Aortic dissection: current expectations and treatment. Experience with 258 patients over 20 years

Aortic dissection, the most common acute disease of the thoracic aorta, is associated with high mortality and morbidity. The authors reviewed their experience over the last 20 years with 258 patients who had aortic dissection (259 dissections). The diagnosis was made at autopsy in 69 (27%) patients (59 type A, 10 type B). Of the remainder, 97 patients had type A dissection (78 acute, 19 chronic) and 93 had type B dissection (56 acute, 37 chronic). The sudden onset of severe, unremitting chest pain associated with hyper- or hypotension or a history of hypertension are suggestive of acute aortic dissection. The diagnosis should be followed by prompt investigation and treatment. The 30-day survival rate for patients with type A dissection who underwent surgical treatment was 62%; survival rates for patients with type B dissection, acute and chronic, were 70% and 86% respectively with pharmacotherapy and 66% and 91% with surgery. The authors stress the importance of early, accurate diagnosis and immediate surgical treatment for all patients who have type A dissection and complicated or unresponsive (carefully monitored pharmacologic control of blood pressure) type B dissection.