Limited repair with tear-oriented approach for type A aortic dissection.

Limited repair with tear-oriented approach for type A aortic dissection. J Cardiovasc Surg (Torino). 2020 Jan 23;: Authors: Tanaka A, Ornekian V, Estrera AL Abstract In 1992, Crawford and colleagues1 reported 21% mortality after acute type A aortic dissection (ATAAD) repair. They also found that 30% of the patients required late distal reoperations. However, none of the patients who had elimination of the intimal tear needed reintervention.1 Ten years later, Westaby and colleagues proposed the "tear-oriented" approach, which has been widely accepted to treat ATAAD2: if the tear is located proximal to the arch vessels, simple limited repair with hemiarch replacement is selected; when the entry-tear is in the lesser curvature of the transverse arch, it can also be excluded with hemiarch replacement by beveling the distal anastomosis, extending the posterior graft suture line to the proximal descending aorta and preserving the arch vessels; and lastly, when the tear is present in the greater curvature of the transverse arch or extending to the arch vessels, total arch replacement is chosen. Other "irrefutable" indications for total arch replacement in patients with ATAAD beyond the tear-oriented approach are excessive enlargement and rupture of the false channel in the arch.1 ATAAD associated with large aortic arch aneurysm is also reasonably considered for total arch replacement. Due to improved survival after ATAAD repair over three d...
Source: The Journal of Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: J Cardiovasc Surg (Torino) Source Type: research