Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection

Bonser, Robert S; Ranasinghe, Aaron M; Loubani, Mahmoud; Evans, Jonathan D; Thalji, Nassir M A; Bachet, Jean E; Carrel, Thierry P; Czerny, Martin; Di Bartolomeo, Roberto; Grabenwöger, Martin; Lonn, Lars; Mestres, Carlos A; Schepens, Marc A A M; Weigang, Ernst (2011). Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. Journal of the American College of Cardiology, 58(24), pp. 2455-74. New York, N.Y.: Elsevier 10.1016/j.jacc.2011.06.067

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Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Carrel, Thierry and Czerny, Martin

ISSN:

0735-1097

Publisher:

Elsevier

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:20

Last Modified:

17 Mar 2015 19:27

Publisher DOI:

10.1016/j.jacc.2011.06.067

PubMed ID:

22133845

Web of Science ID:

000298132300004

URI:

https://boris.unibe.ch/id/eprint/6592 (FactScience: 211588)

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