Li Jing Saw1, Mae-Sing Lim-Cooke2, Beth Woodward3, Ahmed Othman4, Amer Harky1,4. 1. School of Medicine, University of Liverpool, Liverpool, UK. 2. School of Medicine, St George's University, London, UK. 3. College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. 4. Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
Abstract
OBJECTIVE: Acute type A aortic dissection (ATAAD) is a catastrophic condition that can be fatal if not treated immediately. We sought to examine the literature and identify evidence behind each method of surgical intervention. METHOD: A comprehensive electronic literature search was done to identify the articles that reported outcomes and discussed surgical techniques in ATAAD. No limits were placed on timing or type of the articles; all results are summarized in a narrative manner within each relevant section. RESULTS: Different units have different approaches for extensive ATAAD; experienced and high-volume units tend to perform aortic root and total-arch replacement, whereas others tend to perform only hemiarch replacement. The evidence shows no significant differences in long-term outcomes. Frozen elephant trunk and endovascular repair play key roles in managing the rest of the aortic dissection that involve the thoracic aorta, and the evidence evolve with their impact on false lumen patency. CONCLUSION: The management of ATAAD is tailored by individual surgeons and unit experience to save lives. Future directions for reducing mortality depend on effective early recognition and accessibility to centralized specialist centers with experience in a wide range of surgical techniques.
OBJECTIVE: Acute type A aortic dissection (ATAAD) is a catastrophic condition that can be fatal if not treated immediately. We sought to examine the literature and identify evidence behind each method of surgical intervention. METHOD: A comprehensive electronic literature search was done to identify the articles that reported outcomes and discussed surgical techniques in ATAAD. No limits were placed on timing or type of the articles; all results are summarized in a narrative manner within each relevant section. RESULTS: Different units have different approaches for extensive ATAAD; experienced and high-volume units tend to perform aortic root and total-arch replacement, whereas others tend to perform only hemiarch replacement. The evidence shows no significant differences in long-term outcomes. Frozen elephant trunk and endovascular repair play key roles in managing the rest of the aortic dissection that involve the thoracic aorta, and the evidence evolve with their impact on false lumen patency. CONCLUSION: The management of ATAAD is tailored by individual surgeons and unit experience to save lives. Future directions for reducing mortality depend on effective early recognition and accessibility to centralized specialist centers with experience in a wide range of surgical techniques.
Authors: Amer Harky; Sabrina Mason; Ahmed Othman; Matthew Shaw; Omar Nawaytou; Deborah Harrington; Manoj Kuduvalli; Mark Field Journal: JTCVS Open Date: 2021-05-05