Aortic dissection surgery

Aortic dissection Microchapters
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Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]; Aarti Narayan, M.B.B.S [3]

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 B Dissection

• Spinal cord ischemia and [[paralysi