Paradigm Change in the Management of Patients with Acute Type A Aortic Dissection Who Had Prior Cardiac Surgery

BACKGROUND: Acute type A aortic dissection (ATAAD) is a life-threatening disease entity. Untreated, it usually results in death due to rupture of the proximal aorta into the pericardial cavity, leading to cardiac tamponade. Should patients who have had prior cardiac surgery presenting with ATAAD be treated emergently with surgery, or should they be managed medically? We herein present preliminary evidence that suggests that medical treatment, at least initially, is the best option for these patients. Surgery is indicated in the follow-up, depending on increased size of the dissection or aorta, or to prevent or treat complications. PATIENTS AND METHODS: From January 2004 to November 2009, ten consecutive male patients with prior cardiac surgery were admitted to hospital with the diagnosis of ATAAD. Mean age was 61.90 +/- 14.68 years (range, 36 to 79 years), with nine (90%) males and one (10%) female. All were treated medically as the definitive form of management. RESULTS: Mean follow-up duration was 14.62 +/- 11.12 months (range, 1 to 31 months). Overall mortality during follow-up was 20% (two patients). Eight patients (80%) are alive and well. CONCLUSIONS: This initial experience with a small, consecutive series of patients, suggests that medical treatment is an option in the initial management of patients with ATAAD who had prior cardiac surgery. It appears that emergency surgery is seldom needed. A larger series of patients and longer follow-up period are needed prior to recommending this treatment approach for such patients.