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