J Anesth Perioper Med. 2018;5(4):200-214. https://doi.org/10.24015/ebcmed.japm.2018.0075

Evolving Concepts in the Perioperative Management of Acute Stanford Type-A Aortic Dissection

Alexander J. Gregory1, Jehangir J. Appoo2, Natalia Acero-Martinez3, Eric J. Herget2, and Albert T. Cheung3

From the 1Division of Cardiovascular Anesthesia, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; 2Division of Cardiac Surgery, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; 3Department of Anesthesiology and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA.

Correspondence to Dr. Albert T. Cheung at ATCheung@stanford.edu.

EBCMED ID: ebcmed.japm.2018.0075 DOI: 10.24015/ebcmed.japm.2018.0075


Aim of review
Acute Stanford Type A aortic dissection involving the ascending aorta or aortic arch remains a surgical emergency associated with high morbidity and mortality. Recent improvements in diagnosis, schemes to identify subtypes based on end-organ complications, increased number of options for operative repair, and advances in perioperative organ protection have had a major impact in the management of this condition.

Evidence for the past dacades was compiled from published investigations, clinical experience, and expert opinion to provide recommendations for the management of acute Stanford type A aortic dissection.

Recent findings
Operative mortality for acute type A aortic dissection depends largely on the presence of malperfusion, circulatory compromise, or both at the time of presentation. Operative repair requires determination of the extent of aortic root involvement, extent of aortic arch involvement, the location of intimal tears, and the presence of malperfusion. The availability of endovascular grafts and increased experience with endovascular therapy has increased the options for both open- and closed-chest repairs for acute type A aortic dissection. The development and refinement of intraoperative organ protection using deep hypothermic circulatory arrest and selective antegrade cerebral perfusion have decreased the risk of neurologic complications and permitted complex repair or replacement of the aortic arch to be performed with a reasonable degree of risk.

Understanding recent advances in detecting complications associated with aortic dissection, the full range of surgical options for repair, and strategies for intraoperative organ protection are important for the comprehensive perioperative management of patients with acute Stanford type A aortic dissection.

Article Type
Review Article

Declaration of Interests
The author declares no conflicts of interest.

All original artworks were created by Mark Cromwell.

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