Aortic dissection surgery: Difference between revisions
| Line 5: | Line 5: | ||
==Overview== | ==Overview== | ||
Any dissection that involves the ascending aorta is considered a surgical emergency, and urgent surgical consultation is recommended. There is a 90% 3-month mortality among patients with a proximal aortic dissection who do not undergo surgery. These patients can rapidly develop acute aortic insufficiency (AI), tamponade or myocardial infarction (MI). Even acute MI in the setting of dissection is not a surgical contraindication. Acute hemorrhagic stroke is, however, a relative contraindication, due to the necessity of intraoperative heparinization. | Any dissection that involves the ascending aorta is considered a surgical emergency, and urgent surgical consultation is recommended. There is a 90% 3-month mortality among patients with a proximal aortic dissection who do not undergo surgery. These patients can rapidly develop acute aortic insufficiency (AI), tamponade or myocardial infarction (MI). | ||
==Contraindications to the Operative Repair of a Type A Dissection== | |||
Even [[acute MI]] in the setting of dissection is ''not'' a surgical contraindication. Acute [[hemorrhagic stroke]] is, however, a relative contraindication, due to the necessity of intraoperative heparinization. | |||
==Surgical Indications for Operative Repair of a Type B Dissection== | ==Surgical Indications for Operative Repair of a Type B Dissection== | ||
Revision as of 00:54, 30 October 2012
|
Aortic dissection Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Special Scenarios |
|
Case Studies |
|
|
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Any dissection that involves the ascending aorta is considered a surgical emergency, and urgent surgical consultation is recommended. There is a 90% 3-month mortality among patients with a proximal aortic dissection who do not undergo surgery. These patients can rapidly develop acute aortic insufficiency (AI), tamponade or myocardial infarction (MI).
Contraindications to the Operative Repair of a Type A Dissection
Even acute MI in the setting of dissection is not a surgical contraindication. Acute hemorrhagic stroke is, however, a relative contraindication, due to the necessity of intraoperative heparinization.
Surgical Indications for Operative Repair of a Type B Dissection
Dissections involving only the descending aorta can generally be managed medically, but indications for surgery include the following:
- Progression of the dissection
- Continued hemorrhage into the pleural or retroperitoneal space
Surgical Complications Following Repair of a Type Be Dissection
- Spinal cord ischemia and paralysis.
Surgical Risk Factors
Risk factors associated with increased surgical mortality include the following:
- Rrenal insufficiency
- Mesenteric ischemia
- Renal ischemia
- Pericardial tamponade
- Underlying pulmonary disease
Surgical Procedure
Surgical therapy involves excision of the intimal tear, obliteration of the proximal entry site into the false lumen, and reconstitution of the aorta with placement of a synthetic graft. AI can be corrected by resuspension of the native valve, or by aortic valve replacement (AVR).
ACC/ AHA Guidelines - Recommendation for Surgical Intervention for Thoracic Aortic Disease (DO NOT EDIT)
| Class I |
| 1. For patients with ascending thoracic aortic dissection, all aneurysmal aorta and the proximal extent of the dissection should be resected. A partially dissected aortic root may be repaired with aortic valve resuspension. Extensive dissection of the aortic root should be treated with aortic root replacement with a composite graft or with a valve sparing root replacement. If a DeBakey Type II dissection is present, the entire dissected aorta should be replaced. (Level of Evidence: C) |