Surgical Strategy for Acute Aortic Dissection

Abstract

Aims : We reported 5 cases of acute aortic dissection (AAD) and discuss appropriate preoperative management and surgical strategy. Patients : Subjects were 54 to 84 year old. Results : Three bad DeBakey type II dissection, one type II and, one type III b. Two of the 3 with type II dissection associated with cardiac tamponade underwent emergency surgery. One of the 2 was successfully operated on following pericardial drainage and another patient fell into cardiac arrest just before entering the operating room, resulting in postoperative death. One other patient with type II dissection died of re-rupture in spite of strict pressure control following pericardial drainage. Two other patients with type I or type III b dissection were treated conservatively during the acute phase. A patient with type III b dissection underwent operation the next day due to advancing renal impairment. Another with Type I dissection underwent operation successfully 2 months later. Conclusion : Rapid, precise diagnosis and treatment are indispensable for AAD. Immediate pericardial drainage is necessary for patients with cardiac tamponade, even in thrombosed-type dissection.