Recommendations for Surgical Repair Strategies in Acute Type A Aortic Dissection
Referenced studies that support the recommendations are summarized in the Online Data Supplement.
| COR | LOE | Recommendations |
|---|---|---|
| Aortic Repair Strategies | ||
| 1 | B-NR | 1. In patients with acute type A aortic dissection and a partially dissected aortic root but no significant aortic valve leaflet pathology aortic valve resuspension is recommended over valve replacement.1–5 |
| 1 | B-NR | 2. In patients with acute type A aortic dissection who have extensive destruction of the aortic root, a root aneurysm, or a known genetic aortic disorder, aortic root replacement is recommended with a mechanical or biological valved conduit.6–9 In selected patients who are stable, valve-sparing root repair may be reasonable, when performed by experienced surgeons in a Multidisciplinary Aortic Team.10,11 |
| 2b | C-LD | |
| 1 | B-NR | 3. In patients with acute type A aortic dissection undergoing aortic repair, an open distal anastomosis is recommended to improve survival and increase false-lumen thrombosis rates.12–15 |
| 1 | B-NR | 4. In patients with acute type A aortic dissection without an intimal tear in the arch or a significant arch aneurysm, hemiarch repair is recommended over more extensive arch replacement.16–18 |
| 2b | C-LD | 5. In patients with acute type A aortic dissection and a dissection flap extending through the arch into the descending thoracic aorta, an extended aortic repair with antegrade stenting of the proximal descending thoracic aorta may be considered to treat malperfusion and reduce late distal aortic complications.19,20 |
| Perfusion and Cannulation Strategies | ||
| 2a | B-NR | 6. In patients with acute type A aortic dissection undergoing surgical repair, axillary cannulation, when feasible, is reasonable over femoral cannulation to reduce the risk of stroke or retrograde malperfusion.21,22 |
| 2a | B-NR | 7. In patients with acute type A aortic dissection undergoing surgical repair who require circulatory arrest, cerebral perfusion is reasonable to improve neurologic outcomes.23–25 |
| 2a | B-NR | 8. In patients with acute type A aortic dissection undergoing surgical repair, direct aortic26,27 or innominate artery28 cannulation with imaging guidance is reasonable as an alternative to femoral or axillary cannulation.29–31 |