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If I Had an Acute Type A Dissection, How I Would Like to Be Managed?

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Controversies in Aortic Dissection and Aneurysmal Disease

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Abstract

An acute type-A dissection needs an emergency operation to prevent sudden death early after the onset. Cardiopulmonary bypass is established by cannulating a graft sutured to the right axillary artery and femoral artery. As for the protection of brain during arch repair, antegrade Selective Cerebral Perfusion (SCP) is routinely used. Both right axillary artery and left common carotid artery are perfused at a rate of 10 ml/kg/min at a rectal temperature of 25 °C. The operation consisted of resection of the aorta containing intimal tear, obliteration of the false lumen at the site of proximal and distal anastomosis, and interposition of woven Dacron graft. Distal graft anastomosis is performed during systemic circulatory arrest with antegrade SCP. Extent of aortic replacement mainly depends upon the site of intimal tear and patient’s general condition. Total arch replacement with elephant trunk technique is performed in selected patients with acceptable mortality rate.

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Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Hokkaido Ohno Hospital, 4-1-1-30 Nishino, Nishiku, Sapporo, 063 0034, Japan

    Teruhisa Kazui MD, PhD

Authors
  1. Teruhisa Kazui MD, PhD
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Correspondence to Teruhisa Kazui MD, PhD .

Editor information

Editors and Affiliations

  1. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Robert S. Bonser

  2. University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Domenico Pagano

  3. Thoracic and Cardiovascular Surgery Depts., Hannover Medical School, Hannover, Germany

    Axel Haverich

  4. University Hospitals Birmingham, Queen Elizabeth Hospital & Centre, Birmingham, United Kingdom

    Jorge Mascaro

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Kazui, T. (2014). If I Had an Acute Type A Dissection, How I Would Like to Be Managed?. In: Bonser, R., Pagano, D., Haverich, A., Mascaro, J. (eds) Controversies in Aortic Dissection and Aneurysmal Disease. Springer, London. https://doi.org/10.1007/978-1-4471-5622-2_22

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  • DOI: https://doi.org/10.1007/978-1-4471-5622-2_22

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5621-5

  • Online ISBN: 978-1-4471-5622-2

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