[Is delayed surgical repair admitted for the thrombosed aortic dissection?]

Area of Science:

• Cardiovascular Surgery
• Vascular Medicine
• Thoracic Surgery

Context:

• Thrombosed aortic dissection treatment remains controversial.
• Initial management strategies vary, impacting patient outcomes.
• Retrospective analysis of acute thrombosed aortic dissection cases.

Purpose:

• To evaluate the efficacy of delayed surgical repair versus initial medical management for acute thrombosed aortic dissection.
• To compare outcomes between medically and surgically treated patients.
• To identify predictors for delayed surgical intervention.

Summary:

• Ninety-six patients with acute thrombosed aortic dissection (35 Type A, 61 Type B) were initially treated medically.
• Delayed surgery was performed for uncontrollable cardiac tamponade, recanalization, large ulcer-like projections, or aortic enlargement.
• Both Type A and Type B dissections showed similar 1- and 5-year survival and event-free rates, regardless of initial treatment strategy.
• A lower false-to-true lumen ratio (F/T ratio) was observed in operated Type A cases (31% vs. 51%).
• Operated Type B cases presented with a larger initial aortic size compared to non-operated cases.

Impact:

• Conservative management for thrombosed aortic dissection can decrease unnecessary surgeries.
• The strategy of delayed surgical repair is justified, offering a safe and effective alternative.
• Provides evidence supporting a more selective surgical approach in managing thrombosed aortic dissections.