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REVIEW  LIMITED VERSUS EXTENDED REPAIR FOR ACUTE TYPE A DISSECTION 

The Journal of Cardiovascular Surgery 2020 June;61(3):278-84

DOI: 10.23736/S0021-9509.20.11259-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Limited repair with tear-oriented approach for type A aortic dissection

Akiko TANAKA, Vahram ORNEKIAN, Anthony L. ESTRERA

Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA



Acute type A aortic dissection (ATAAD) remains an eminent, life-threatening disease. Although centers of excellence report mortality rate after ATAAD repair as low as 5% to 8%, data from the International Registry of Acute Aortic Dissection continue to demonstrate a high mortality rate of around 17% to 18%. Tear-oriented approach to determine the extent of repair has been widely accepted to treat ATAAD. In recent years, aggressive approach with total arch replacement - especially using hybrid procedure with the antegrade stent grafting in the proximal descending aorta - have been advocated to decrease the future downstream reoperations in younger patients or to treat malperfusion syndrome. In this article, we review outcomes comparing limited/tear-oriented approach vs. extended repair based on updated outcomes after ATAAD repair to evaluate for the indications and validity of each approach. We found that extended repair remains a high-risk operation in most hands and distal reoperation rate in contemporary series are as low as 10%. In addition, we did not find data to support concomitant antegrade stenting to improve outcomes in patients with distal malperfusion. In conclusion, we do not recommend beyond the tear-oriented approach, as any future benefit with extended repair seems outweighed by the incremental risk with the short-term risk in most hands.


KEY WORDS: Dissecting aneurysm; Aortic aneurysm; Endovascular procedures

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