Surgical management of acute type a aortic dissection: A review

Sreekumar - Subramanian, M. A. Borger, F. W. Mohr, M. Misfeld

Research output: Contribution to journalArticle

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 2010
Externally publishedYes

Fingerprint

Tears
Thoracic Aorta
Aortic Valve
Cardiovascular Surgical Procedures
Aorta
Dissection
Hypertension
Minimally Invasive Surgical Procedures
Brain Ischemia
Causality
Connective Tissue
Mental Competency
Stents
Rupture
Extremities
Tomography
Blood Pressure
Morbidity
Transplants

Keywords

  • Aortic diseases
  • General surgery
  • Surgical procedures, operative

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Surgical management of acute type a aortic dissection : A review. / Subramanian, Sreekumar -; Borger, M. A.; Mohr, F. W.; Misfeld, M.

In: Italian Journal of Vascular and Endovascular Surgery, Vol. 17, No. 2, 06.2010, p. 83-94.

Research output: Contribution to journalArticle

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