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. 2022 Oct 10;35(5):ivac254.
doi: 10.1093/icvts/ivac254.

Aortic wrapping is life-saving in high-risk acute aortic dissection and intramural haematoma

Thierry Carrel  1 , Juri Sromicki  1 , Martin Schmiady  1 , Raed Aser  1 , Ahmed Ouda  1 , Paul Robert Vogt  1
Affiliations

Aortic wrapping is life-saving in high-risk acute aortic dissection and intramural haematoma

Thierry Carrel et al. Interact Cardiovasc Thorac Surg. .

Abstract

Aortic wrapping is a controversial repair in patients presenting with acute type A aortic dissection or intramural haematoma, but this method may be a potential alternative to medical treatment or conventional repair in patients aged >80 years and in those presenting with prohibitive co-morbidities such as stroke, circulatory collapse, full oral anticoagulation with the last generation drugs. We report on 5 high-risk and/or patients over 80 years who received external aortic wrapping with or without cardiopulmonary bypass during the last 18 months. All survived the procedure and could be extubated early postoperatively. No patient remained on the intensive care longer than 2 days and all were discharged without additional complications. Postoperative radiological control was acceptable and no patient had any new aortic event up to 18 months postoperatively.

Keywords: Aortic dissection; Early outcome; External wrapping; High risk; Surgery.

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Figures

Figure 1:
Figure 1:
Intraoperative view of external wrapping with a polypropylene mesh graft and a reduction of the overall diameter by 5–10 mm.
Figure 2:
Figure 2:
(A) Preoperative CT scan of the 87-year-old patient with an intramural haematoma of the ascending aorta (left) with a thickness of 22 mm (*) and postoperative control 3 months following wrapping (right): the intramural haematoma has practically completely disappeared (arrow) and the aortic diameter has remained stable. Retrospectively, it was suspected that the primary tear occurred in the proximal descending aorta and extended in a retrograde way up to the ascending aorta. (B) Preoperative CT scan in a 72-year-old female under oral anticoagulation demonstrating acute aortic dissection with the flap in the ascending aorta (left with red arrow) and postoperative control 12 months later (right) showing an almost disappearance of the dissecting membrane in the ascending aorta (red arrow) and absence of aortic growth, peri-aortic haematoma and/or pericardial effusion.
See this image and copyright information in PMC

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