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J Thorac Cardiovasc Surg 2007;133:134-135
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Discussion

Dr Axel Haverich (Hannover, Germany). Dr Griepp and his group have to be congratulated on an excellent presentation for late outcome in patients with acute type A aortic dissection. As we all know, these patients present with numerous problems at the time of initial presentation; during surgical intervention, which is usually performed on an emergency basis; and during long-term follow-up. The unique features of this abstract are the low operative mortality that was maintained over the years and the true long-term follow-up. This retrospective analysis includes an initial group of 179 patients operated on during a period of 19 years at a single institution. One important difference to other series, including this long-term follow-up, is the fact that more than two thirds of these patients underwent initial replacement of the ascending aorta and portions of the aortic arch. This approach of an open distal anastomosis was pioneered by Dr Griepp and colleagues, and their technique has been adopted by many groups worldwide. As in our own series of late reoperation after initial ascending aorta–only repair in acute type A aortic dissection, many groups have reported on late repair involving the distal ascending aorta or the proximal arch as a frequent indication for late reoperation.

Dr Griepp, do you believe that the initial repair, including an open distal anastomosis, has influenced the considerably lower reoperation rates in your series compared with those of others, and what are your recommendations for the initial repair in the year 2005? Second, in an earlier series from Stanford with an initial 175 patients after repair for acute type A aortic dissection that I had the privilege to publish in Circulation in 1985, there were distinct risk factors for late reoperation. Among these, younger age and the presence of . . . [Full Text of this Article]

Related Article

The fate of the distal aorta after repair of acute type A aortic dissection

James C. Halstead, Matthias Meier, Christian Etz, David Spielvogel, Carol Bodian, Michael Wurm, Rohit Shahani, and Randall B. Griepp
J. Thorac. Cardiovasc. Surg. 2007 133: 127-135. [Abstract] [Full Text] [PDF]