Key result
Complete excision of the diseased aorta including root and distal arch is increasingly endorsed for Type A aortic dissection, though no standard protocol exists for the extent of resection.
Why the study?
Despite evolving techniques, there is no standard protocol regarding the extent of proximal and distal diseased aortic tissue resection in Type A aortic dissection.
Does complete excision of the diseased aorta including root and distal arch improve outcomes in patients with Type A aortic dissection compared to a conservative approach?
Systematic Review
Does complete excision of the diseased aorta including root and distal arch improve outcomes in patients with Type A aortic dissection compared to a conservative approach?
There is a paradigm shift in Type A aortic dissection management towards more extensive resections, including aortic root and total arch replacement, which show good outcomes especially in young and stable patients.
May inform evolving surgical strategies for Type A dissection; leaves open need for prospective outcome trials.
The management of Type A aortic dissection has evolved over a period of a decade or so, and contemporary reports are suggesting a paradigm shift from a conservative approach to complete excision of the diseased aorta including root and distal arch. Improved cardiopulmonary bypass perfusion techniques, better understanding of the cerebral perfusion, and wide-ranging obtainability of prosthetic conduits gave surgical teams numerous choices. With improving outcomes and maturing surgical techniques, surgeons are performing extensive resections of the diseased aorta, but there is no standard protocol as far as the extent of the proximal and distal diseased aortic tissue resection is concerned. Aortic root replacement is associated with good early- and long-term outcomes and proffered solution in young and stable patients, for that reason many busy centres are endorsing total arch replacement in complex distal aortic dissections. This systemic review is discussing contemporary literature and associated pros and cons during surgical decision-making for these high-risk cases.
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Rathore et al. (2022) conducted a systematic review in Type A aortic dissection. Complete excision of the diseased aorta including root and distal arch vs. Conservative approach was evaluated. Complete excision of the diseased aorta including root and distal arch is increasingly endorsed for Type A aortic dissection, though no standard protocol exists for the extent of resection.
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