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The Journal of Cardiovascular Surgery 2020 Apr 27

DOI: 10.23736/S0021-9509.20.11397-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Current Status in decision making to treat acute type A dissection. Limited versus extended repair: India & APAC approach

Bashi V. VELAYUDHAN 1, Mohammed IDHREES 1, George MATALANIS 2, Kay-Hyun PARK 3, David TANG 4, Pierre M. SFEIR 5, Saeid HOSSEINI 6, Mohamad BASHIR 7

1 Institute of Cardiac and Aortic Diseases, SIMS Hospital, Chennai, India; 2 Austin Hospital, Heidelberg, Australia; 3 Seoul National University Bundang Hospital, Seongnam, Korea; 4 Queen Elizabeth Hospital (II), Jalan Damai, Kota Kinabalu, Malaysia; 5 American University of Beirut Medical Center, Beirut, Lebanon; 6 Department of Cardiac Surgery, Rajaei Heart Hospital, Tehran, Iran; 7 Vascular & Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK


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Acute Type A aortic dissection remains one of the most challenging conditions in aortic surgery. Despite the advancements in the field the mortality rate still remains high. Though there is a general consensus that the ascending aorta should be replaced, the distal extension of the surgery still remains a controversy. Few surgeons argue for a conservative approach to reduce operative and postoperative morbidity while others considering the problems associated with “downstream problems” support an aggressive approach including a frozen elephant trunk. The cohort in the Indian subcontinent and APAC is far different from the western world. Many factors determine the decision for surgery apart from the pathology of the disease. Economy, availability of the suitable prosthesis, the experience of the surgeon, ease of access to the medical facility all contribute to the decision making to treat acute type A dissection.


KEY WORDS: Aortic dissection; Type A dissection; Hemi arch replacement; Total arch replacement; Frozen elephant trunk

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