Type A aortic dissection: the extent of surgical intervention.

Acute DeBakey type I aortic dissection is a life-threatening emergency and requires immediate surgical intervention. For untreated DeBakey type I aortic dissection mortality increases up to 50% in the first 24 hours and 75% within two weeks after the initial event (1). Although surgical techniques and perioperative care have significantly improved during the decades, mortality remains high and is reported between 15% and 30% (2-6). Bearing in mind that this is a high risk surgical subset, the primary target of an emergency operation for acute DeBakey type I aortic dissection has to be survival of the patient with a low morbidity rate. Various steps have been taken over the last few years to improve the surgical outcome of these complex aortic pathologies. The practice of hypothermic circulatory arrest and open distal anastomosis with visual inspection of the arch vessels was introduced in the 1980s and became routine soon afterward. Cerebral protection techniques were introduced in the 1990s. Ultimately, there is strong evidence that antegrade cerebral perfusion has a beneficial effect on neurological outcome. The combination of moderate hypothermic circulatory arrest with cold selective antegrade cerebral perfusion is an adequate tool for neuroprotection during aortic surgery (7,8).