[Surgical therapy of thoracic aortic dissection]

Area of Science:

• Cardiovascular Surgery
• Vascular Biology
• Medical Technology

Context:

• Significant advancements in aortic dissection treatment over the last decade.
• Acute ascending aorta dissection (Stanford type A) is an emergency; descending aorta dissection (type B) is treated surgically for complications.
• Major surgical complications have been mitigated by improved cardiopulmonary bypass, myocardial protection, and monitoring.

Purpose:

• To review surgical progress in treating aortic dissection.
• To highlight advancements in managing type A and type B dissections.
• To discuss the role of new materials and imaging in improving surgical outcomes.

Summary:

• Surgical treatment for aortic dissection has improved, with reduced mortality and morbidity due to advances in cardiopulmonary bypass, myocardial protection, and suture materials like French glue.
• French glue offers effective closure of the false lumen and reinforcement of the aortic wall, serving as an alternative to traditional methods.
• While ascending aorta replacement is standard for type A, recurrence necessitates considering transverse arch repair. Advanced imaging (CT, MRI, TEE) aids in diagnosis and treatment planning.
• Conservative management is typical for type B dissection, with surgery reserved for complicated cases such as intractable pain, aneurysm, or organ ischemia.

Impact:

• Improved patient outcomes and reduced mortality in aortic dissection surgery.
• Enhanced reinforcement techniques for the diseased aortic wall, potentially reducing re-dissection rates.
• Better diagnostic capabilities through advanced imaging, leading to more rational therapeutic strategies.
• Established standard operative techniques for type A dissection, with evolving approaches for transverse arch repair.