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**61**

**Chapter 4**

**Abstract**

Dissection

*and Julian A. Smith*

hemi arch, endovascular techniques

protection will be discussed in this review.

**1. Introduction**

**2. Classification**

Current and Future Management

Type A Aortic dissection is a life-threatening emergency. It has varied clinical presentation from acute severe chest pain radiating to the back, collapse due to aortic rupture or pericardial tamponade or features of myocardial infarction, end organ or limb ischemia. The outcome is determined by the extent of the dissection, timing of presentation, comorbid factors, prompt diagnosis, adequate cerebral protection strategies, and skilled post-operative intensive care. Good immediate and mid-term results have been obtained with standard surgical techniques of aortic root, ascending aorta +/− hemi arch replacement. Endovascular techniques can be

used as a hybrid procedure to provide more durable long term results.

**Keywords:** dissection, cerebral protection strategies, aortic root, ascending aorta,

Type A aortic dissection is a life threatening condition requiring emergency surgical intervention. Statistics show an incidence of approximately three cases per 100,000 per year [1, 2]. Data analysis from the International Registry of Acute Aortic Dissections (IRAD) reported a predominant male patient population and a mean age of 63 years at presentation [3]. Surgical repair for Type A Aortic dissection is challenging, the complexity proportionate to the location and extent of aortic tissue dissected, cardiac complications and end organ ischemia. The current standard surgical approach includes replacement of the aortic root (Bentall technique) or valve sparing root replacement, isolated ascending aorta replacement, and hemi or full arch replacement. Recent advances include frozen elephant trunk (FET) technique, total aortic repair, endovascular and hybrid approaches and stenting. All of these surgical approaches, including classification, clinical presentation, risk factors, diagnosis, pre-operative preparation, cannulation strategies, and cerebral

The Stanford classification (1970) is the most commonly used system (**Figure 1**) [4]. It does not classify the site of tear. It is more of a clinically useful classification

Strategies of Type A Aortic

*Imran Khan, Prashant Joshi, Adrian W. Pick* 
