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Treatment
7.4.1.3. Surgical Repair Strategies in Acute Type A Aortic
Dissection
COR LOE
Recommendations
Aortic Repair Strategies
1 B-NR 1. In patients with acute type A aortic dissection and a partially
dissected aortic root but no significant aortic valve leaflet
patholog y, aortic valve resuspension is recommended over
valve replacement.
1 B-NR 2. In patients with acute type A aortic dissection who have
extensive destruction of the aortic root, a root aneurysm, or
a known genetic aortic disorder, aortic root replacement is
recommended with a mechanical or biological valved conduit.
2b C-LD In selected patients who are stable, valve-sparing root repair
may be reasonable, when performed by experienced surgeons
in a Multidisciplinary Aortic Team.
1 B-NR 3. In patients with acute type A aortic dissection undergoing
aortic repair, an open distal anastomosis is recommended to
improve survival and increase false-lumen thrombosis rates.
1 B-NR 4. In patients with acute type A aortic dissection without
an intimal tear in the arch or a significant arch aneurysm,
hemiarch repair is recommended over more extensive arch
replacement.
2b C-LD 5. In patients with acute type A aortic dissection and a dissection
flap extending through the arch into the descending thoracic
aorta, an extended aortic repair with antegrade stenting of the
proximal descending thoracic aorta may be considered to treat
malperfusion and reduce late distal aortic complications.
Perfusion and Cannulation Strategies
2a B-NR 6. In patients with acute type A aortic dissection undergoing
surgical repair, axillary cannulation, when feasible, is
reasonable over femoral cannulation to reduce the risk of
stroke or retrograde malperfusion.
2a B-NR 7. In patients with acute type A aortic dissection undergoing
surgical repair who require circulatory arrest, cerebral
perfusion is reasonable to improve neurologic outcomes.
2a B-NR 8. In patients with acute type A aortic dissection undergoing
surgical repair, direct aortic or innominate artery cannulation
with imaging guidance is reasonable as an alternative to
femoral or axillary cannulation.
