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Updated: Aug 15, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Acute Type A Aortic Dissection and Coarctation: Single-Stage Repair Using a Clamshell Incision and a Systematic
Andrei George Iosifescu1, Alina Teodora Timișescu2, Bogdan Prodan3
1Department of Cardiac Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania. iosifescuag@yahoo.com.
Insights
Acute type A aortic dissection (ATAAD) with aortic coarctation (CoAo) can be treated in one stage. Surgical options include clamshell incision and extra-anatomic bypass for improved outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease
Background:
- Aortic coarctation (CoAo) can remain undiagnosed until complicated by acute type A aortic dissection (ATAAD).
- This association presents unique surgical challenges requiring tailored treatment strategies.
Conclusions:
- One-stage repair, including hybrid or surgical approaches, is a viable option for ATAAD with CoAo.
- Double arterial perfusion and extra-anatomic ascending-to-descending aorta bypass are frequently employed.
- The clamshell incision offers optimal access for complex aortic arch procedures and simultaneous isthmus repair.
Background:
Aortic coarctation (CoAo) may be discovered only when complicated by acute type A aortic dissection (ATAAD). We present a case with a one-stage repair of this pathologic association and review the relevant literature focusing on the surgical choices.
Case Report:
A 43-year-old man presented with acute thoracic pain. Computed tomography and echocardiography demonstrated CoAo, ATAAD type II, an ascending aorta aneurysm, and moderate regurgitation of a bicuspid aortic valve. Emergency surgery was performed. A clamshell incision, cardiopulmonary bypass with dual arterial cannulation (axillo-femoral), CoAo repair (by resection-interposition), and supracoronary aorta replacement were performed. Four years later, the patient was healthy and asymptomatic.
Review:
Thirty surgical cases of ATAAD with CoAo repair after the dissection onset were included. Iatrogenic dissections and formerly repaired CoAo without surgical indication were excluded.
Results:
The mean patient age was 27.8 ± 12 years; there was a male predominance (76.7%). The patients frequently presented with ascending aorta aneurysm (86.2%), bicuspid aortic valve (69%), and type II dissection (79.3%); dissection never extended below the CoAo. The one-stage treatment (15 patients; 55.5%) included 12 surgical repairs of CoAo (mostly by ascending-to-descending aorta extra-anatomic bypass; 58.3%) and three balloon angioplasties. In patients with uncorrected CoAo at the onset of cardiopulmonary bypass, double arterial perfusion was used in 55.5%.
Conclusions:
One-stage repair (hybrid or surgical), double arterial perfusion, and extra-anatomic ascending-to-descending aorta bypass are the most common options for treating ATAAD-CoAo. The clamshell incision provides excellent access for an extended arch procedure and facilitates anatomic isthmus repair.
