Commentary: Open repair is the gold standard for treatment of chronic distal aortic dissection—For now

Abstract

In this issue of the Journal, Hong and Coselli 1 discuss the rationale for open repair of chronic distal aortic dissection, examine the limitations of endovascular repair for this condition, and provide an excellent description of their technique for open repair of chronic Crawford extent II dissecting thoracoabdominal aortic aneurysms, including preoperative assessment and early postoperative management. The descriptive text is greatly enhanced by several elegant and informative illustrations and photographs. The authors conclude that open repair remains the gold standard for chronic distal aortic dissection and provide justification for this conclusion. Dr Coselli and his present and former colleagues at the Baylor University School of Medicine have played a major role in the development of open surgical repair as a method of management for aneurysms of the descending thoracic and thoracoabdominal aorta, including those resulting from aortic dissection. Following in the footsteps of Drs Michael DeBakey, Denton Cooley, and E. Stanley Crawford at Baylor, Dr Coselli has amassed an extraordinary experience with open repair of thoracoabdominal aortic aneurysms, which has evolved from simple aortic clamping to the incorporation of adjuncts, including left heart bypass, 2 permissive hypothermia, drainage of cerebral spinal fluid, 3 aggressive implantation of intercostal or lumbar arteries, separate perfusion of the kidneys with cold crystalloid