Acute type-A aortic dissection - a review

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  • Tomas Gudbjartsson, Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
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  • Anders Ahlsson, Department of Cardiothoracic Surgery, Karolinska University Hospital , Stockholm , Sweden.
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  • Arnar Geirsson, Division of Cardiac Surgery, Yale School of Medicine , New Haven , CT , USA.
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  • Jarmo Gunn, Department of Cardiothoracic Surgery, Turku University Hospital, Turku, Finland.
  • ,
  • Vibeke Hjortdal
  • Anders Jeppsson, Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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  • Ari Mennander, Tampere University Heart Hospital and Tampere University, Tampere, Finland. Electronic address: ari.mennander@sydansairaala.fi.
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  • Igor Zindovic, Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden; Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
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  • Christian Olsson, Department of Cardiothoracic Surgery, Karolinska University Hospital , Stockholm , Sweden.

Objectives. Acute type-A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. Design. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. Results and conclusions. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate.

Original languageEnglish
JournalScandinavian Cardiovascular Journal
Pages (from-to)1-13
Number of pages13
ISSN1401-7431
DOIs
Publication statusE-pub ahead of print - 23 Sep 2019

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