2009 The American Association for Thoracic Surgery
Discussion
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Dr R. Scott Mitchell
(Stanford, Calif). I congratulate you on a truly fine presentation. It is a difficult subject. You and your coauthors report on a subject of great interest, that is, the long-term utility of endografts in both acute and chronic dissections. Although stent grafts may be truly lifesaving for patients with acute dissections who have malperfusion or impending rupture, many of us harbor significant reservations regarding their utility in uncomplicated type B dissections or in any chronic dissection. In this respect, 20% of your patients were treated urgently for acute complications, whereas the remainder were treated in a stable condition. In-hospital mortality occurred in 5% of patients, 2 of whom died intraoperatively from ruptures of their dissection, which always is a very challenging patient cohort. Not surprisingly, older age, emergency status, and increasing ASA scores were independent predictors. Four patients had retrograde type A dissections in the acute phase, and 2 other patients had late type A dissections. This brings me to my first question. Do you have any information about these patients? Was it difficult to achieve a proximal seal? Did they get ballooning at the proximal anastomosis or proximal extensions? Can you elucidate on that?
Dr Ehrlich. Four of 7 patients had retrograde type A dissection within 30 days, and there is no doubt that this complication was . . . [Full Text of this Article]
Copyright © 2009 by The American Association for Thoracic Surgery.
