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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
REVIEWS ALL ABOUT AORTIC DISSECTIONS
Italian Journal of Vascular and Endovascular Surgery 2010 June;17(2):83-93
Surgical management of acute type A aortic dissection: a review
Subramanian S., Borger M. A., Mohr F. W., Misfeld M.
Department of Cardiac Surgery, Herzzentrum, Leipzig, Germany
Acute type A aortic dissection arises from an aortic intimal 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 echocardiography and computerized tomography scan should be followed by immediate operative repair in most patients. The goals of surgery are resection of the intimal 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.