State-of-the-Art Surgical Management of Acute Type A Aortic Dissection

Ismail El-Hamamsy; Maral Ouzounian; Philippe Demers; Scott McClure; Ansar Hassan; Francois Dagenais; Michael W A Chu; Zlatko Pozeg; John Bozinovski; Mark D Peterson; Munir Boodhwani; Roderick G G McArthur; Jehangir J Appoo; Canadian Thoracic Aortic Collaborative (CTAC)

doi:10.1016/j.cjca.2015.07.736

State-of-the-Art Surgical Management of Acute Type A Aortic Dissection

Can J Cardiol. 2016 Jan;32(1):100-9. doi: 10.1016/j.cjca.2015.07.736. Epub 2015 Aug 21.

Affiliations

¹ Division of Cardiac Surgery Montreal Heart Institute, University of Montreal, Quebec, Canada. Electronic address: [email protected].
² Division of Cardiac Surgery, Peter Munk Cardiac Centre, University of Toronto, Ontario, Canada.
³ Division of Cardiac Surgery Montreal Heart Institute, University of Montreal, Quebec, Canada.
⁴ Division of Cardiac Surgery, Kingston General Hospital, Queen's University, Ontario, Canada.
⁵ Department of Cardiac Surgery, New Brunswick Heart Centre, Saint John, New Brunswick, Canada.
⁶ Division of Cardiac Surgery, Quebec Heart and Lung Institute, Québec City, Québec, Canada.
⁷ Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada.
⁸ Division of Cardiac Surgery, St Boniface Hospital, University of Winnipeg, Manitoba, Canada.
⁹ Division of Cardiac Surgery, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada.
¹⁰ Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Ontario, Canada.
¹¹ Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
¹² Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
¹³ Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada.

PMID: 26604123
DOI: 10.1016/j.cjca.2015.07.736

Abstract

Acute type A aortic dissections still present a major challenge to cardiac surgeons. Although surgical management remains the gold standard, operative mortality remains high, including in experienced centres. Nevertheless, recent advances in the understanding and management of various aspects of these complex operations are expected to improve overall patient outcomes. The Canadian Thoracic Aortic Collaborative (CTAC) represents a group of surgeons with interest and expertise in the management of patients with aortic diseases. The purpose of this state-of-the-art review is to detail our approach to the contemporary surgical management of acute type A aortic dissections. We focus specifically on cannulation strategies, cerebral protection, and extent of proximal and distal resection. In addition, specific clinical scenarios-including malperfusion, intramural hematomas, and surgery in octogenarians-are explored.

Publication types

Review

MeSH terms

Aortic Aneurysm, Thoracic / surgery*
Aortic Dissection / surgery*
Humans
Vascular Surgical Procedures / methods*
Vascular Surgical Procedures / standards*