[Evolution and recent trends in patient selection and reconstruction method for chronic aortic dissection]

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Context:

• Chronic aortic dissection management involves complex surgical decisions.
• Advancements in diagnostic tools and surgical techniques are improving outcomes.
• Type A and Type B dissections present unique challenges in patient selection and reconstruction.

Purpose:

• To review the evolution and current trends in patient selection for chronic aortic dissection.
• To discuss contemporary reconstruction methods for chronic aortic dissections, including Type A and Type B.
• To highlight the challenges and areas for improvement in aortic dissection surgery.

Summary:

• Patient selection for chronic Type A aortic dissection mirrors acute cases, often requiring extensive aortic arch reconstruction.
• Aortic valve-sparing procedures are increasingly used for associated aortic regurgitation.
• Surgical indications for chronic Type B aortic dissection include diameters >5 cm, symptoms, or rapid enlargement, involving intimal tear resection and segment replacement.
• Despite improved results due to better organ protection and techniques, extensive thoracoabdominal reconstruction for Type B dissection poses challenges, particularly regarding spinal cord protection.

Impact:

• Improved surgical outcomes for chronic aortic dissection patients.
• Increased application of aortic valve-sparing operations.
• Ongoing research needed for spinal cord protection strategies in complex Type B aortic dissections.