AHA/ACC Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (2010)

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Commentary by Reed E. Pyeritz, MD, PhD

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Surgical management

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Acute AoD: surgical management in acute AoD

Aortic dissection classification: DeBakey and Stanford classifications

[Insert Fig. 3, p. 33 from pocket guide]

Recommendations for definitive management

  Class I   
  1. Urgent surgical consultation should be obtained for all patients diagnosed with thoracic aortic dissection, regardless of the anatomic location (ascending versus descending), as soon as the diagnosis is made or highly suspected. (LOE: C)
 
  1. Acute thoracic aortic dissection involving the ascending aorta should be urgently evaluated for emergent surgical repair because of the high risk of associated life-threatening complications such as rupture. (LOE: B)
 
  1. Acute thoracic aortic dissection involving the descending aorta should be managed medically unless life-threatening complications develop (i.e., malperfusion syndrome, progression of dissection, enlarging aneurysm, inability to control blood pressure, or symptoms). (LOE: B)
 

Recommendations for surgical intervention for acute thoracic aortic dissection

  Class I   
  1. For patients with ascending thoracic aortic dissection, all aneurysmal aorta and the proximal extent of the dissection should be resected. A partially dissected aortic root may be repaired with aortic valve resuspension. Extensive dissection of the aortic root should be treated with aortic root replacement with a composite graft or with a valve sparing root replacement. If a DeBakey Type II dissection is present, the entire dissected aorta should be replaced. (LOE: C)

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