Typ-A-Dissektion

Abstract

Acute type A dissection is among the most dangerous of vascular diseases and is associated with a high lethality. Surgery for type A dissection is a complex procedure which is accompanied by relevant blood losses and severe deterioration of the coagulation system. Either due to the dissection or the surgical procedure, perfusion of affected organs can be diminished or completely disrupted with the risk of irreversible organ damage especially in the brain. Perioperative anesthesiological management for type A dissection is demanding and involves maintaining hemodynamic stability, surveillance of cerebral oxygenation and transesophageal echocardiographical diagnostic support for the decision-making of the most appropriate surgical approach. Furthermore, reestablishment of sufficient hemostasis can be challenging and requires thorough understanding of the relevant aspects affecting normal hemostasis during surgical repair of aortic dissection. In this article relevant pathophysiological aspects and basic principles of anesthesiological management of type A dissection are described.

Prognostic Implications of Acute Renal Failure after Surgery for Type A Acute Aortic Dissection

“…The current state of the art in neuroprotection considers hypothermic circulatory arrest as the main option, even if nowadays the optimal temperature and the "safe time" remain debated [7]. Among the surgical neuroprotective techniques, anterograde cerebral perfusion (ACP) allows a moderate grade of hypothermia (according to the Kazui technique).…”