Recent Advances in Acute Type A Aortic Dissection


by

Ying-Fu Chen, Chwan-Yau Luo, Dominique Shum-Tim

DOI: 10.2174/97816810808881150101
eISBN: 978-1-68108-088-8, 2015
ISBN: 978-1-68108-089-5



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Indexed in: EBSCO.

Type A acute aortic dissection (TAAAD) is an acute cardiovascular condition that is normally associated with genetic conditions such a...[view complete introduction]

Table of Contents

Preface

- Pp. i-ii (2)

Ying-Fu Chen, Chwan-Yau Luo and Dominique Shum-Tim

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List of Contributors

- Pp. iii-v (3)

Ying-Fu Chen, Chwan-Yau Luo and Dominique Shum-Tim

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Introduction

- Pp. vii

Ying-Fu Chen

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Epidemiology of Acute Type A Aortic Dissection

- Pp. 3-29 (27)

Wen-Huang Li and Ping-Yen Liu

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Pathophysiology and Risk Factors of Type A Acute Aortic Dissection

- Pp. 31-50 (20)

Yi-Heng Li and Chwan-Yau Luo

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Marfan Syndrome and Marfan-like Disorders

- Pp. 51-68 (18)

Alice Le Huu and Dominique Shum-Tim

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Contemporary Diagnostic Modalities for Acute Type A Aortic Dissection

- Pp. 69-99 (31)

Shawn Pun, Genevieve Belley and Thao Huynh

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Management Options for Acute Type A Aortic Dissection Complicated with Malperfusion Syndrome: Operative Delay or Immediate Repair?

- Pp. 101-122 (22)

Li Zhang, François Dagenais and Siamak Mohammadi

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Acute Type A Aortic Dissection Associated with Acute Coronary Involvement --- with or without Coronary Malperfusion

- Pp. 123-152 (30)

Chih-Wei Chen, Tsu-Ming Chien, Huai-Ming Chen, Hui-Chen Yu, Chun-Chen Chen and Ying-Fu Chen

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Optimal and Safe Cannulation for Repairing Acute Ascending Aortic Dissection

- Pp. 153-172 (20)

Huai-Min Chen and Ying-Fu Chen

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Brain Protection During Repair for Acute Type A Aortic Dissection

- Pp. 173-210 (38)

Meng-Ta Tsai and Chwan-Yau Luo

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Therapeutic Strategies for Repairing Acute Aortic Dissection Involving the Aortic Root

- Pp. 211-226 (16)

Xin Chen and Fuhua Huang

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Valve-Sparing Root Replacement in Marfan Syndrome with Acute Type A Aortic Dissection

- Pp. 227-247 (21)

Osama Benhameid, Dimitri Kalavrouziotis and Siamak Mohammadi

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Is Emergency Total Arch Replacement with an Open Stent Graft Justified for Acute Type A Aortic Dissection?

- Pp. 249-263 (15)

Li-Zhong Sun and Rui-Dong Qi

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Risk Factor Analysis of Surgical and Long-term Results in Patients with Acute Type A Aortic Dissection

- Pp. 265-285 (21)

Jun-Neng Roan, Hsuan-Yin Wu and Chwan-Yau Luo

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Acute Type A Dissection in the Octogenarian

- Pp. 287-297 (11)

Jennifer Chung and Dominique Shum-Tim

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Effects of False Lumen Patency on the Residual Dissected Thoracic Aorta after Repair of Acute Type A Aortic Dissection

- Pp. 299-318 (20)

Meng-Ta Tsai, Yi-Shan Tsai and Chwan-Yau Luo

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Strategies for Distal Aortic Reintervention after Repaired Acute Ascending Aortic Dissection

- Pp. 319-336 (18)

Simon Neequaye and Cherrie Abraham

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Clinical Presentation, Diagnosis, and Management of Type A Aortic Intramural Hematoma: Update, Controversies, and Unknowns

- Pp. 337-351 (15)

Rony Atoui and Chris S. Malaisrie

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Subject Index

- Pp. 353-358 (6)

Ying-Fu Chen, Chwan-Yau Luo and Dominique Shum-Tim

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Preface

“Learning without thinking is begets ignorance”

“Thinking without learning is perilous”

Confucius

Cardiovascular diseases remain one of the most common causes of death worldwide. Parallel to the remarkable improvement in the treatment of patients with this common disease, advanced age and comorbidities of the patient population undergoing surgery are also increasing at a rapid pace. Many previously high-risk cardiac procedures, such a complex heart valve repair/replacement concomitant with coronary artery bypass surgery, and an arterial switch operation to transpose great arteries and many acquired and congenital malformations, can now be done at a much lower risk and with a single-digit mortality rate. Yet, certain cardiovascular diseases still pose a significant challenge even in the current era of high-tech molecular medicine and precision robotic and laser-based medical technologies.

Modern paleoclimatology provides irreplaceable tools in constructing increasingly confident histories or chronologies of past climatic changes using natural archives. High-resolution paleodata are particularly perspective. Dendroclimatological reconstructions, which use tree-rings as climate proxies, have the advantage of annual resolution. Stable isotope data (18O, D) make it possible to investigate climate variability over much longer time scales often with annual resolution too. Borehole temperature measurement, paleobotanic data, historical documentary records and melt layer thickness are other proxies used by paleoclimatology.

Type A acute aortic dissection (TAAAD) is an acute cardiovascular event that is associated with extremely high mortality if not addressed on time. In the current literature, the surgical mortality of this acquired disease averages over 20-25% despite various surgical techniques to reduce it. TAAAD is an interesting disease because it is predictably associated with genetic conditions such as Marfan Syndrome, yet it occurs in patients with no known predisposing risk factors. The surgical management of TAAAD also varies tremendously depending on the pathologies involved on presentation. Almost the entire spectrum of cardiac surgery can be implicated in the management of TAAAD, ranging from a simple replacement of the ascending aorta to aortic root sparing or replacement, and an aortocoronary bypass to total arch and descending aortic stenting involving hypothermic circulatory arrest or other cerebral protection strategies. Interestingly, the intraoperative surgical management of TAAAD has an important effect on the long-term natural history and progression of the disease. Emerging evidence suggests that concomitant management of the arch and descending aorta is associated with better long-term outcomes and minimizes the need for future redo procedures in patients who are operated on for TAAAD. Diagnostic and follow-up imaging technologies are also evolving, and newer diagnostic modalities are available for follow-up and diagnosis.

We believe that the book will not only help the readers in developing a better understanding of the solar and climatic variability and solar-terrestrial interactions but will emphasize the necessity of further systematic and intensive study in all these areas.

This eBook contains a collection of comprehensive review essays from many experts on TAAAD. The latest opinions and consensuses on genetic predisposition, diagnostic modalities, intraoperative management, surgical options, cerebral protection strategies, and long-term follow-up can be found in this volume.

We sincerely thank the authors for their contributions, their effort, and their patience. We also thank Salma Sarfaraz, the Manager of Publications for Bentham Science Publishers, for her seemingly infinite patience. We are grateful to our English editor, Bill Franke. His help has been incredibly important, and his experience invaluable. We are also indebted to Ms. Jade Yu-Ching Huang, our Publishing Process Manager, who has made important contributions to this eBook. We especially thank our medical artist, Prof. I-Wen Huang for her magnificent drawings for our eBook cover picture and the well-designed back cover.

Finally, we acknowledge the support of our families and the many sacrifices they have made to allow this eBook to become a reality. Our wives, Jane-Jane Wang, Ruey-Ling Huang, and Veronique Chu, are our greatest source of support and encouragement, and their love and support make all of what we have done worthwhile.

Ying-Fu Chen
Division of Cardiovascular Surgery
Kaohsiung Medical University Hospital
Kaohsiung, Taiwan

Chwan-Yau Luo
Division of Cardiovascular Surgery
National Cheng Kung University Hospital
Tainan, Taiwan

&

Dominique Shum-Tim
Division of Cardiac Surgery
McGill University
Quebec, Canada



DEDICATION:

To the memory of Prof. Ray C-J Chiu

A Great Clinician-Scientist

A Great Teacher

A Great Friend

A Great Gentleman

We dedicate this eBook to our best friend, teacher, and mentor, Dr. Ray C-J Chiu, who passed away while this book was being prepared.

His words of wisdom, vision, and accomplishments in cardiac surgery research will always be remembered, and he will always be our role model.

Dominique Shum-Tim
Division of Cardiac Surgery
McGill University
Quebec, Canada

&

Chwan-Yau Luo
Division of Cardiovascular Surgery
National Cheng Kung University Hospital
Tainan, Taiwan

List of Contributors

Editor(s):
Ying-Fu Chen


Chwan-Yau Luo


Dominique Shum-Tim




Contributor(s):
Alice Le Huu
Division of Cardiac Surgery
McGill University Health Center
687 Avenue des Pins Ouest, Room S-8-73b
Montreal
QC, H3A 1A1
Canada


Cherrie Abraham
Division of Vascular Surgery
Jewish General Hospital, McGill University
E-110, 3755 Cote-Ste-Catherine
Montreal
Quebec, H3T 1E2
Canada


Chih-Wei Chen
Department of Internal Medicine
Taipei Medical University Hospital
252, Wuxing Street, Xinyi District
Taipei City, 11031
Taiwan


Chris S. Malaisrie
Department of Cardiac Surgery
Northwestern University
201 East Huron Street, Suite 11-140
Chicago
Illinois, 60611
USA


Chun-Chen Chen
Division of Cardiovascular Surgery, Department of Surgery
Kaohsiung Medical University Hospital
100 Shih-Chuan 1st Road
Kaohsiung
Illinois, 80708
Taiwan


Chwan-Yau Luo
Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital and College of Medicine
Cardiovascular Research Center, National Cheng Kung University
138 Sheng-Li Road
Tainan, 70403
Taiwan


Dimitri Kalavrouziotis
Division of Cardiac Surgery
Quebec Heart and Lung University Hospital
2725 Chemin Ste-Foy
Quebec City
Quebec
Canada


Dominique Shum-Tim
Division of Cardiac Surgery
McGill University Health Center
687 Avenue des Pins Ouest, Room S-8-73b
Montreal
QC, H3A 1A1
Canada


François Dagenais
Division of Cardiac Surgery
Quebec Heart and Lung University Hospital
2725 Chemin Ste-Foy, Quebec City
Quebec, G1V 4G5
Canada


Fuhua Huang
Department of Thoracic and Cardiovascular Surgery, Nanjing Cardiovascular Disease Research Institute
Nanjing Hospital affiliated to Nanjing Medical University
68 Changle Road, Nanjing First Hospital
Nanjing
PR, 210006
China


Genevieve Belley
McGill University Health Center, Department of Radiology
1650 Cedar Avenue
Montreal
Quebec, H3G 1A4
Canada


Hsuan-Yin Wu
Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital and College of Medicine
Division of Cardiovascular Surgery, Department of Surgery, E-Da Hospital
I-Shou University, 138 Sheng-Li Road
Tainan, 70403
Taiwan


Huai-Min Chen
Division of Cardiovascular Surgery, Department of Surgery
Kaohsiung Medical University Hospital
Graduate Institute of Medicine, Kaohsiung Medical University
100 Shih-Chuan 1st Road
Kaohsiung
Taiwan


Hui-Chen Yu
Division of Cardiovascular Surgery, Department of Surgery
Kaohsiung Medical University Hospital
100 Shih-Chuan 1st Road
Kaohsiung
Taiwan


Jennifer Chung
Division of Cardiac Surgery
McGill University Health Center
687 Avenue des Pins Ouest, Room S-8-73b
Montreal
QC, H3A 1A1
Canada


Jun-Neng Roan
Institute of Clinical Medicine, National Cheng Kung University Hospital and College of Medicine; Division of Cardiovascular Surgery, Department of Surgery
National Cheng Kung University Hospital and College of Medicine
138 Sheng-Li Road
Tainan, 70403
Taiwan


Li Zhang
Division of Cardiac Surgery
Division of Cardiac Surgery, Quebec Heart and Lung University Hospital
2725 Chemin Ste-Foy, Quebec City
Quebec, G1V 4G5
Canada


Li-Zhong Sun
Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases and Beijing Anzhen Hospital
Capital Medical University
2 Anzhen Road, Chaoyang District
Beijing, 100029
China


Meng-Ta Tsai
Division of Cardiovascular Surgery, Department of Surgery
National Cheng Kung University Hospital
138 Sheng-Li Road
Tainan
Taiwan


Osama Benhameid
Division of Cardiac Surgery
Quebec Heart and Lung University Hospital
2725 Chemin Ste-Foy, Quebec City
Quebec, G1V 4G5
Canada


Ping-Yen Liu
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital and College of Medicine
Institute of Clinical Medicine, National Cheng Kung University Hospital and College of Medicine
138 Sheng-Li Road
Tainan 704
Taiwan


Rony Atoui
Division of Cardiac Surgery, Health Sciences North
865 Regent street, suite 131
Sudbury
Ontario, P3E3Y9
Canada


Rui-Dong Qi
Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases and Beijing Anzhen Hospital
Capital Medical University
2 Anzhen Road, Chaoyang District
Beijing, 100029
China


Shawn Pun
McGill University Health Center, Division of Cardiology, Department of Medicine
1650 Cedar Avenue
Montreal
Quebec, H3G 1A4
Canada


Siamak Mohammadi
Division of Cardiac Surgery
Quebec Heart and Lung University Hospital
2725 Chemin Ste-Foy, Quebec City
Quebec, G1V 4G5
Canada


Simon Neequaye
Division of Vascular Surgery
Jewish General Hospital, McGill University
E-110, 3755 Cote-Ste-Catherine
Montreal
Quebec, H3T 1E2
Canada
/
Department of Vascular Surgery
8C Link, Royal Liverpool University Hospital
Liverpool, L7 8XP
UK


Thao Huynh
McGill University Health Center, Division of Cardiology, Department of Medicine
1650 Cedar Avenue
Montreal
Quebec, H3G 1A4
Canada


Tsu-Ming Chien
Department of Urology
Kaohsiung Medical University Hospital
100 Shih-Chuan 1st Road
Kaohsiung, 80708
Taiwan


Wen-Huang Li
Division of Cardiology, Department of Internal Medicine
National Cheng Kung University Hospital and College of Medicine
138 Sheng-Li Road
Tainan
Taiwan


Xin Chen
Department of Thoracic and Cardiovascular Surgery, Nanjing Cardiovascular Disease Research Institute, Nanjing Hospital affiliated to Nanjing Medical University
68 Changle Road, Nanjing First Hospital
Nanjing
PR, 210006
China


Yi-Heng Li
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital and College of Medicine
Cardiovascular Research Center, National Cheng Kung University
138 Sheng-Li Road
Tainan, 70403
Taiwan


Ying-Fu Chen
Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Medical University Hospital
Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Graduate Institute of Medicine, Kaohsiung Medical University
100 Shih-Chuan 1st Road
Kaohsiung, 80708
Taiwan


Yi-Shan Tsai
Department of Radiology
National Cheng Kung University Hospital
138 Sheng-Li Road
Tainan
Taiwan




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