Excision of the aortic wall in the surgical treatment of acute type-A aortic dissection

Long-term effectiveness of operations for ascending aortic dissections

“…Increased 946 control over intraoperative events and appreciation of late aortic complications led some to suggest that extended operative procedures, such as routine aortic arch replacement and total aortic root replacement, should be undertaken to decrease late aortic or aortic valve complications. [1][2][3] In contrast, we and others have followed a more conservative operative approach.We attempted to tailor the management of the aortic root to the pathology. If the aortic valve and sinuses were structurally normal, aortic valve reconstruction at the level of the sinotubular junction and supracoronary ascending aortic graft replacement were used.…”

“…Increased 946 control over intraoperative events and appreciation of late aortic complications led some to suggest that extended operative procedures, such as routine aortic arch replacement and total aortic root replacement, should be undertaken to decrease late aortic or aortic valve complications. [1][2][3] In contrast, we and others have followed a more conservative operative approach.…”

Surgery for Acute Type A Aortic Dissection

“…Thus, many surgeons have tried to obliterate distal false channels by means of complete resection of intimal tears or aggressive replacement of the aortic arch. [19][20][21][22] The former is now widely accepted as a standard approach in this surgery. [23][24][25][26]6 However, it seems extremely difficult to promote thrombosis of the false lumen 25 and seemingly complete resection of the intimal tear is not associated with complete obliteration of the false channel.…”

Results of a total aortic arch replacement for an acute aortic arch dissection

“…7 In addition to these significant improvements in perioperative management, surgical techniques have also been improved as a result of advances, such as biologic glues 14 and the introduction of nonwrapping techniques. 15 In the optimal surgical strategy the dissected aortic arch should be replaced with a prosthetic graft irrespective of whether the intimal tear is located in the aortic arch. As a result, our hospital mortality was only 11%, which is lower than that in most other series, including recent ones, in which an aggressive aortic repair was not tried.…”