What is the definitive treatment of acute aortic dissection (AAD)?

Updated: Nov 09, 2018
  • Author: John M Wiesenfarth, MD, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
  • Print
Answer

Answer

Definitive treatment involves segmental resection of the dissection, with interposition of a synthetic graft.

When thoracic dissections are associated with aortic valvular disease, replace the defective valve. With combined reconstruction–valve replacement, the operative mortality rate is approximately 5%, with a late mortality rate of less than 10%.

Operative repair of the transverse aortic arch is technically difficult, with an operative mortality rate of 10% despite induction of hypothermic cardiocirculatory arrest.

Repair of the descending aorta is associated with a higher incidence of paraplegia than repair of other types of dissections because of interruption of segmental blood supply to the spinal cord.

The operative mortality rate is approximately 5%.

In a study by Mimoun et al of patients with Marfan syndrome who had acute aortic dissection, the patients were found to have a better event-free survival when there were no dissected portions of the aorta remaining after surgery. [8]

A study by Rylski et al indicated that in patients with type A aortic dissection, aggressive hemiarch replacement is associated with a low mortality rate and a low incidence of reintervention. The study involved 534 patients with acute type A dissection who underwent hemiarch replacement. The investigators found that at 1-, 5-, and 10-year follow-up, the patient survival rate was 80%, 68%, and 51%, respectively. During the same follow-up period, no distal reintervention was required in 97%, 90%, and 85% of patients, respectively. [9]


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!