Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Redo Opeations for Recurrent Dissection After Operation for Type A Aortic Dissection

A형 대동맥 박리 수술 후 재발성 박리의 재수술

  • 홍유선 (연세대학교 의과대학 심장혈관센터 심장혈관외과) ;
  • 강정한 (연세대학교 의과대학 심장혈관센터 심장혈관외과) ;
  • 윤치순 (건양대학교 의과대학 흉부외과학교실) ;
  • 이현성 (연세대학교 의과대학 심장혈관센터 심장혈관외과) ;
  • 박형동 (킬리만자로 크리스찬 의료원)
  • Published : 2001.08.01
Download PDF
⟨ Previous Next ⟩

Abstract

Stanford type A aortic dissection after graft replacement of ascending aorta and/or aortic arch required careful follow-up due to progression of the enlarged false lumen or the recurrence of dissection. From June 1984 to June 200, 124 patients underwent operations for type A aortic dissection. Among them, 6 patients underwent reoperation due to recurred aneurysm or dissection. We evaluated that the causes of reoperation, including Marfan syndrome, the approach and result of reoperation, and strategy to reduce the risk of reoperation. Material and method: The first operation was done on acute stage in 4 cases, and chronic stage in 2 cases. There were Marfan syndromes in 3 cases. The entry site was the ascending aorta for all cases except one who underwent Bentall operation(n=3) or ascending aorta graft replacement(n=2). In one case, Bentall operation and total arch replacement was performed due to chronic type A dissection with multiple fenestrations. Mean interval of reoperation was 67.6months(range 5 months to 14 year 4months) after the first operation. Reoperations were performed with recurrence of dissection(n=4), threatening aneurysmal evolution of persisting dissection(n=1), and false aneurysm with infection(n=1). The redo operation involved the hemiarch in 1 case, distal ascending to total arch and descending thoracic aorta in 4 cases, and only descending thoracic aorta in 1 case. Result: There were Marfan syndromes in 18 patients. The mean age in type A dissection was 56.7 years and that in the first operation of reoperationc ases was 32.2 years. Especially in 3 patients with Marfan syndrome, the mean age was 29 years.

배경: Stanford 제A형(type A) 대동맥 박리증은 상행대동맥이나 대동맥궁의 인조혈관 치환 수술 후에도 남은 대동맥의 가강이 확장되거나 파열의 가능성이 있기 때문에 철저한 추적관리가 필요하다. 연세대학교 세브란스병원에서는 1984년 6월부터 2000년 3월까지 Stanford 제A형의 대동맥박리 수술이 124예 있었다. 수술 후 가강의 확장이나 파열로 재수술한 6예에서 Marfan 증후군과의 관련성 등 원인을 조사하고 재수술의 방법과 결과, 재수술의 위험을 줄일 수 있는 방법 등을 알아보고자 한다. 대상 및 방법: 처음 대동맥 박리로 수술시급성인 경우가 4예 만성이 2예였으며 이중 3예가 Marfan 증후군이였다. 1예를 제외한 모든 환자에서 상행대동맥내에 내막파열이 있어 대동맥판막의 폐쇄부전의 정도에 따라 상행대동맥 인조혈관 치한수술(2례) 또는 Bentall 수술을 시행하였으며(3례) 1예는 여러 개의 가강과의 연결부위가 있는 만성 박리 환자로 Bentall 수술과 더불어 대동맥궁까지 인조혈관으로 치환을 하였다. 재수술은 평균 67.6개월(4개월-14년4개월) 후에 시행하였는데 1예는 만성 하행대동맥 박리 및 동맥류로 1예는 염증성 가성동맥류로 나머지 4예는 급성대동맥 박리로 재수술을 시행하였다. 수술은 하행흉부대동맥만을 치환한 경우가 1예, Hemiarch로 시행한 경우가 1예 그리고 나머지 4예는 원위부 상행대동맥에서 대동맥궁을 포함하여 근위부 또는 중간부위의 하행 흉부대동맥까지 인조혈관으로 치환하였다. 결과: 전체 124예 중 Marfan 증후군이 동반된 경우는 18예였다.

Keywords

References

  1. Circulation v.35 Clinical featrues and prognosis in dissecting aneurysms of the aora Lindsay JJ;Hurst JW
  2. J Thorac Cardiovasc Surg v.102 Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation Fann JI;Glower DD;Miller DC;(et al.)
  3. Ann Thorac Surg v.56 Reoperations after operation on the thoracic aorta: Etiology, surgical techniques, and prevention Carrel T;Pasic M;Jenni R;(et al.)
  4. Euro J Cardiothorac Surg v.11 no.4 Retrograde cerebral perfusion through antero-axillary thoracotomy in the aortic arch surgery Sasaguri S;Yamamoto S;Fukuda T;Hosoda Y
  5. Ann Thorac Surg v.44 Operative management of acute arotic arch dissection using profound hypothermia and circulatory arrest Graham JM;Stinnett DM
  6. J Thorac Cardiovasc Surg v.97 Urgent operation for acute transverse aortic arch dissection Lansman SL;Raissi S;Ergin MA;Griepp RB
  7. Ann Thorac Surg v.10 Management of acute dissection Daily PO;Trueblood HW;Stinson EB;Wuerflein RD;Shumway NE
  8. Surgery v.92 Dissection and dissecting aneurysms of the aorta: twenty-seven patients treated surgically DeBakey ME;McCollin C;Crawford ES;(et al.)
  9. Ann Surg v.198 Marfan's syndrome: broad spectrum surgical treatment of cardiovascular manifestations Crawford ES
  10. J Cardiovasc Surg v.31 Surgery of type A acute aortic dissection with Gelatine-Resorcing-Formol biological glue: a twelve-year experience Bachet JE;Goudot B;Teodori G;(et al.)
  11. Circulation v.92 Surgical management of aortic dissection during a 30-year period Fann JI;Smith JA;Miller DC;(et al.)
  12. Circulation v.72 Acute and chronic dissections-determinants of long-term outcome for operative survivors Haverich A;Miller DC;Scott WC;(et al.)
  13. J Thorac Cardiovasc Surg v.104 Surgery for acute dissection of ascending aorta: Should the arch be included? Crawford ES;Kirklin JW;Naftel DC;(et al.)
  14. J Throac Cardiovasc Surg v.98 Surgical treatment of aneurysm and/or dissection of the ascending aorta.transverse aortic arch, and ascending aorta and trunsverse aortic arch Crawford ES;Svensson LG;Coselli JS;(et al.)
  15. Ann Thorac Surg v.40 Redooperations for recurrent aneutysmal disease of the ascending aorta and transverse aortic arch Crawford ES;Crawford JL;Safi HJ;(et al.)
  16. J Thorac Cardiovasc Surg v.119 Extended total arch replacement for acute type A aortic dissection: Experience with seventy patients Kazui T;Washiyama N;Muhammad BAH;(et al.)
  17. J Thorac Cardiovasc Surg v.108 Aortic dissection : Prevalence, cause,and result of late reoperations Bachet JE;Termingnon JL;Dreyfus G;(et al.)
  18. Ann Thorac Surg v.49 Thoracic aortic aneurysms after acute type A aortic dissection: Necessity for follow-up Heinemann M;Laas J;Karck M;(et al.)
  19. CT study Radiology v.170 Natural history of the false channel of type A aortic dissection after surgical repair Yamaguchi T;Guthaner DF;Wexler L;(et al.)