Medical Management of Three Patients with an Acute Type A Aortic Dissection: Case Series and a Review of the Literature

Khaled Salhab; William Gioia; Andrew P. Rabenstein; George Gubernikoff; Scott Schubach

doi:10.1055/s-0039-1679870

AORTA, Table of Contents

CC BY 4.0 · Aorta (Stamford) 2018; 06(04): 098-101
DOI: 10.1055/s-0039-1679870

Case Report

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Medical Management of Three Patients with an Acute Type A Aortic Dissection: Case Series and a Review of the Literature

Khaled Salhab

¹Department of Thoracic and Cardiovascular Surgery, NYU Winthrop Hospital, Mineola, New York

,

William Gioia

²Department of Surgery, Stony Brook University Hospital, Stony Brook, New York

,

Andrew P. Rabenstein

²Department of Surgery, Stony Brook University Hospital, Stony Brook, New York

,

George Gubernikoff

³Department of Cardiology, NYU Winthrop Hospital, Mineola, New York

,

Scott Schubach

¹Department of Thoracic and Cardiovascular Surgery, NYU Winthrop Hospital, Mineola, New York

› Author Affiliations

Abstract

The model of surgery first and always for Type A aortic dissections has continued to evolve. During the last three decades, various studies have demonstrated that in select patients, surgery should be delayed or avoided. This case series examines three cases in which patients were medically treated. Furthermore, we review the literature and when surgery should be delayed for acute Type A aortic dissections.

Keywords

aortic dissection - Type A aortic dissection - ascending aorta

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References

References
1 Cohn LH. Cardiac Surgery in the Adult. New York, NY: McGraw-Hill; 2012
2 Anagnostopoulos CE, Prabhakar MJ, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol 1972; 30 (03) 263-273
3 Hirst Jr AE, Johns Jr VJ, Kime Jr SW. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958; 37 (03) 217-279
4 Feldman M, Shah M, Elefteriades JA. Medical management of acute type A aortic dissection. Ann Thorac Cardiovasc Surg 2009; 15 (05) 286-293
5 Gillinov AM, Lytle BW, Kaplon RJ, Casselman FP, Blackstone EH, Cosgrove DM. Dissection of the ascending aorta after previous cardiac surgery: differences in presentation and management. J Thorac Cardiovasc Surg 1999; 117 (02) 252-260
6 Deeb GM, Williams DM, Bolling SF. , et al. Surgical delay for acute type A dissection with malperfusion. Ann Thorac Surg 1997; 64 (06) 1669-1675 , discussion 1675–1677
7 Pape 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 (04) 350-358
8 Piccione Jr W, Hamilton IN, Najafi H. Intentional delayed repair of acute dissection of the ascending aorta complicated by stroke. J Thorac Cardiovasc Surg 1995; 109 (04) 807-808
9 Pocar M, Passolunghi D, Moneta A, Mattioli R, Donatelli F. Coma might not preclude emergency operation in acute aortic dissection. Ann Thorac Surg 2006; 81 (04) 1348-1351
10 Trimarchi S, Nienaber CA, Rampoldi V. , et al; International Registry of Acute Aortic Dissection Investigators. Contemporary results of surgery in acute type A aortic dissection: the International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg 2005; 129 (01) 112-122
11 Tochii M, Takami Y, Hattori K. , et al. Early and late outcomes of surgical repair for Stanford A acute aortic dissection in octogenarians. Circ J 2016; 80 (12) 2468-2472
12 Tang GH, Malekan R, Yu CJ, Kai M, Lansman SL, Spielvogel D. Surgery for acute type A aortic dissection in octogenarians is justified. J Thorac Cardiovasc Surg 2013; 145 (3, Suppl): S186-S190
13 Scholl FG, Coady MA, Davies R. , et al. Interval or permanent nonoperative management of acute type A aortic dissection. Arch Surg 1999; 134 (04) 402-405 , discussion 405–406
14 Centofanti P, Flocco R, Ceresa F. , et al. Is surgery always mandatory for type A aortic dissection?. Ann Thorac Surg 2006; 82 (05) 1658-1663 , discussion 1664