Acute type A aortic dissection: surgical intervention for all: CON.

This article considers the role for interval or permanent medical therapy for specific groups of acute type A aortic dissection patients. These include patients with extremely advanced age or prohibitive comorbidities, realized stroke, prior aortic valve replacement, and those who have already survived several days after onset of symptoms. This consideration represents a "back to the future" paradigm shift reminiscent of the earliest recommendations before surgical therapy was feasible or safe. Copyright 2010 Elsevier Inc. All rights reserved.