State-of-the-Art Surgical Management of Acute Type A Aortic Dissection

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• 作者：Ismail El-Hamamsy ; MD ; PhD^a ; ^{i.elhamamsy@icm-mhi.org" class="auth_mail" title="E-mail the corresponding author} ; Maral Ouzounian ; MD ; PhD^b ; Philippe Demers ; MD^a ; Scott McClure ; MD^c ; Ansar Hassan ; MD ; PhD^d ; Francois Dagenais ; MD^e ; Michael W.A. Chu ; MD^f ; Zlatko Pozeg ; MD^g ; John Bozinovski ; MD ; MSc^h ; Mark D. Peterson ; MD ; PhDⁱ ; Munir Boodhwani ; MD ; MMSc^j ; Roderick G.G. McArthur ; MD^k ; Jehangir J. Appoo ; MDCM^l ; on behalf of the Canadian Thoracic Aortic Collaborative (CTAC)^&lowast ;
• 刊名：Canadian Journal of Cardiology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：32
• 期：1
• 页码：100-109
• 全文大小：993 K

文摘

Acute type A aortic dissections still present a major challenge to cardiac surgeons. Although surgical management remains the gold standard, operative mortality remains high, including in experienced centres. Nevertheless, recent advances in the understanding and management of various aspects of these complex operations are expected to improve overall patient outcomes. The Canadian Thoracic Aortic Collaborative (CTAC) represents a group of surgeons with interest and expertise in the management of patients with aortic diseases. The purpose of this state-of-the-art review is to detail our approach to the contemporary surgical management of acute type A aortic dissections. We focus specifically on cannulation strategies, cerebral protection, and extent of proximal and distal resection. In addition, specific clinical scenarios—including malperfusion, intramural hematomas, and surgery in octogenarians—are explored.