A Comprehensive Review of Acute Type A Aortic Dissection: Epidemiology, Classification, Management Strategies,...

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Anesthesiology

Background:

• Acute type A aortic dissection (ATAAD) presents a 20-25% mortality rate, posing a significant surgical emergency.
• Current research focuses on morphology, epidemiology, and evolving classification systems for ATAAD.
• Socioeconomic factors influence ATAAD incidence and long-term patient outcomes.

Purpose of the Study:

• To provide a comprehensive overview of current research on ATAAD.
• To examine anesthetic, perfusion, and surgical strategies for ATAAD.
• To explore mortality risk prediction and clinician-patient communication, particularly for patients refusing blood transfusions.

Main Methods:

• Literature search across PubMed, Google Scholar, Web of Science, and ScienceDirect.
• Inclusion of 144 sources: 129 peer-reviewed articles and 15 book chapters/books.
• Review of modern classification systems, surgical techniques, and risk prediction models.

Main Results:

• Updated classification systems incorporate coronary artery dissection.
• Moderate hypothermic circulatory arrest (HCA) with cerebral perfusion shows benefits over deep HCA.
• Anemia mortality risk scores improve prognostic accuracy for patients refusing blood transfusions.
• Interpretive-deliberative models aid in managing patient preferences for bloodless surgery.

Conclusions:

• Significant advancements have been made in ATAAD in-hospital mortality assessment, communication, and surgical techniques.
• Refined anesthetic and perfusion strategies, alongside improved surgical management, enhance patient outcomes.
• Further research is required to validate novel approaches in ATAAD management and risk stratification.