Aortic dissection surgery: Difference between revisions

	Aortic dissection Microchapters
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Revision as of 00:53, 30 October 2012

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). 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 a Type Be 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:

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)

@@ Line 4: / Line 4: @@
 {{CMG}}
+==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. Without surgery, there is a 90% 3-month mortality. 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.
+==Surgical Indications for a Type Be Dissection==
-:*Operative mortality for ascending dissections is surgeon dependant, and averages ~ 5 – 20 %. This however, is well below the 50% mortality when these cases are managed with medical therapy.
+Dissections involving only the descending aorta can generally be managed medically, but indications for surgery include the following:
-:*Factors that increase surgical risk include renal insufficiency, visceral ischemia, tamponade and underlying pulmonary disease.
+*Progression of the dissection
-:*Surgical therapy involves excision of the intimal tear, obliteration of the proximal entry site into the false leumen, 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).
+*Continued hemorrhage into the pleural or retroperitoneal space
-:*Dissections involving the descending aorta only can be managed medically unless there is progression or continued hemorrhage into the pleural or retroperitoneal space. The major surgical complication in descending dissections is spinal cord ischemia and paralysis.
+==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)==