3.Infections:

	- i.Acute kidney injury 39%.
	- ii.Renal replacement therapy 12%
	- i.Mesenteric ischemia 6%.
	- ii.Myocardial infarction 6%.

**75**

*Current and Future Management Strategies of Type A Aortic Dissection*

[46]. Acute kidney injury may occur in 40–55% [50].

Bleeding is one of the most feared complication from a surgeon's point of view. When blood comes in contact with subendothelial tissue of false lumen, it leads to a coagulopathy. Consumption of coagulation factors and fibrinolysis leads to disseminated intravascular coagulation. Activation and consumption of platelets also contributes to mortality [51]. Patients with pre-operative cardiac mal-perfusion was found to be associated with 30-day mortality of 33% (47). Pre-operative cerebral malperfusion is associated with three-fold increase in risk of stroke. Post-operative stroke and coma occurred in 10–15% and 3–9% patients respectively in one series

Long-term post-operative survival in recent years at 5, 10 and 30 years is 84–85, 64–68, and 38%, respectively [52]. Health-related quality of life is lower compared to the general population. There is 32% incidence of depression and post-traumatic stress disorder [53]. Over 50% patients have resistant hypertension on follow-up. As per the EACTS/ESC 2014 guidelines, a follow-up CT-scan of the aorta is recommended at 1, 6 and 12 months and annually thereafter [54]. There are no recommendations specific to the aortic valve or aortic regurgitation for follow-up. To follow general guidelines, one can perform follow-up echocardiography every 1–2 years for mild regurgitation and annually for moderate and asymptomatic

Type A Aortic dissection is an emergency requiring timely surgical intervention. With improved imaging techniques, an accurate diagnosis can now be made. Open surgical repair techniques have given good long-term results. Endovascular intervention is an emerging less invasive option which can be combined with a surgical

*DOI: http://dx.doi.org/10.5772/intechopen.93015*

6.Reoperations of the aorta

i.Proximal reoperation.

ii. 1 year 0.8%.

iii. 5 years 2.1%

i.year 0.8%

ii. 5 years 4.3%

**16. Long-term follow-up**

severe regurgitation [55].

approach to give excellent long-term results.

TAAD type A aortic dissection

RCP retrograde cerebral perfusion

aSCP antegrade selective cerebral perfusion

**17. Conclusion**

**Abbreviations**

7.Distal reoperations.

*Current and Future Management Strategies of Type A Aortic Dissection DOI: http://dx.doi.org/10.5772/intechopen.93015*

6.Reoperations of the aorta


*Advances in Complex Valvular Disease*

**15. Complications of surgery for ATAD**

Based on the NORCAAD registry [50].

i.Major bleeding −39 %

iii.Cardiac tamponade −15%

ii.Reoperation for bleeding 22%.

iii.Transient ischemic attack 5%.

ii.Deep sternal wound infections 2%.

stress gets modified.

1.Bleeding

2.Neurological

i.Stroke 20%.

ii.Coma 11%.

i.Sepsis 10%.

iii.Pneumonia 19%

i.Acute kidney injury 39%.

i.Mesenteric ischemia 6%.

ii.Myocardial infarction 6%.

iii.Limb ischemia requiring surgery 4%

ii.Renal replacement therapy 12%

3.Infections:

4.Renal

5.Malperfusion

false lumen, (ii) helicoidal flow distal to the endoprosthesis, (iii) aortic wall shear

Matalanis [49] has introduced the concept of total aortic repair to prevent the above mentioned complication. Patients presenting with TAAD and a descending thoracic aorta diameter of more than 40 mm can benefited from this approach. The repair involves a "Branch first "total aortic arch repair and surgical ascending aorta repair. Second part included endovascular treatment of descending aorta. It includes covered stent graft deployment in the proximal part of descending aorta and rupture of the intimal flap for the last part of aorta. The rupture is managed with the deployment and dilation under balloon of uncovered stent graft. With this approach, aneurysmal dilatation of the false channel is avoided by the creation of this new aortic channel. But, currently there is no long-term follow-up of this approach.

**74**

	- i.year 0.8%
	- ii. 5 years 4.3%

Bleeding is one of the most feared complication from a surgeon's point of view. When blood comes in contact with subendothelial tissue of false lumen, it leads to a coagulopathy. Consumption of coagulation factors and fibrinolysis leads to disseminated intravascular coagulation. Activation and consumption of platelets also contributes to mortality [51]. Patients with pre-operative cardiac mal-perfusion was found to be associated with 30-day mortality of 33% (47). Pre-operative cerebral malperfusion is associated with three-fold increase in risk of stroke. Post-operative stroke and coma occurred in 10–15% and 3–9% patients respectively in one series [46]. Acute kidney injury may occur in 40–55% [50].

## **16. Long-term follow-up**

Long-term post-operative survival in recent years at 5, 10 and 30 years is 84–85, 64–68, and 38%, respectively [52]. Health-related quality of life is lower compared to the general population. There is 32% incidence of depression and post-traumatic stress disorder [53]. Over 50% patients have resistant hypertension on follow-up.

As per the EACTS/ESC 2014 guidelines, a follow-up CT-scan of the aorta is recommended at 1, 6 and 12 months and annually thereafter [54]. There are no recommendations specific to the aortic valve or aortic regurgitation for follow-up. To follow general guidelines, one can perform follow-up echocardiography every 1–2 years for mild regurgitation and annually for moderate and asymptomatic severe regurgitation [55].
