Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

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• 作者：Robert S.  ; Bonser MD^?/sup> ;   ; ^&dagger ; ;   ; ^&Dagger ; ;   ; ^{robert.bonser@uhb.nhs.uk} ; Aaron M.  ; Ranasinghe MD^?/sup> ;   ; ^&dagger ; ; Mahmoud  ; Loubani MD^&Dagger ; ;   ; ^§ ; ; Jonathan D.  ; Evans BMedSci^&dagger ; ; Nassir M.A.  ; Thalji MB ChB^&dagger ; ; Jean E.  ; Bachet MD^?/sup> ; Thierry P.  ; Carrel MD^&dagger ; ; Martin  ; Czerny MD^&Dagger ; ;   ; ^¶ ; ; Roberto  ; Di Bartolomeo MD^&Dagger ; ;   ; ^# ; Martin  ; Grabenw&ouml ; ger MD^&Dagger ; ;   ; ^?? ; Lars  ; Lonn MD ; PhD^&dagger ; &dagger ; ; Carlos A.  ; Mestres MD ; PhD^&Dagger ; ;   ; ^&Dagger ; &Dagger ; ; Marc A.A.M.  ; Schepens MD^&Dagger ; ;   ; ^§ ; § ; ; Ernst  ; Weigang MD ; PhD^&Dagger ; ;   ; ^¡Î¡Î
• 关键词：evidence ; surgery ; treatment ; type A aortic dissection
• 刊名：Journal of the American College of Cardiology
• 出版年：2011
• 出版时间：6 December 2011
• 年：2011
• 卷：58
• 期：24
• 页码：2455-2474
• 全文大小：2259 K

文摘

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¡ªparticularly with regard to extent of surgery¡ªare 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.