Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection

TY - JOUR

T1 - Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection

AU - Bonser, Robert S

AU - Ranasinghe, Aaron M

AU - Loubani, Mahmoud

AU - Evans, Jonathan D

AU - Thalji, Nassir M A

AU - Bachet, Jean E

AU - Carrel, Thierry P

AU - Czerny, Martin

AU - Di Bartolomeo, Roberto

AU - Grabenwöger, Martin

AU - Lönn, Lars

AU - Mestres, Carlos A

AU - Schepens, Marc A A M

AU - Weigang, Ernst

N1 - Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2011/12/6

Y1 - 2011/12/6

N2 - Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.

AB - Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.

U2 - 10.1016/j.jacc.2011.06.067

DO - 10.1016/j.jacc.2011.06.067

M3 - Journal article

SN - 0735-1097

VL - 58

SP - 2455

EP - 2474

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 24

ER -