[HSF] Type I Dissection

[Tea Acuff]

Just for clarification why assume that this is an acute dissection? By teaching if this were a primary dissection there would be a greater than 90% chance that this is not the case (ie the patient is alive for a week). If the patient was spared sudden death by a suture line for AVR (which I believe by a few observations, and indeed the theory of our therapy, is a real phenomenon), then it is quite likely that this dissection is old. Then the primary (perhaps) indication would not be the disection but the aneurysmal dilation to 7cm. Do the symptoms (or lack of other more typical ones) mean anything ? Comments from anyone?
Tea


----- Original Message ----
From: Giulio Rizzoli <giulio.rizzoli at unipd.it>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, February 9, 2007 3:31:19 AM
Subject: Re: [HSF] Type I Dissection


>I would like to insist on the fact that the use of deep hypothermia is not
>necessary if you use selective antegrade cerebral perfusion. As we all know,
>it is tedious, time -consuming (very long duration of CPB) provides  unsafe
>brain protection beyond 30 minutes and may be the cause of many
>complications in the postoperative course. Moderate hypothermia with SACP is
>very safe and much more patient and surgeon friendly. For me (as for many
>others) Deep hypothermia associated with total circulatory arrest has no
>place in this kind of surgery.
>Jean Bachet.

Having used both the techniques I completely 
agree with Bachet in the setting of a chronic 
disease, but I assumed this patient has an acute 
aortic dissection of a chronic aortic aneurysm.
In the acute scenary my choice in favour of  one 
or the other technique is guided by 
emergency,  presence of pericardial effusion, 
risk of clamp tear of the innominate artery and  body size of patient.
I completely agree with Bachet that an operation 
at 25°  (i used 27° without problems)  is much 
better than one at 18° , both for the patient and 
the surgeon, who spares hours of rewarming and 
hemostasis (we do proximal repair while cooling).
In the setting of acute aortic dissection the 
traditional technique has in our hands a risk 
below 20% and a 7% risk was reported years ago 
from Stanford (difficoult to beat).
                         Giulio Rizzoli

Giulio Rizzoli MD FETCS
Cardiochirurgia Padova
tel. 049 821-2408
fax 049 821-2409
e-mail giulio.rizzoli at unipd.it

***************************************************************************
Ich hatte einst ein schönes Vaterland.
Der Eichenbaum wuchs dort so hoch, die Veilchen nickten sanft.
Es war ein Traum .... Heinrich Heine



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