title: Contemporary insights into the management of type A aortic dissection.
abstract: Acute Type A Dissection remains a surgical emergency with a relatively high operative mortality despite advances in cardiac surgical techniques and medical management over the past thirty years.
  
  
  
  In this presentation we will discuss the issues surrounding diagnosis, triage, surgical treatment and perioperative medical management as well as long term surveillance of patients suffering from Acute Type A Dissection and present the literature that supports our management strategies. Expert commentary: The ultimate goal of surgical intervention for patients with Type A Acute Aortic Dissection is an alive patient. A more complicated operation which addresses the root and arch and potentially reduces late complications should be approached with caution since it may increase the operative mortality of the procedure itself. With the recent evolution in endovascular techniques, there is hope that later complications can be reduced without increasing the risk of the primary operation. It remains to be seen whether the improved distal aortic remodeling afforded by a combined open/endovascular approach to Acute Type A Dissection will lead to decreased need for aortic reinterventions and overall long term complications of a residual descending thoracic chronic dissection.
authors.affiliation: a Division of Cardiac Surgery , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: George
authors.initials: G
authors.lastname: Tolis
authors.affiliation: a Division of Cardiac Surgery , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D019468:Disease Management; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
keywords: Aortic dissection; aortic aneurysm; aortic arch replacement; aortic root replacement; ascending aortic replacement; malperfusion