Surgical management of acute type a aortic dissection: A review

S. Subramanian, M. A. Borger, F. W. Mohr, M. Misfeld

Research output: Contribution to journalReview article

Abstract

Acute type A aortic dissection arises from an aortic intimai tear with ascending aortic involvement. Hypertension is the most common predisposing factor, and connective tissue disorders are often present. With the rise in percutaneous and minimally invasive cardiovascular surgical procedures, iatrogenic causes are becoming more and more frequent. The dissection process can lead to coronary, cerebral and systemic malperfusion, as well as free intrapericardial rupture and tamponade. Aggressive blood pressure control, and expeditious diagnosis with echo-cardiography and computerized tomography scan should be followed by immediate operative repair in most patients. The goals of surgery are resection of the intimai tear(s) in the ascending aorta and/or arch, restoration of aortic valvular competence, correction of coronary ischemia, and alleviation of cerebral and systemic malperfusion. Aortic valve-sparing techniques are increasingly common. A hybrid reconstruction can be achieved with the use of a stent graft in the descending aorta as a frozen elephant trunk. Aggressive correction of coagulopathy and close monitoring for extremity and visceral malperfusion are important to minimize perioperative morbidity. Long-term hypertension control as well as aortic ± aortic valve surveillance are required for all patients. Novel endovascular approaches to the ascending aorta are in their infancy and require significant technological advances prior to implementation.

Original languageEnglish (US)
Pages (from-to)83-94
Number of pages12
JournalItalian Journal of Vascular and Endovascular Surgery
Volume17
Issue number2
StatePublished - Jun 1 2010

Keywords

  • Aortic diseases
  • General surgery
  • Surgical procedures, operative

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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