Knowledge gaps in surgical management for aortic dissection
Akiko Tanaka, Avery M Hebert, Akili Smith-Washington, Tabea Hoffstaetter, Richard Goldenberg, Sreekanth Vemulapalli, Lourdes Del Río-Solá, George J. Arnaoutakis, Firas F. Mussa, Takeyoshi Ota, Melanie Case, Novelett E. Cotter, Carmen C. David, Mark Fasano, Richard Goldenberg, Jake Howitt, Timo T. Söderlund, Debra Trotter, Asaf Rabin, Mattie Boehler-Tatman, Melissa L. Russo, Laura M. Drudi, Laura L. Marks, Maisoon D. Yousif, Tabea Hoffstaetter, Ella Taubenfeld, Sreekanth Vemulapalli, Chrisanne S. Campos, Lindsey Rusche, Robert C.F. Pena, Firas F. Mussa, Gretchen MacCarrick, Earl Goldsborough, Christeen Samuel, Lillian Xu, Nicolas J. Mouawad, Eanas S. Yassa, Xiaoyi Teng, Amani D. Politano, Jesse Teindl, Lara Bloom, Rebecca Gluck, Meredith Ford O'Neal, Josephine Grima, Eileen Masciale, Takeyoshi Ota, Katelyn Wright, Alan J. Hakim, Gareth Owens, George J. Arnaoutakis, Dejah R. Judelson, Mario D’Oria, Lurdes del Rio-Sola, Mark Ajalat, Marvin Chau, Stephanie D. Talutis, Karen Woo, Max V. Wohlauer, JeniannA. Yi, Kim A. Eagle, Marion A. Hofmann Bowman, Eva Kline‐Rogers, Hyein Kim, Claudine Henoud, Scott M. Damrauer, Emilia Król, Rana O. Afifi, Alana C. Cecchi, Madeline Drake, Anthony L. Estrera, Avery M Hebert, Dianna M. Milewicz, Siddharth K. Prakash, Aaron W. Roberts, Harleen K. Sandhu, Akili Smith-Washington, Akiko Tanaka, Jacob Watson, Myra Ahmad, Catherine M. Albright, Christopher R. Burke, Peter H. Byers, L’Oreal Kennedy, Sarah Lawrence, Jenney R. Lee, Jonathan Medina, Thamanna Nishath, Julie Pham, Courtney Segal, Sherene Shalhub, Michael Soto, Linell Catalan, Megan Patterson, Nicole Ilonzo
Abstract
Aortic dissection (AD) is recognized as a potentially fatal condition and its standard treatment has been surgical intervention for acute type A AD (TAAD) and complicated acute type B AD (TBAD), and medical management for uncomplicated acute type B AD. Due to rapidly evolving device technologies and minimally invasive surgical techniques that have lowered perioperative risk, there are paradigm shifts for the indications and treatment options for both TAAD and TBAD. In this article, we will discuss the current indications and treatment options for TAAD and TBAD by chronicity of the disease, which comprises four categories: acute TAAD, chronic (repaired) TAAD, acute TBAD, and chronic TBAD. We will also discuss the knowledge gaps in the current surgical management strategies and literature evidence. Open surgical intervention remains the reference standard for acute TAAD and chronic TAAD with complications until an endoprosthesis that will suit the complex anatomy of aortic root, ascending aorta, and aortic arch is developed. Thoracic endovascular aortic repair is now the first line for complicated acute and chronic TBADs. However, we need a larger trials to support the safety and durability of the procedures in patients with uncomplicated TBAD. Without additional data, patients are left to choose between existing treatment options, such as open surgical repair and stent-grafting.