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Current review of acute type A aortic dissection in Malaysia

Paneer Selvam Krishna Moorthy1, Abdul Samad Sakijan2, Deventhiran Permal2

  • 1Department of Cardiothoracic & Vascular Surgery, National Heart Institute, 145 Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia.

Indian Journal of Thoracic and Cardiovascular Surgery
|December 14, 2023
PubMed

Insights

Acute type A aortic dissection (ATAAD) presents surgical challenges, with outcomes often poor, especially in malperfusion syndrome (MPS). Optimal therapy remains debated, necessitating urgent, expert surgical intervention for better results.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Acute type A aortic dissection (ATAAD) remains a significant clinical challenge globally.
  • Despite advancements, outcomes for ATAAD, particularly with malperfusion syndrome (MPS), are often poor, and optimal treatment strategies are debated.
  • Delayed diagnosis contributes to variable patient outcomes.

Purpose of the Study:

  • To review current literature and analyze outcomes of surgical repair for ATAAD.
  • To highlight the challenges and management dilemmas in ATAAD, focusing on surgical outcomes.
  • To discuss the role of advanced surgical techniques in improving long-term benefits for selected ATAAD patients.

Main Methods:

  • Literature review of current management strategies for ATAAD.
  • Analysis of data from the Aortic Registry of the National Heart Institute of Malaysia (NHIM).
  • Examination of various surgical techniques and perfusion strategies employed in ATAAD treatment.

Main Results:

  • Surgical repair outcomes for ATAAD are variable, often influenced by diagnostic delays.
  • Urgent treatment and a high index of suspicion are crucial for managing this dynamic disease.
  • Complex procedures like total arch replacement (TAR) with frozen elephant trunk and valve-sparing root surgery show potential for long-term benefits in specific patient groups.

Conclusions:

  • ATAAD requires a high index of suspicion and prompt management due to its varied presentation and clinical course.
  • Advanced surgical techniques, while demanding expertise, may offer improved long-term outcomes for carefully selected ATAAD patients.
  • Optimal therapy for ATAAD, especially with MPS, continues to be a subject of debate, underscoring the need for experienced surgical teams.

Keywords:
Aortic dissection, Type ADiagnosis, TreatmentReview

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