Aortic wrapping is life-saving in high-risk acute aortic dissection and intramural haematoma

Abstract

Aortic wrapping is a controversial repair in patients presenting with acute type A aortic dissection or intramural haematoma but this method may be a potential alternative to medical treatment or conventional repair in patients aged more than 80 years and in those presenting with prohibitive co-morbidities such as stroke, circulatory collapse, full oral anticoagulation with the last generation drugs. We report on 5 high-risk and/or patients over 80 years who received external aortic wrapping with or without cardiopulmonary bypass during the last 18 months. All survived the procedure and could be extubated early postoperatively. No patient remained on the intensive care longer than 2 days and all were discharged without additional complications. Postoperative radiological control was acceptable and no patient had any new aortic event up to 18 months postoperatively. Against the currently accepted strategy, we found external aortic wrapping an interesting alternative method to stabilize the ascending aorta and prevent delayed rupture in the setting of acute aortic dissection and intramural hematoma that would qualify for operative repair. We believe that wrapping should be discussed in patients that would be otherwise denied for conventional aortic repair.