REVIEW  LIMITED VERSUS EXTENDED REPAIR FOR ACUTE TYPE A DISSECTION 

The Journal of Cardiovascular Surgery 2020 June;61(3):268-71

DOI: 10.23736/S0021-9509.20.11223-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Current status in decision making to treat acute type A dissection: limited versus extended repair

Mohamad BASHIR ¹ ✉, Amer HARKY ²

¹ Department of Vascular and Endovascular Surgery, Royal Blackburn Hospital, Blackburn, UK; ² Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK

Type A dissection is a clinical emergency and the extent of repairing the damaged tissue is variable and depends on several factors including the expanse of dissection, entry tear, surgeon’s experience, and unit resource availability and performance. The conservative surgeon prefers to perform aortic root up-to hemi arch replacement while the patient recovers planning onward for the second stage approach, however, the aggressive school prefers to replace the entire aortic arch with the deployment of a frozen elephant trunk and control intimal tear and alter false lumen natural history. Data to date remains debatable in terms of short- and long-term outcomes with equivocal results between both approaches. Through our manuscript, we aim to highlight the indifferences, challenges, resultant optimum outcomes from the surgeon and patients’ perspectives, plus we will mull over the evidence best practice in limited versus extended type A aortic dissection repair.

KEY WORDS: Aorta; Dissecting aneurysm; Aortic aneurysm; Clinical decision making