Ann Thorac Surg 2004;78:857
© 2004 The Society of Thoracic Surgeons
Invited commentary
Enio Buffolo, MD, PhD
São Paulo Federal University, R. Borges Lagoad, 1080-CJ 701 São Paulo SP Cep. 04038-002, Brazil
enio.buffolo{at}terra.com.br
The study by Hata and colleagues is interesting regarding several view points. First of all, the low mortality rate of 6.0% in a series of 84 consecutive patients with type A acute dissection can be compared with the best series in the literature.
The incidence of only 14% (8 of 58 patients) of patent distal false lumen after type A surgical correction is much less than the average, especially if you consider that only 20 cases had limited dissection into the intrapericardial aorta (Type II DeBakey).
From our experience it is common to observe distal dissection after appropriate surgical correction because at the time of surgery you have already distal dissection that in some cases extends to the iliac arteries. Residual distal dissection is an independent factor of either using or not using gelatin resorcin formalin (GRF) glue, and depends on preoperative anatomical conditions.
Finally, the author presents an important contribution demonstrating that in three reoperations the histologic examination did not manifest important inflammatory reaction or wall weakness that have been pointed out by others as disadvantages of GRF glue use.
Related Article
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Type A acute aortic dissection: Immediate and mid-term results of emergency aortic replacement with the aid of gelatin resorcin formalin glue
- Mitsumasa Hata, Motomi Shiono, Akira Sezai, Mitsuru Iida, Nanao Negishi, and Yukiyasu Sezai
Ann. Thorac. Surg. 2004 78: 853-857.
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