Treatment of acute aortic dissection type A (AADA): technical considerations

Abstract

Aortic dissection is one of the the most common and lethal catastrophes involving the aorta. Speedy diagnosis, as well as appropriate therapy are essential for survival of the patients. Because the clinical presentation in patients suffering AADA can differ substantially, discussion concerning specific surgical therapy remains controversial. This implies questions regarding the treatment of the aortic root as well as the aortic arch and the proximal descending aorta. The current manuscript raises important issues regarding surgical treatment of AADA patients which are discussed in the light of the institutional policy in the author's department.

Treatment strategies for left subclavian artery during total arch replacement combined with stented elephant trunk implantation

“…Simplifying the surgery and minimizing bleeding are particularly important during aortic arch surgery. [2][3][4] An original surgical technique for total arch replacement was formulated by several cardiovascular centers in recent years and showed encouraging outcomes. Kato and colleagues 8 developed a classic hybrid technique in which the ascending aorta and aortic arch were replaced with a 4-branched graft, and a conventional straight stent graft was implanted into the descending aorta.…”

“…1 Emergency type A aortic dissection is a challenging and complex surgery for cardiac surgeons because of the fragility of the tissues and instability of the patients, and it carries a high morbidity and mortality. [2][3][4] Since introduced in 2002, total arch replacement combined with elephant trunk implantation and stenting of the descending aorta has became the standard treatment for type A aortic dissection. 5,6 However, during total arch replacement, the left subclavian artery (LSA) anastomosis and the distal anastomosis at the descending aorta are often remarkably difficult because of their deep location in the surgical field.…”

Oral surgery under local anesthesia with dexmedetomidine sedation in a morbidly obese patient with aortic dissection

“…Aortic aneurysm is a serious condition characterized by the tearing of the inner layer of the aorta. It can lead to sudden death caused by cardiac failure and occasionally, aortic rupture 1 2 . In addition, hypertension can increase the stress on the weakened aortic wall, increasing its susceptibility to tearing.…”

“…Aortic aneurysms are divided into Stanford type A and Stanford type B dissections. While type B dissections generally are initially treated medically, with surgery reserved for complications, type A aortic aneurysms, which involve a tear in the aorta ascendens, generally require emergency or quasiemergency surgical treatment 2 .…”

Simplified total aortic arch replacement with an in situ stent graft fenestration technique for acute type A aortic dissection

“…1 Presently, with advances in surgical techniques, the outcome of AAAD has improved significantly, but its morbidity and mortality rates are still high. [2][3][4] Up to now, various surgical procedures have been used for AAAD, but the optimal procedure is still controversial. Conventional procedures have focused on replacement of the ascending aorta with or without hemiarch replacement.…”