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How should we manage type A aortic dissection?

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  • Controversies in Surgery for Thoracic Aorta
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Abstract

The outcome of surgery for acute aortic dissection is improving, but many debates remain as to the optimal treatment. These include the necessary extent of the operation proximally and distally, as well as the use of endovascular technologies.

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References

  1. Hagan PG, Nienaber CA, Isselbacher EM, et al. The international registry of acute aortic dissection (IRAD): new insights into an old disease. JAMA. 2000;283(7):897–903.

    Article  CAS  PubMed  Google Scholar 

  2. Fann JI, Smith JA, Miller DC, et al. Surgical management of aortic dissection during a 30-year period. Circulation. 1995;92(9 Suppl):II113–II121.

    Article  CAS  PubMed  Google Scholar 

  3. Scholl FG, Coady MA, Davies R, et al. Interval or permanent nonoperative management of acute type A aortic dissection. Arch Surg. 1999;134(4):402–5 (discussion 405–406).

    Article  CAS  PubMed  Google Scholar 

  4. Parikh N, Trimarchi S, Gleason TG, et al. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. J Thorac Cardiovasc Surg. 2017;153(4):S74–S79.

    Article  PubMed  Google Scholar 

  5. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol. 2015;66(4):350–8.

    Article  PubMed  Google Scholar 

  6. Tsai TT, Evangelista A, Nienaber CA, et al. Long-term survival in patients presenting with type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD). Circulation. 2006;114(1 Suppl):I350–I356.

    PubMed  Google Scholar 

  7. Di Eusanio M, Trimarchi S, Patel HJ, et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg. 2013;145(2):385.e381–90.e381.

    Article  Google Scholar 

  8. Tsukube T, Haraguchi T, Okada Y, et al. Long-term outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma. J Thorac Cardiovasc Surg. 2014;148(3):1013–8 (discussion 1018–1019).

    Article  PubMed  Google Scholar 

  9. Estrera AL, Garami Z, Miller CC, et al. Acute type A aortic dissection complicated by stroke: can immediate repair be performed safely? J Thorac Cardiovasc Surg. 2006;132(6):1404–8.

    Article  PubMed  Google Scholar 

  10. Morimoto N, Okada K, Okita Y. Lack of neurologic improvement after aortic repair for acute type A aortic dissection complicated by cerebral malperfusion: predictors and association with survival. J Thorac Cardiovasc Surg. 2011;142(6):1540–4.

    Article  PubMed  Google Scholar 

  11. de Beaufort HWL, Trimarchi S, Korach A, et al. Aortic dissection in patients with Marfan syndrome based on the IRAD data. Ann Cardiothorac Surg. 2017;6(6):633–41.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rylski B, Bavaria JE, Beyersdorf F, et al. Type A aortic dissection in Marfan syndrome: extent of initial surgery determines long-term outcome. Circulation. 2014;129(13):1381–6.

    Article  PubMed  Google Scholar 

  13. Isselbacher EM, Bonaca MP, Di Eusanio M, et al. Recurrent aortic dissection: observations from the international registry of aortic dissection. Circulation. 2016;134(14):1013–24.

    Article  PubMed  Google Scholar 

  14. Berretta P, Patel HJ, Gleason TG, et al. IRAD experience on surgical type A acute dissection patients: results and predictors of mortality. Ann Cardiothorac Surg. 2016;5(4):346–51.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rylski B, Milewski RK, Bavaria JE, et al. Long-term results of aggressive hemiarch replacement in 534 patients with type A aortic dissection. J Thorac Cardiovasc Surg. 2014;148(6):2981–5.

    Article  PubMed  Google Scholar 

  16. Trivedi D, Navid F, Balzer JR, et al. Aggressive aortic arch and carotid replacement strategy for type A aortic dissection improves neurologic outcomes. Ann Thorac Surg. 2016;101(3):896–903 (Discussion 903–895).

    Article  PubMed  Google Scholar 

  17. Rylski B, Siepe M, Beyersdorf F, et al. Bicuspid aortic valve resuspension in acute type A aortic dissection patients. Ann Thorac Surg. 2015;100(3):827–32.

    Article  PubMed  Google Scholar 

  18. Leshnower BG, Myung RJ, McPherson L, Chen EP. Midterm results of David V valve-sparing aortic root replacement in acute type A aortic dissection. Ann Thorac Surg. 2015;99(3):795–800 (discussion 800–791).

    Article  PubMed  Google Scholar 

  19. Yang B, Patel HJ, Sorek C, et al. Sixteen-year experience of david and bentall procedures in acute type A aortic dissection. Ann Thorac Surg. 2018;105(3):779–84.

    Article  PubMed  Google Scholar 

  20. Beckmann E, Martens A, Pertz J, et al. Valve-sparing David I procedure in acute aortic type A dissection: a 20-year experience with more than 100 patients. Eur J Cardiothorac Surg. 2017;52(2):319–24.

    Article  PubMed  Google Scholar 

  21. Olsson C, Hillebrant CG, Liska J, Lockowandt U, Eriksson P, Franco-Cereceda A. Mortality and reoperations in survivors operated on for acute type A aortic dissection and implications for catheter-based or hybrid interventions. J Vasc Surg. 2013;58(2):333–9.e331.

    Article  PubMed  Google Scholar 

  22. Omura A, Miyahara S, Yamanaka K, et al. Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement. J Thorac Cardiovasc Surg. 2016;151(2):341–8.

    Article  PubMed  Google Scholar 

  23. Rylski B, Beyersdorf F, Kari FA, Schlosser J, Blanke P, Siepe M. Acute type A aortic dissection extending beyond ascending aorta: limited or extensive distal repair. J Thorac Cardiovasc Surg. 2014;148(3):949–54 (discussion 954).

    Article  PubMed  Google Scholar 

  24. Geirsson A, Bavaria JE, Swarr D, et al. Fate of the residual distal and proximal aorta after acute type A dissection repair using a contemporary surgical reconstruction algorithm. Ann Thorac Surg. 2007;84(6):1955–64 (discussion 1955–1964).

    Article  PubMed  Google Scholar 

  25. Larsen M, Trimarchi S, Patel HJ, et al. Extended versus limited arch replacement in acute type A aortic dissection. Eur J Cardiothorac Surg. 2017;52(6):1104–10.

    Article  PubMed  Google Scholar 

  26. Poon SS, Theologou T, Harrington D, Kuduvalli M, Oo A, Field M. Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2016;5(3):156–73.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kim JB, Chung CH, Moon DH, et al. Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection. Eur J Cardiothorac Surg. 2011;40(4):881–7.

    PubMed  Google Scholar 

  28. Conzelmann LO, Weigang E, Mehlhorn U, et al. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg. 2016;49(2):e44–52.

    Article  PubMed  Google Scholar 

  29. Shrestha M, Kaufeld T, Beckmann E, et al. Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: single-center results of the first 100 patients. J Thorac Cardiovasc Surg. 2016;152(1):148.e141–59.e141.

    Article  Google Scholar 

  30. Kimura N, Itoh S, Yuri K, et al. Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2015;149(2 Suppl):S91.e91–98.e91.

    Google Scholar 

  31. Wang H, Wagner M, Benrashid E, et al. Outcomes of reoperation after acute type A aortic dissection: implications for index repair strategy. J Am Heart Assoc 2017;6(10):e006376.

    PubMed  PubMed Central  Google Scholar 

  32. Roselli EE, Loor G, He J, et al. Distal aortic interventions after repair of ascending dissection: the argument for a more aggressive approach. J Thorac Cardiovasc Surg. 2015;149(2 Suppl):S117.e113–124.e113.

    Google Scholar 

  33. Halstead JC, Meier M, Etz C, et al. The fate of the distal aorta after repair of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2007;133(1):127–35.

    Article  PubMed  Google Scholar 

  34. Kimura N, Tanaka M, Kawahito K, Yamaguchi A, Ino T, Adachi H. Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2008;136(5):1160–1166 (1166.e1161-1163).

    Article  PubMed  Google Scholar 

  35. Rylski B, Hahn N, Beyersdorf F, et al. Fate of the dissected aortic arch after ascending replacement in type A aortic dissection†. Eur J Cardiothorac Surg. 2017;51(6):1127–34.

    Article  PubMed  Google Scholar 

  36. Fattouch K, Sampognaro R, Navarra E, et al. Long-term results after repair of type A acute aortic dissection according to false lumen patency. Ann Thorac Surg. 2009;88(4):1244–50.

    Article  PubMed  Google Scholar 

  37. Shrestha M, Fleissner F, Ius F, et al. Total aortic arch replacement with frozen elephant trunk in acute type A aortic dissections: are we pushing the limits too far?†. Eur J Cardiothorac Surg. 2015;47(2):361–6 (discussion 366).

    Article  PubMed  Google Scholar 

  38. Ma WG, Zheng J, Dong SB, et al. Sun’s procedure of total arch replacement using a tetrafurcated graft with stented elephant trunk implantation: analysis of early outcome in 398 patients with acute type A aortic dissection. Ann Cardiothorac Surg. 2013;2(5):621–8.

    PubMed  PubMed Central  Google Scholar 

  39. Takagi H, Umemoto T, Group A. A meta-analysis of total arch replacement with frozen elephant trunk in acute type A aortic dissection. Vasc Endovascular Surg. 2016;50(1):33–46.

    Article  PubMed  Google Scholar 

  40. Uchida N, Shibamura H, Katayama A, Shimada N, Sutoh M, Ishihara H. Operative strategy for acute type A aortic dissection: ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk. Ann Thorac Surg. 2009;87(3):773–7.

    Article  PubMed  Google Scholar 

  41. Geirsson A, Szeto WY, Pochettino A, et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg. 2007;32(2):255–62.

    Article  PubMed  Google Scholar 

  42. Girdauskas E, Kuntze T, Borger MA, Falk V, Mohr FW. Surgical risk of preoperative malperfusion in acute type A aortic dissection. J Thorac Cardiovasc Surg. 2009;138(6):1363–9.

    Article  PubMed  Google Scholar 

  43. Pacini D, Leone A, Belotti LM, et al. Acute type A aortic dissection: significance of multiorgan malperfusion. Eur J Cardiothorac Surg. 2013;43(4):820–6.

    Article  PubMed  Google Scholar 

  44. Patel HJ, Williams DM, Dasika NL, Suzuki Y, Deeb GM. Operative delay for peripheral malperfusion syndrome in acute type A aortic dissection: a long-term analysis. J Thorac Cardiovasc Surg. 2008;135(6):1288–95 (discussion 1295–1286).

    Article  PubMed  Google Scholar 

  45. Vallabhajosyula P, Gottret JP, Menon R, et al. Central repair with antegrade TEVAR for malperfusion syndromes in acute Debakey I aortic dissection. Ann Thorac Surg. 2017;103(3):748–55.

    Article  PubMed  Google Scholar 

  46. Tsagakis K, Konorza T, Dohle DS, et al. Hybrid operating room concept for combined diagnostics, intervention and surgery in acute type A dissection. Eur J Cardiothorac Surg. 2013;43(2):397–404.

    Article  PubMed  Google Scholar 

  47. Leshnower BG, Veeraswamy RK, Duwayri YM, Chen EP. The “TEVAR-first” approach to DeBakey I aortic dissection with mesenteric malperfusion. Ann Thorac Surg. 2014;97(2):693–6.

    Article  PubMed  Google Scholar 

  48. Smith HN, Boodhwani M, Ouzounian M, et al. Classification and outcomes of extended arch repair for acute type A aortic dissection: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2017;24(3):450–9.

    PubMed  Google Scholar 

  49. Shrestha M, Bachet J, Bavaria J, et al. Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS. Eur J Cardiothorac Surg. 2015;47(5):759–69.

    Article  PubMed  Google Scholar 

  50. Khoynezhad A, Donayre CE, Walot I, Koopmann MC, Kopchok GE, White RA. Feasibility of endovascular repair of ascending aortic pathologies as part of an FDA-approved physician-sponsored investigational device exemption. J Vasc Surg. 2016;63(6):1483–95.

    Article  PubMed  Google Scholar 

  51. Senay S, Alhan C, Toraman F, Karabulut H, Dagdelen S, Cagil H. Endovascular stent-graft treatment of type A dissection: case report and review of literature. Eur J Vasc Endovasc Surg. 2007;34(4):457–60.

    Article  CAS  PubMed  Google Scholar 

  52. Roselli EE, Brozzi N, Albacker T, Lytle BW. Transapical endovascular ascending repair for inoperable acute type A dissection. JACC Cardiovasc Interv. 2013;6(4):425–6.

    Article  PubMed  Google Scholar 

  53. Merlo AE, Chauhan D, Pettit C, et al. Outcomes following emergent open repair for thoracic aortic dissection are improved at higher volume centers in direct admissions and transfers. J Cardiothorac Surg. 2016;11(1):118.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Bashir M, Harky A, Fok M, et al. Acute type A aortic dissection in the United Kingdom: surgeon volume-outcome relation. J Thorac Cardiovasc Surg. 2017;154(2):398.e391–406.e391.

    Article  Google Scholar 

  55. Andersen ND, Benrashid E, Ross AK, et al. The utility of the aortic dissection team: outcomes and insights after a decade of experience. Ann Cardiothorac Surg. 2016;5(3):194–201.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Harris KM, Strauss CE, Duval S, et al. Multidisciplinary standardized care for acute aortic dissection: design and initial outcomes of a regional care model. Circ Cardiovasc Qual Outcomes. 2010;3(4):424–30.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiac Surgery, Massachusetts General Hospital, 55 Fruit St, Cox 630, Boston, MA, 02114, USA

    Arminder S. Jassar & Thoralf M. Sundt III

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Correspondence to Arminder S. Jassar.

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Jassar, A.S., Sundt, T.M. How should we manage type A aortic dissection?. Gen Thorac Cardiovasc Surg 67, 137–145 (2019). https://doi.org/10.1007/s11748-018-0957-3

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