Behandlung der Thorakalen Aortendissektion Typ A

A. ZUSAMMENFASSUNG DER FESTSTELLUNGEN UND EMPFEHLUNGEN S108 B. LEITLINIENTEXT S109 1. Defi nition S109 2. Epidemiologie, Inzidenz und Risikofaktoren S110 3. Klinisches Bild und Komplikationen S110 4. Diagnostik S111 5. Zeitpunkt des Eingriff es S112 6. Operatives Vorgehen S112 6.1. Operatives Ziel S112 6.2. Kanülierungsstrategien für das Einsetzen der HLM S113 6.3. Organprotektion S113 6.4. Intraoperatives Monitoring S114 6.5. Ausmaß der Sanierung und zur Verfügung stehende chirurgische Verfahren S114 6.5.1. Aortenwurzelbeteiligung S114 6.5.2. Beteiligung des Aortenbogens S115 6.5.3. Beteiligung der Aorta deszendens S115 6.5.4. Frozen Elephant Trunk (FET) Technik S115 7. Postoperative intensivmedizinische Behandlung und Erkennen von Komplikationen S116 8. Rehabilitation und Nachsorge S116 C. LEITLINIENREPORT S117 1. Verantwortlichkeiten S117 1.1. Beteiligte Fachgesellschaften S117 1.2. Zusammensetzung der Leitliniengruppe S117 1.3. Struktur des Leitlinienkomitees S117 2. Adressaten der Leitlinie S117 3. Zeitplan S117 4. Leitlinienerstellung S119 4.1. Notwendigkeit der Leitlinie S119 4.2. Ziele S119 4.3. Verfügbare Leitlinien S119 4.4. Systematische Literaturrecherche S119 4.5. Bewertung der Literatur S119 4.6. Strukturierte Konsensusfi ndung und Konsensuskonferenzen S119 4.7. Gültigkeit der Leitlinie (Stand 03. Februar 2021) S119 4.8. Redaktionelle Unabhängigkeit S119 4.9. Verbreitung der Leitlinie S119 D. ANHANG S119 1. Literaturverzeichnis S119 2. Abkürzungsverzeichnis S121 3. Tabelle zur Erklärung von Interessen und Umgang mit Interessenkonfl ikten S122

[1]  M. Czerny,et al.  Multicentre experience with two frozen elephant trunk prostheses in the treatment of acute aortic dissection†. , 2019, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[2]  M. B. Bacchi Reggiani,et al.  Open distal anastomosis in the frozen elephant trunk technique: initial experiences and preliminary results of arch zone 2 versus arch zone 3†. , 2019, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[3]  S. Haulon,et al.  Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS) , 2018, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[4]  J. Steurer,et al.  A systemic review and meta-analysis: Bentall versus David procedure in acute type A aortic dissection , 2018, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[5]  K. Eagle,et al.  Malperfusion syndromes in type A aortic dissection: what we have learned from IRAD. , 2018, Journal of visualized surgery.

[6]  W. Vorster,et al.  The anatomical variation of the circulus arteriosus cerebri in a cadaver cohort representing the population dynamics of the Western Cape , 2018, British journal of neurosurgery.

[7]  J. Elefteriades,et al.  In DeBakey Type I Aortic Dissection, Bovine Aortic Arch Is Associated With Arch Tears and Stroke. , 2017, The Annals of thoracic surgery.

[8]  M. Czerny,et al.  Acute non-A non-B aortic dissection: incidence, treatment and outcome , 2017, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[9]  K. Eagle,et al.  Delay from Diagnosis to Surgery in Transferred Type A Aortic Dissection. , 2017, The American journal of medicine.

[10]  M. Karck,et al.  Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years† , 2017, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[11]  T. Carrel,et al.  Re-interventions on the thoracic and thoracoabdominal aorta in patients with Marfan syndrome. , 2017, Annals of cardiothoracic surgery.

[12]  S. Blankenberg,et al.  Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS). , 2017, Cardiovascular diagnosis and therapy.

[13]  J. Elefteriades,et al.  Positive family history of aortic dissection dramatically increases dissection risk in family members. , 2017, International journal of cardiology.

[14]  M. Czerny,et al.  Fate of the dissected aortic arch after ascending replacement in type A aortic dissection† , 2017, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[15]  F. Bamberg,et al.  Aortic elongation and the risk for dissection: the Tübingen Aortic Pathoanatomy (TAIPAN) project† , 2017, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[16]  M. Czerny,et al.  Is right axillary artery cannulation safe in type A aortic dissection with involvement of the innominate artery? , 2016, The Journal of thoracic and cardiovascular surgery.

[17]  K. Eagle,et al.  IRAD experience on surgical type A acute dissection patients: results and predictors of mortality. , 2016, Annals of cardiothoracic surgery.

[18]  A. Modi,et al.  Open and closed distal anastomosis for acute type A aortic dissection repair. , 2016, Interactive cardiovascular and thoracic surgery.

[19]  M. Blettner,et al.  Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). , 2016, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[20]  U. Benedetto,et al.  Axillary versus femoral arterial cannulation in type A acute aortic dissection: evidence from a meta-analysis of comparative studies and adjusted risk estimates. , 2015, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[21]  M. Blettner,et al.  The Impact of Pre-Operative Malperfusion on Outcome in Acute Type A Aortic Dissection: Results From the GERAADA Registry. , 2015, Journal of the American College of Cardiology.

[22]  J. Bavaria,et al.  Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS. , 2015, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[23]  C. Cotrim,et al.  Controlled pericardiocentesis in patients with cardiac tamponade complicating aortic dissection: Experience of a centre without cardiothoracic surgery , 2015, European heart journal. Acute cardiovascular care.

[24]  Zhiwei Wang,et al.  Which cannulation (axillary cannulation or femoral cannulation) is better for acute type A aortic dissection repair? A meta-analysis of nine clinical studies. , 2015, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[25]  V. Rao,et al.  Profound hypothermia compared with moderate hypothermia in repair of acute type A aortic dissection. , 2014, The Journal of thoracic and cardiovascular surgery.

[26]  J. Bavaria,et al.  Modeling of predissection aortic size in acute type A dissection: More than 90% fail to meet the guidelines for elective ascending replacement. , 2014, The Journal of thoracic and cardiovascular surgery.

[27]  S. Vanni,et al.  Diagnostic performance of emergency transthoracic focus cardiac ultrasound in suspected acute type A aortic dissection , 2014, Internal and Emergency Medicine.

[28]  A. Diegeler,et al.  Near-infrared spectroscopy for neuromonitoring of unilateral cerebral perfusion. , 2013, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[29]  C. Miller,et al.  Management of limb ischemia in acute proximal aortic dissection. , 2013, Journal of vascular surgery.

[30]  Raimund Erbel,et al.  Hybrid operating room concept for combined diagnostics, intervention and surgery in acute type A dissection. , 2013, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[31]  F. Mohr,et al.  Valve-sparing root reconstruction does not compromise survival in acute type A aortic dissection. , 2012, The Annals of thoracic surgery.

[32]  Y. Okita,et al.  Impact of Controlled Pericardial Drainage on Critical Cardiac Tamponade With Acute Type A Aortic Dissection , 2012, Circulation.

[33]  Omeed Saghafi.  Correlates of Delayed Recognition and Treatment of Acute Type A Aortic Dissection: The International Registry of Acute Aortic Dissection (IRAD) , 2012 .

[34]  G. Vanzetto,et al.  Direct admission to the operating room: an efficient strategy for patients with diagnosed or highly suspected acute type a aortic dissection. , 2011, The Canadian journal of cardiology.

[35]  F. Biancari,et al.  Contemporary results after surgical repair of type A aortic dissection in patients aged 80 years and older: a systematic review and meta-analysis. , 2011, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[36]  M. Blettner,et al.  Cerebral Protection During Surgery for Acute Aortic Dissection Type A: Results of the German Registry for Acute Aortic Dissection Type A (GERAADA) , 2011, Circulation.

[37]  N. Kouchoukos,et al.  Does the technique of distal anastomosis influence clinical outcomes in acute type A aortic dissection? , 2011, Interactive cardiovascular and thoracic surgery.

[38]  C. Vahl,et al.  Reevaluation of direct true lumen cannulation in surgery for acute type A aortic dissection. , 2009, The Annals of thoracic surgery.

[39]  M. Karck,et al.  Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[40]  R. Erbel,et al.  ICU controlled delay for acute type a aortic dissection repair after intervention for total visceral malperfusion: a way out of a dilemma? , 2008, The Thoracic and cardiovascular surgeon.

[41]  David M. Williams,et al.  Operative delay for peripheral malperfusion syndrome in acute type A aortic dissection: a long-term analysis. , 2008, The Journal of thoracic and cardiovascular surgery.

[42]  A. Laggner,et al.  D-dimer in ruling out acute aortic dissection: a systematic review and prospective cohort study. , 2007, European heart journal.

[43]  J. Bavaria,et al.  Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[44]  S. Taguchi,et al.  Ascending aorta cannulation in acute type A aortic dissection. , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[45]  J. Elefteriades,et al.  Familial thoracic aortic aneurysms and dissections--incidence, modes of inheritance, and phenotypic patterns. , 2007, The Annals of thoracic surgery.

[46]  E. Natour,et al.  Comparison of Operative Techniques in Acute Type A Aortic Dissection Performing the Distal Anastomosis , 2007, Journal of cardiac surgery.

[47]  Y. Takanashi,et al.  Aortic root necrosis after surgical treatment using gelatin-resorcinol-formaldehyde (GRF) glue in patients with acute type A aortic dissection. , 2006, Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.

[48]  T. Shiga,et al.  Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. , 2006, Archives of internal medicine.

[49]  Ç. Engin,et al.  Impact of Organ Malperfusion on Mortality and Morbidity in Acute Type A Aortic Dissections , 2006, Journal of cardiac surgery.

[50]  K. Eagle,et al.  Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. , 2005, The Journal of thoracic and cardiovascular surgery.

[51]  J. Elefteriades,et al.  Femoral cannulation is safe for type A dissection repair. , 2004, The Annals of thoracic surgery.

[52]  M. Karck,et al.  Evolving Strategies for Treatment of Acute Aortic Dissection Type A , 2004, Circulation.

[53]  M. Lachat,et al.  Advantages of subclavian artery perfusion for repair of acute type A dissection. , 2004, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[54]  A. Tortolani,et al.  Management strategies for type A dissection complicated by peripheral vascular malperfusion. , 2004, The Annals of thoracic surgery.

[55]  M. Jahangiri,et al.  The role of coronary angiography in acute type A aortic dissection. , 2004, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[56]  M. Karck,et al.  The frozen elephant trunk technique: a new treatment for thoracic aortic aneurysms. , 2003, The Journal of thoracic and cardiovascular surgery.

[57]  A. Laggner,et al.  Acute type A aortic dissection: the prognostic impact of preoperative cardiac tamponade. , 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[58]  T. Kazui,et al.  Role of biologic glue repair of proximal aortic dissection in the development of early and midterm redissection of the aortic root. , 2001, The Annals of thoracic surgery.

[59]  N. Smedira,et al.  Does coronary angiography before emergency aortic surgery affect in-hospital mortality? , 2000, Journal of the American College of Cardiology.

[60]  M. Karck,et al.  The use of gelatin-resorcin-formalin glue in acute aortic dissection type A. , 1999, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[61]  L. Quint,et al.  Surgical delay for acute type A dissection with malperfusion. , 1997, The Annals of thoracic surgery.

[62]  L. Quint,et al.  Evaluation of thoracic aortic disease with the use of helical CT and multiplanar reconstructions: comparison with surgical findings. , 1996, Radiology.

[63]  S. Takamoto,et al.  Intraoperative echocardiography for diagnosis and treatment of aortic dissection. Utility of color flow mapping for surgical decision making in acute stage. , 1992, Herz.

[64]  O. Linton,et al.  American College of Radiology , 2018, Definitions.

[65]  N E Shumway,et al.  Management of acute aortic dissections. , 1970, The Annals of thoracic surgery.

[66]  M. Karck,et al.  Aneurysm and Dissection of the Thoracic and Thoracoabdominal Aorta , 2017 .

[67]  C. Nienaber.  The role of imaging in acute aortic syndromes. , 2013, European heart journal cardiovascular Imaging.

[68]  R. Zanoli,et al.  The role of transthoracic echocardiography in the diagnosis and management of acute type A aortic syndrome. , 2012, American heart journal.

[69]  K. Eagle,et al.  Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. , 2005, The Journal of thoracic and cardiovascular surgery.

[70]  Borut Marincek,et al.  Thoracic aorta: motion artifact reduction with retrospective and prospective electrocardiography-assisted multi-detector row CT. , 2002, Radiology.

[71]  D. Weisz,et al.  Effect of hypothermia on cerebral blood flow and metabolism in the pig. , 2002, The Annals of thoracic surgery.