Aortic dissection surgery

	Aortic dissection Microchapters
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Case #1
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Any dissection that involves the ascending aorta is considered a surgical emergency, and urgent surgical consultation is recommended. There is a 90% 3-month mortality among patients with a proximal aortic dissection who do not undergo surgery. These patients can rapidly develop acute aortic insufficiency (AI), tamponade or myocardial infarction (MI).

Contraindications to the Operative Repair of a Type A Dissection

Even acute MI in the setting of dissection is not a surgical contraindication. Acute hemorrhagic stroke is, however, a relative contraindication, due to the necessity of intraoperative heparinization.

Surgical Indications for Operative Repair of a Type B Dissection

Dissections involving only the descending aorta can generally be managed medically, but indications for surgery include the following:

Progression of the dissection
Continued hemorrhage into the pleural or retroperitoneal space

Surgical Complications Following Repair of a Type Be Dissection

Spinal cord ischemia and paralysis.

Surgical Risk Factors

Risk factors associated with increased surgical mortality include the following:

Surgical Procedure

Surgical therapy involves excision of the intimal tear, obliteration of the proximal entry site into the false lumen, and reconstitution of the aorta with placement of a synthetic graft. AI can be corrected by resuspension of the native valve, or by aortic valve replacement (AVR).

ACC/ AHA Guidelines - Recommendation for Surgical Intervention for Thoracic Aortic Disease (DO NOT EDIT)

Class I
1. For patients with ascending thoracic aortic dissection, all aneurysmal aorta and the proximal extent of the dissection should be resected. A partially dissected aortic root may be repaired with aortic valve resuspension. Extensive dissection of the aortic root should be treated with aortic root replacement with a composite graft or with a valve sparing root replacement. If a DeBakey Type II dissection is present, the entire dissected aorta should be replaced. (Level of Evidence: C)

References