Current status in decision making to treat acute type A dissection: limited versus extended repair. The Bologna approach

The best surgical treatment for acute type A aortic dissection (AAAD) is still a strongly debated issue of every cardiac surgeon. The successful result is obtained by taking into consideration both the preoperative and intraoperative aspects, such as cerebral, visceral or coronary malperfusion before surgery. More conservative approaches or more aggressive treatments are different strategies with their pros and cons to face the same problem, especially for the aortic arch management. The expertise of the center, the perfect surgical timing and a dedicated aortic team composed of expert aortic surgeons, anesthesiologist, radiologist and cardiologist are important but not mandatory to achieve the best results in this type of surgery since is not possible to offer it in all the hospitals. The accurate assessment of the aortic anatomy has to be performed, including the extension of the dissection process, the exact location of the entry and re-entry tears, the aortic diameters, the distribution of visceral vessels between the true and the false lumen and the assessment of perfect size of the prosthesis to avoid the oversize since it may cause new entry site in the descending thoracic aorta. We reviewed and analyzed different scenarios and techniques used for the aortic arch replacement in patients with AAAD, taking into consideration that the aim of surgery is to save patients life.