From January '82 to April '91, 117 patients with
aortic disease were operated upon at our University Hospital in Genoa, Italy. Thirty-seven had arch dissections or
aneurysms; 66 had acute
aortic dissection type A and 14 had
aortic dissections or
aneurysms type B, acute and chronic. Patients with arch or type B aortic pathology but without surgical indication and cases of post-traumatic aortic transections are not included. There were 84 male and 33 female patients with a mean age of 52 (6 min and 74 max). In the acute patients, the mean interval between clinical onset and surgery was 34 hours (6 min-72 max). All patients with primary arch disease had surgical repair with the aid of deep
hypothermia and circulatory arrest (17-96 min). Type A dissections were treated with standard CPBP at 28 degrees C. Surgical techniques included direct
suture of intimal tear alone, direct suturing of the two aortic stumps; interposition of
Dacron tubular
prosthesis; Bentall repair; separated valve and aortic replacement; an original aortic bulb aortoplasty with valve repair; arch replacement with resuturing of one or more aortic trunks. Human
fibrin glue (
Tissucol) was employed either as haemostatic agent, widely spread over the
suture lines or as
tissue adhesion agent between dissected aortic layers. Human
fibrin glue is adopted because it gathers high glueing capacity and maintenance of the elastic property of the vessel wall. Hospital mortality (30 days) has been 25% in
ascending aortic dissections (16/66 patients) and 50% in patients with arch disease (18/37 patients) who needed circulatory arrest. Late mortality 5/83 (6%). Reoperations for
aortic valve insufficiency or re-dissection have been 7 (8.4%). Early diagnosis (increasing reliability of 2D-Echo and CT scans), aggressive surgery, meticulous myocardial and cerebral protection and introduction in clinical use of
biological glues seem to be the milestones of present and further improvements in surgical results.