Aortic Dissection

Aortic Dissection: Hemiarch Versus Total Arch Replacement
Taylor Aubin
Sinclair Community College
October 1, 2015

Aortic dissection is a life threatening condition in which the intima, the inner most layer, of the aorta tears. As the blood flows through the aorta it rushes through this tear resulting in dissection of the intima from the media, the middle layer of the aorta. This unfortunate condition is often fatal if the newly created false lumen ruptures through the aortic wall. Aortic dissection must be immediately detected and treated to increase the opportunity of survival. There are different types of aortic dissection categorized using two classifications which are DeBakey and Stanford. The specific type of aortic

There is a vast amount of grey area with this subject matter. Generally hemiarch replacement seems to be a temporary fix. Those with a milder case of aortic dissection could have ultimately positive results with hemiarch surgery, but type A aortic dissection is not a mild disease. Though total arch replacement is an extensive, complicated and risky surgery, I think it is the best route for assuring the patient will not have to endure future procedures due to their false lumen from the dissection not being entirely thrombosed. Yes, total arch surgery has a high risk of death during or soon after operation but total arch surgery can be performed with slight variations in stenting and grafting that can make it much safer. There are many variations in options during surgeries and differences among studies on type A aortic dissection. Some of these include: surgical skill, difference in exact dissection patient to patient, patient conditions, precise location of intimal tear, diameter of arch, definitions of early mortality and other terms, how often data was obtained, technical and device differences, number of patients in study, health status and conditions of patients, anesthetic management, surgical techniques, strategies of brain protection and stent use/type of stent. I believe it ultimately comes down to the individual patient. Age, condition, severity and so much more

Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection. Eur J Cardiothorac Surg 2011;40:881-7. http://ejcts.oxfordjournals.org/content/40/4/881.long#ack-1 Uchida N, Shibamura H, Katayama A, Shimada N, Sutoh M, Ishihara H. Operative strategy for acute type A aortic dissection: ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk. Ann Thorac Surg 2009;87:773–7. http://www.annalsthoracicsurgery.org/article/S0003-4975(08)02525-3/fulltext Marco Di Eusanio, Sebastiano Castrovinci, David H. Tian, Gianluca Folesani, Mariano Cefarelli, Antonio Pantaleo, Giacomo Murana, Paolo Berretta, Tristan D. Yan, and Roberto Di Bartolomeo.
Antegrade stenting of the descending thoracic aorta during DeBakey type 1 acute aortic dissection repair. Eur J Cardiothorac Surg 2014 45: 967-975. http://ejcts.oxfordjournals.org/content/45/6/967.full Easo J, Weigang E, Holzl PP, Horst M, Hoffmann I, Blettner M, et al. Influence of operative strategy for the aortic arch in DeBakey type I aortic dissection: analysis of the German Registry for Acute Aortic Dissection type A. J Thorac Cardiovasc Surg 2012;144:617-23.