title: State-of-the-Art Surgical Management of Acute Type A Aortic Dissection.
abstract: Acute type A aortic dissections still present a major challenge to cardiac surgeons. Although surgical management remains the gold standard, operative mortality remains high, including in experienced centres. Nevertheless, recent advances in the understanding and management of various aspects of these complex operations are expected to improve overall patient outcomes. The Canadian Thoracic Aortic Collaborative (CTAC) represents a group of surgeons with interest and expertise in the management of patients with aortic diseases. The purpose of this state-of-the-art review is to detail our approach to the contemporary surgical management of acute type A aortic dissections. We focus specifically on cannulation strategies, cerebral protection, and extent of proximal and distal resection. In addition, specific clinical scenarios-including malperfusion, intramural hematomas, and surgery in octogenarians-are explored.
authors.affiliation: Division of Cardiac Surgery Montreal Heart Institute, University of Montreal, Quebec, Canada. Electronic address: i.elhamamsy@icm-mhi.org.
authors.forename: Ismail
authors.initials: I
authors.lastname: El-Hamamsy
authors.affiliation: Division of Cardiac Surgery, Peter Munk Cardiac Centre, University of Toronto, Ontario, Canada.
authors.forename: Maral
authors.initials: M
authors.lastname: Ouzounian
authors.affiliation: Division of Cardiac Surgery Montreal Heart Institute, University of Montreal, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Demers
authors.affiliation: Division of Cardiac Surgery, Kingston General Hospital, Queen's University, Ontario, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: McClure
authors.affiliation: Department of Cardiac Surgery, New Brunswick Heart Centre, Saint John, New Brunswick, Canada.
authors.forename: Ansar
authors.initials: A
authors.lastname: Hassan
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung Institute, Québec City, Québec, Canada.
authors.forename: Francois
authors.initials: F
authors.lastname: Dagenais
authors.affiliation: Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada.
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
authors.affiliation: Division of Cardiac Surgery, St Boniface Hospital, University of Winnipeg, Manitoba, Canada.
authors.forename: Zlatko
authors.initials: Z
authors.lastname: Pozeg
authors.affiliation: Division of Cardiac Surgery, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Bozinovski
authors.affiliation: Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Ontario, Canada.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Peterson
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Munir
authors.initials: M
authors.lastname: Boodhwani
authors.affiliation: Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Roderick G G
authors.initials: RG
authors.lastname: McArthur
authors.affiliation: Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada.
authors.forename: Jehangir J
authors.initials: JJ
authors.lastname: Appoo
mesh_terms: D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D006801:Humans; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000592:standards*