Stanford type A aortic dissection. A new surgical approach

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Dissection Repair

Background:

• Stanford type A aortic dissection poses significant surgical challenges, particularly regarding cardiopulmonary bypass and potential malperfusion.
• Traditional surgical approaches often involve femoral artery cannulation, which can exacerbate retrograde flow and malperfusion in dissected aortas.

Observation:

• A novel surgical technique for Stanford type A aortic dissection repair is presented, focusing on cannulating the dissected ascending aorta (true or false lumen).
• This approach avoids femoral artery cannulation to minimize malperfusion risks associated with retrograde flow during cardiopulmonary bypass.
• The technique involves cannulating the false lumen under deep hypothermic circulatory arrest without aortic clamping, followed by aortic arch and bulb repair using a Dacron graft prosthesis.

Findings:

• Two cases of Stanford type A aortic dissection were successfully treated using the described novel surgical technique.
• The cannulation of the dissected ascending aorta, specifically the false lumen, under deep hypothermic circulatory arrest proved effective.
• No postoperative cerebral complications were observed in the treated patients.

Implications:

• This technique offers a potentially safer alternative for managing Stanford type A aortic dissection, mitigating risks of malperfusion.
• Further clinical validation with larger patient cohorts and extended follow-up is necessary to confirm the long-term efficacy and safety of this approach.
• The findings may influence future surgical strategies for complex aortic dissections, emphasizing hemodynamic preservation.