Improved clinical outcomes and survival following repair of acute type A aortic dissection in the current era

Abstract

Surgical era significantly impacts early outcomes and actuarial survival following repair of acute type A aortic dissection.

Who may operate on acute aortic dissections? The squaring of the circle

“…This is not quite true. The results of surgery of acute dissection have dramatically improved in the last 2 decades and many centres presently report on large experiences with a hospital mortality of <10% [3][4][5]. Therefore, the discrepancy between the results obtained by the two groups of surgeons in the present study (4 vs 21% hospital mortality) is rather intriguing, especially when considering that each 'non-aortic' surgeon has an experience of more than 2000 cases of cardiac surgery.…”

Acute type A aortic dissection repair in younger patients

“…The majority of patients with acute type A aortic dissection (AAAD) requiring surgical intervention are in their 60s and 70s . However, AAAD repair is sometimes necessary in younger patients .…”

“…The majority of patients with acute type A aortic dissection (AAAD) requiring surgical intervention are in their 60s and 70s. [1][2][3] However, AAAD repair is sometimes necessary in younger patients. [4][5][6] These patients are more likely than older patients to have a genetic component.…”

Commentary: Open versus clamp-on distal anastomosis techniques in acute type A aortic dissection: The ship has already left the port

“…In the contemporary era, there is growing consensus that the distal anastomosis should be performed using the opendistal technique because of a better visualization of the dissected aorta, proper exclusion of the false lumen, and possibility of inspecting and identifying intimal tears in the arch. 4 Moreover, the natural history of aortic dissection teaches us that in most cases there is a distal progression of the aortic disease that often requires further surgical or endovascular treatments. Considering this, increasing the extent of aortic replacement during the first operation, such as performing a total arch replacement with the frozen elephant trunk technique, may improve the outcomes, reducing the probability of a second surgery.…”