Present-day policy of surgical treatment for type A acute aortic dissection

Rukosujew A.¹, Usai M.V.², Martens S.¹, Ibrahim A.², Shakaki M.¹, Bruenen A.³, Dell’aquila A.M.¹

1) Department of Cardiothoracic Surgery,
2) Department of Vascular and Endovascular Surgery,
3) Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany

A surgical intervention for type A acute aortic dissection is the only effective method of treatment making it possible to prevent the development of life-threatening complications and to attain clinical recovery of the patient. Supracoronary replacement of the ascending aorta and the proximal portion of the aortic arch is considered to be the classical and most commonly used method of an open operative intervention. On the one hand, it is technically the simplest and shortest operation, and on the other, this surgical technique is often accompanied by long-term proximal and distal complications, and first of all those caused by a persistent false lumen. The accumulated surgical experience and contemporary operative techniques, as well as advances of intensive therapy in treatment of type A acute aortic dissection make it possible to currently perform more extensive primary resections in order to improve the remote results. Total aortic arch replacement, including the use of the "frozen elephant trunk" technique leads to fast thrombosis of the false lumen, preventing progression of the disease of the thoracic aorta and promoting its positive remodelling.

The article describes the perioperative therapeutic policy accepted and pursued in our medical facility, also presenting the authors’ opinion on the role and place of the "frozen elephant trunk" technique in rendering medical care for patients with type A acute aortic dissection.

KEY WORDS: aortic dissection, cannulation, cerebral protection, prosthetic repair of the ascending portion and aortic arch, frozen elephant trunk.

P. 92-101

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