[Current status and future progress of surgical treatment for acute aortic dissection]

The number of operations performed for acute aortic dissection increased 2.6-fold during the last 10 years. The hospital mortality rate was 13.4% in 2006, decreasing from 21.8% in 1997. Current points at issue are: indications for surgery for thrombosed type-A acute aortic dissection; selection of the cannulation site for cardiopulmonary bypass; method to protect the brain during open distal anastomosis; extent of prosthetic replacement in acute-phase surgery; treatment strategy for visceral ischemia caused by dissection; and application of endovascular therapeutic techniques such as aortic stent grafts, percutaneous transluminal angioplasty, etc. Remarkable progress has been achieved in understanding the pathophysiology of acute aortic dissection, but the surgical mortality rate is not yet satisfactory. Accurate diagnosis using multislice computed tomography, prompt surgery, and systemic control of visceral ischemia are recommended. Cardiovascular surgeons require assistance from radiologists, cardiologists, neurosurgeons, and gastroenterologists for further improvement of the surgical results.