Surgical decision making in acute aortic dissection type A

In principle there are 3 different approaches to the treatment of acute aortic dissection type A (AADA): replacement of the aortic valve and ascending aorta, reconstruction of these structures, and a combination of both techniques. This study summarizes our experiences with these methods and delineates indication for the different surgical procedures. Since 1979, a total of 51 patients (39 male, 12 female, mean age 45.5 years) underwent surgery for AADA with an overall mortality of 25%. Differences in mortality of the operative variants (reconstruction 12%, composite replacement 18%, combined reconstruction and replacement 47%) predominantly mirror growing experience than applicability of the methods. The follow-up of patients with reconstruction of the aortic valve revealed a reoperation rate of only 9% after 0.3 to 6.3 years. Four patients with constant and minor annuloectasia and/or subclinical aortic insufficiency are observed in short intervals. We conclude, that the operative procedure in AADA must be adapted to the intraoperative pathoanatomical findings. Patients with primary annuloectasia should undergo graft replacement. Reconstruction of the ascending aorta and aortic valve is considered to be the preferable method in patients with primarily normal caliber of the ascending aorta and aortic anulus.