Overview of acute type A aortic dissection in India

AbstractAcute type A aortic dissection (TAAD) is a life-threatening surgical emergency. Though the entity is associated with high mortality and morbidity, with well-executed and timely surgical intervention, mortality and morbidity could be reduced to a reasonable extent. Information about demographics, clinical pattern, and results of management of acute TAAD from the Indian subcontinent largely remains unpublished. There are only a few specialized centers performing aortic operations. Very often, the patients with acute TAAD are operated on by surgeons with limited experience and resources. The surgeon is operating like a “lone warrior” without the support of a specialized radiologist, interventionalist, and specialized anesthetist. In most of the hospitals, facilities for sophisticated monitoring, sealants, specialized grafts, and stent graft are not available. We follow a simple algorithm of diagnosis and surgi cal management. The goal of treatment is to save the life. We follow a conservative approach best suited to our circumstances. Mild hypothermia, carotid cannulation, and antegrade cerebral perfusion as cerebral protection strategies have yielded satisfactory results. In case of organ malperfusion, w ith some exceptions, we perform aortic repair first. Our policy, towards arch management is less aggressive. In high-risk cases, we perform an endovascular-compliant hemiarch or arch replacement, followed by stent grafting in the post-operative period.
Source: Indian Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research