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A Journal on Vascular and Endovascular Surgery
THORACIC AORTA UPDATE
Journal of Vascular and Endovascular Surgery 2009 June;16(2):101-6
Contemporary surgical management of acute type A dissection: pathogenesis, principles and technique
Romano M. A., Haft J. W., Deeb G. M., Patel H. J.
Department of Surgery University of Michigan Cardiovascular Center Ann Arbor, MI, USA
Acute type A aortic dissection is a potentially fatal disease with catastrophic complications. Flow into the false lumen of the ascending aorta if left untreated has historically been associated with mortality as high as 50% within the first 48 hours of presentation. Death usually results from complications of aortic rupture or malperfusion. The operative morality continues to be significant at 26% according to a report by the International Registry of Acute Aortic Dissection. We have adopted a standardized algorithm of preoperative evaluation and management. The use of an open distal repair technique and hypothermic circulatory arrest with retrograde cerebral perfusion and if necessary selective antegrade cerebral perfusion is routinely employed. Additionally, we are strong proponents of root preservation and aggressive arch reconstruction. Significant malperfusion syndrome has been managed with percutaneous fenestration in the preoperative period. With is routine standardized approach we have experienced a operative mortality of 9.2% over a 10 year period.