SPECIAL ISSUE
Current management of acute aortic syndrome
Peter S.Y. Yu,
Takuya Fujikawa,
Malcolm J. Underwood,
Randolph H.L. Wong,
Peter S.Y. Yu
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
Search for more papers by this authorTakuya Fujikawa
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
Search for more papers by this authorMalcolm J. Underwood
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
Search for more papers by this authorCorresponding Author
Randolph H.L. Wong
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
Author to whom all correspondence should be addressed.
Email: [email protected]
Search for more papers by this authorPeter S.Y. Yu,
Takuya Fujikawa,
Malcolm J. Underwood,
Randolph H.L. Wong,
Peter S.Y. Yu
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
Search for more papers by this authorTakuya Fujikawa
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
Search for more papers by this authorMalcolm J. Underwood
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
Search for more papers by this authorCorresponding Author
Randolph H.L. Wong
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
Author to whom all correspondence should be addressed.
Email: [email protected]
Search for more papers by this authorFirst published: 19 September 2018
Abstract
Acute aortic dissection and intramural haematoma are the most common disease entities under the category of ‘acute aortic syndromes’. High mortalities and morbidities remain clinical challenges in their management, even in the international arena. Continuous advancement and new evidence about open, endovascular and hybrid interventions offer new insights towards improvements in treatment outcomes. Careful planning and execution of operative management with attention to specific patient characteristics remain the prerequisites for a reduction in mortality and complications.
References
- 1Erbel R, Aboyans V, Boileau C et al. ESC Committee for Practice Guidelines; 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC). Eur. Heart J. 2014; 35 (41): 2873–926.
- 2Augoustides JG, Geirsson A, Szeto WY, Walsh EK, Cornelius B, Pochettino A et al. Observational study of mortality risk stratification by ischemic presentation in patients with acute type A aortic dissection: the Penn classification. Nat. Clin. Pract. Cardiovasc. Med. 2009; 6 (2): 140–6.
- 3Dake MD, Thompson M, van Sambeek M, Vermassen F, Morales JP, Investigators D. DISSECT: a new mnemonic-based approach to the categorization of aortic dissection. Eur. J. Vasc. Endovasc. Surg. 2013; 46 (2): 175–90.
- 4Mehta RH, Suzuki T, Hagan PG et al. Predicting death in patients with acute type a aortic dissection. Circulation 2002; 105 (2): 200–6.
- 5Hagan PG, Nienaber CA, Isselbacher EM et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000; 283 (7): 897–903.
- 6Mussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA. Acute aortic dissection and intramural hematoma: a systematic review. JAMA 2016; 316 (7): 754–63.
- 7Pape LA, Awais M, Woznicki EM et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J. Am. Coll. Cardiol. 2015; 66 (4): 350–8.
- 8Lee TC, Kon Z, Cheema FH et al. Contemporary management and outcomes of acute type A aortic dissection: an analysis of the STS adult cardiac surgery database. J. Card. Surg. 2018; 33 (1): 7–18.
- 9Wiedemann D, Kocher A, Dorfmeister M, Vadehra A, Mahr S, Laufer G, Ehrlich M. Effect of cerebral protection strategy on outcome of patients with Stanford type A aortic dissection. J. Thorac. Cardiovasc. Surg. 2013; 146 (3): 647–55 e1.
- 10Englum BR, He X, Gulack BC et al. Hypothermia and cerebral protection strategies in aortic arch surgery: a comparative effectiveness analysis from the STS Adult Cardiac Surgery Database. Eur. J. Cardiothorac. Surg. 2017; 52 (3): 492–8.
- 11Suenaga E, Sato M, Fumoto H, Kawasaki H, Koga S. Impact of transapical aortic cannulation for acute type A aortic dissection. Ann. Thorac. Cardiovasc. Surg. 2015; 21 (4): 382–7.
- 12Stamou SC, Gartner D, Kouchoukos NT, Lobdell KW, Khabbaz K, Murphy E, Hagberg RC. Axillary versus femoral arterial cannulation during repair of type A aortic dissection?: An old problem seeking new solutions. Aorta (Stamford). 2016; 4 (4): 115–23.
- 13Patris V, Toufektzian L, Field M, Argiriou M. Is axillary superior to femoral artery cannulation for acute type A aortic dissection surgery? Interact. Cardiovasc. Thorac. Surg. 2015; 21 (4): 515–20.
- 14Swee W, Dake MD. Endovascular management of thoracic dissections. Circulation 2008; 117 (11): 1460–73.
- 15Roselli EE, Idrees J, Greenberg RK, Johnston DR, Lytle BW. Endovascular stent grafting for ascending aorta repair in high-risk patients. J. Thorac. Cardiovasc. Surg. 2015; 149 (1): 144–51.
- 16Czerny M, Schoenhoff F, Etz C et al. The impact of pre-operative Malperfusion on outcome in acute type a aortic dissection: results from the GERAADA registry. J. Am. Coll. Cardiol. 2015; 65 (24): 2628–35.
- 17Williams DM, Lee DY, Hamilton BH et al. The dissected aorta: part III. Anatomy and radiologic diagnosis of branch-vessel compromise. Radiology 1997; 203 (1): 37–44.
- 18Perera NK, Galvin SD, Seevanayagam S, Matalanis G. Optimal management of acute type A aortic dissection with mesenteric malperfusion. Interact. Cardiovasc. Thorac. Surg. 2014; 19 (2): 290–4.
- 19Charlton-Ouw KM, Sandhu HK, Leake SS, Jeffress K, Miller CCR, Durham CA et al. Need for limb revascularization in patients with acute aortic dissection is associated with mesenteric ischemia. Ann. Vasc. Surg. 2016; 36: 112–20.
- 20Di Eusanio M, Trimarchi S, Patel HJ, Hutchison S, Suzuki T, Peterson MD et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J. Thorac. Cardiovasc. Surg. 2013; 145 (2): 385–90 e1.
- 21Hsu HL, Chen YY, Huang CY, Huang JH, Chen JS. The Provisional Extension To Induce Complete Attachment (PETTICOAT) technique to promote distal aortic remodelling in repair of acute DeBakey type I aortic dissection: preliminary results. Eur. J. Cardiothorac. Surg. 2016; 50 (1): 146–52.
- 22Tsagakis K, Konorza T, Dohle DS et al. Hybrid operating room concept for combined diagnostics, intervention and surgery in acute type A dissection. Eur. J. Cardiothorac. Surg. 2013; 43 (2): 397–404.
- 23Shrestha M, Bachet J, Bavaria J, Carrel TP, De Paulis R, Di Bartolomeo R et al. Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS. Eur. J. Cardiothorac. Surg. 2015; 47 (5): 759–69.
- 24Wong RH, Ho JY, Underwood MJ. Multimodality imaging assessment for Thoraflex hybrid total arch replacement. Asian Cardiovasc. Thorac. Ann. 2016; 24 (5): 496–501.
- 25Imoto K, Uchida K, Karube N et al. Risk analysis and improvement of strategies in patients who have acute type A aortic dissection with coronary artery dissection. Eur. J. Cardiothorac. Surg. 2013; 44 (3): 419–24 discussion 24-5.
- 26Alsaad AA, Odunukan OW, Patton JN. Ascending aortic dissection presented as inferior myocardial infarction: a clinical and diagnostic mimicry. BMJ Case Rep. 2016; 2016. pii: bcr2016217543.
- 27Tsigkas G, Kasimis G, Theodoropoulos K et al. A successfully thrombolysed acute inferior myocardial infarction due to type A aortic dissection with lethal consequences: the importance of early cardiac echocardiography. J. Cardiothorac. Surg. 2011; 6: 101.
- 28Luo JL, Wu CK, Lin YH, Kao HL, Lin MS, Ho YL et al. Type A aortic dissection manifesting as acute myocardial infarction: still a lesson to learn. Acta Cardiol. 2009; 64 (4): 499–504.
- 29Doguet F, Vierne C, Leguillou V, Bessou JP. Place of extracorporeal membrane oxygenation in acute aortic dissection. Interact. Cardiovasc. Thorac. Surg. 2010; 11 (5): 708–10.
- 30Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J. Am. Coll. Cardiol. 2013; 61 (16): 1661–78.
- 31Fujikawa T, Yamamoto S, Sekine Y et al. Operative results and clinical features of chronic Stanford type B aortic dissection: examination of 234 patients over 6 years. Eur. J. Vasc. Endovasc. Surg. 2015; 50 (6): 738–43.
- 32White RA, Miller DC, Criado FJ et al. Multidisciplinary Society for Vascular Surgery Outcomes Committee; Report on the results of thoracic endovascular aortic repair for acute, complicated, type B aortic dissection at 30 days and 1 year from a multidisciplinary subcommittee of the Society for Vascular Surgery Outcomes Committee. J. Vasc. Surg. 2011; 53 (4): 1082–90.
- 33Nienaber CA, Kische S, Ince H, Fattori R. Thoracic endovascular aneurysm repair for complicated type B aortic dissection. J. Vasc. Surg. 2011; 54 (5): 1529–33.
- 34Fattori R, Montgomery D, Lovato L, Kische S, Di Eusanio M, Ince H et al. Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD). JACC Cardiovasc. Interv. 2013; 6 (8): 876–82.
- 35Brunkwall J, Kasprzak P, Verhoeven E, Heijmen R, Taylor P, Trialists A et al. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur. J. Vasc. Endovasc. Surg. 2014; 48 (3): 285–91.
- 36Nienaber CA, Kische S, Rousseau H et al. for the INSTEAD-XL trial; Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ. Cardiovasc. Interv. 2013; 6 (4): 407–16.
- 37Williams JB, Andersen ND, Bhattacharya SD, Scheer E, Piccini JP, McCann RL et al. Retrograde ascending aortic dissection as an early complication of thoracic endovascular aortic repair. J. Vasc. Surg. 2012; 55 (5): 1255–62.
- 38Canaud L, Ozdemir BA, Patterson BO, Holt PJ, Loftus IM, Thompson MM. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann. Surg. 2014; 260 (2): 389–95.
- 39Wang G, Zhai S, Li T et al. Mechanism and management of retrograde type A aortic dissection complicating TEVAR for type B aortic dissection. Ann. Vasc. Surg. 2016; 32: 111–8.
- 40Ramdass M. TEVAR for symptomatic Stanford B dissection: a systematic review of 30-day mortality and morbidity. Thorac. Cardiovasc. Surg. 2015; 63 (2): 97–112.
- 41Steuer J, Eriksson MO, Nyman R, Bjorck M, Wanhainen A. Early and long-term outcome after thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection. Eur. J. Vasc. Endovasc. Surg. 2011; 41 (3): 318–23.
