Contemporary repair of type a aortic dissection

INTRODUCTION Type A dissection is a surgical emergency with an extremely high mortality rate without intervention. Despite over four decades of surgical treatment mortality and morbidity remain high. traditionally, type a dissections have been approached through an open surgical operation, and the extent ranges from a basic ascending aortic replacement, to valvular suspension, aortic root replacement, supra-aortic trunk debranching, or total arch replacement. With the improvement in endovascular devices, the rates of stent graft repair have increased dramatically, albeit with off label devices. EVIDENCE ACQUISITION A PubMed search of literature published in English language between 1965 and 2017 to survey past and present-day type a aortic dissection management. In addition we review our institutions experience with type a dissection management. EVIDENCE SYNTHESIS This review is a focus on the evolution of surgical therapy and early outcomes for endovascular treatment. Disadvantages and advantages to both approaches are reviewed here. CONCLUSIONS Improvements in surgical technique and peri-operative management has led to a decrease in mortality and morbidity although results remain sub-optimal. New approaches and techniques including endovascular stent graft repair are under development with promising early results.