Acute type A aortic dissection: Rationale and outcomes of extensive repair of the arch and distal aorta. (15th September 2018)

• Record Type: Journal Article
• Authors: Di Marco, Luca; Leone, Alessandro; Murana, Giacomo; Castelli, Andrea; Alfonsi, Jacopo; Di Bartolomeo, Roberto; Pacini, Davide
• Is Part Of: International journal of cardiology. Volume 267(2018)
• Page Start: 145
• Page End: 149
• Publication Date: 2018-09-15
• Subjects: Acute type A aortic dissection -- Aortic arch -- Thoracic aorta -- Frozen elephant trunk; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.05.111
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Type A acute aortic dissection represents one of the most complex and life-threatening disorders of the cardiovascular system. Cardiac tamponade caused by ascending aorta rupture is the most common cause of death. In light of this, emergent surgery with ascending and partial arch replacement represents, in most of cases, the best and the faster therapeutic option. The natural history of aortic dissection, however, teaches us that in most cases there is a distal progression of the aortic disease that often requires further surgical and/or endovascular treatments. In light of this, it can be hypothesized that, by increasing the extent of aortic replacement during the first operation, it may improve the outcome of these patients by reducing the probability of a second surgery or, in selected cases and for appropriate indications, by treating with a single surgical step, the disease. In this short review of the literature, we focalized on the rationale and outcome of an extensive repair of the thoracic aorta. Highlights: Type A acute aortic dissection represents a life-threatening disease. Emergent surgery is the "gold standard" therapy. Ascending aorta and hemiarch replacement is the treatment of choice in the majority of patients. FET represents a feasible and promising option in selected patients. FET is likely to improve long-term survival and reduce the need for further procedures.