Unsolved issues in acute type A aortic dissection. (January 2023)

• Record Type: Journal Article
• Authors: Park, Sung Jun; Kim, Joon Bum
• Other Names: Idhrees Mohammed guest-editor.; Bashir Mohamad guest-editor.
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 31:Number 1(2023)
• Page Start: 32
• Page End: 36
• Publication Date: 2023-01
• Subjects: Aortic dissection -- disease -- aortic -- cerebral protection (including perfusion -- hypothermia) -- cardiac -- aortic arch -- cardiac -- aortic replacement -- intervention -- aortic; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/02184923221083365
• Languages: English
• ISSNs: 0218-4923

Abstract

Surgery for acute type A aortic dissection remains challenging with considerable mortality and morbidity despite the remarkable advances in this field. Particularly, surgical outcomes of acute type A aortic dissection are known to be associated with the hospital volume. The optimal cerebral protective method and extent of surgery have been long-standing controversies in acute type A aortic dissection surgery. Given that data from randomized trial are not available and future trials are also unrealistic, observational data based on large registry or meta-analyses may alternatively provide reliable and reasonable evidence. With regard to neuroprotective methods for arch repair, currently available observational data strongly suggest that there are no overt superiority among unilateral-antegrade cerebral perfusion, bilateral-antegrade cerebral perfusion, and retrograde cerebral perfusion, by which their availabilities are still open in real clinical practices depending on institutional preferences. When deciding the extent of arch repair in acute DeBakey type I aortic dissection, multiple factors should be considered altogether such as aortic anatomic characteristics as well as patient's risk profiles for optimizing early safety and late aortic longevity.