1. Knowledge gaps in surgical management for aortic dissection
- Author
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Akiko Tanaka, Avery M. Hebert, Akili Smith-Washington, Tabea Hoffstaetter, Richard Goldenberg, Sreekanth Vemulapalli, Lourdes del Río-Solá, George J. Arnaoutakis, Firas Mussa, Takeyoshi Ota, Melanie Case, Novelett E. Cotter, Carmen C. David, Mark Fasano, Jake Howitt, Timo T. Söderlund, Debra Trotter, Asaf Rabin, Mattie Boehler-Tatman, Melissa L. Russo, Laura Marie Drudi, Laura L. Marks, Maisoon D. Yousif, Ella Taubenfeld, 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 Politano, Jesse Teindl, Lara Bloom, Rebecca Gluck, Meredith Ford O'Neal, Josephine Grima, Eileen Masciale, Katelyn Wright, Alan J. Hakim, Gareth Owens, Dejah 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 MS, Hyein Kim, Claudine Henoud, Scott Damrauer, Emilia Krol, Rana O. Afifi, Alana C. Cecchi, Madeline Drake, Anthony Estrera, Avery M Hebert, Dianna M. Milewicz, Siddharth K. Prakash, Aaron W. Roberts, Harleen Sandhu, Jacob Watson, Myra Ahmad, Catherine M. Albright, Christopher R. Burke, Peter H. Byers, L'Oreal Kennedy, Sarah O. Lawrence, Jenney R. Lee, Jonathan Medina, Thamanna Nishath, Julie Pham, Courtney Segal, Sherene Shalhub, Michael Soto, Linell Catalan, Megan Patterson, and Nicole Ilonzo
- Subjects
Aortic Dissection ,Endovascular Procedures ,Humans ,Surgery ,Aorta, Thoracic ,Stents ,Cardiology and Cardiovascular Medicine ,Aorta - 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.
- Published
- 2021