J.Jpn. Surg. Soc.. 97(10): 906-915, 1996

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Feature topic

EVOLUTION AND RECENT TRENDS IN PATIENT SELECTION AND RECONSTRUCTION METHOD FOR CHRONIC AORTIC DISSECTION

Evolution and recent trends in patient selection and reconstruction method for chronic aortic dissection are reported. Although patient selection and reconstruction method for chronic type A aortic dissection are essentially identical with those for acute type A aortic dissection, chronic dissection frequently necessitates extended reconstruction of the aortic arch. Aortic valve-sparing operation is increasingly applied for associated aortic regurgitation. In chronic type B aortic dissection, operation is indicated when the diameter exceeds 5cm, if it is symptomatic (i.e. those accompanied with pain or malperfusion of the vital organ), or when it is enlarging rapidly. Operative treatment includes resection of the intimal tear and replacement of the dilated segment. With the advance in diagnosis, methods of organ protection and operative tehcniques, operative results for chronic aortic dissection had been improving, despite the fact that these complex lesion frequently requires extensive aortic reconstruction with reimplantation of the major aortic branches. Spinal cord protection in extensive thoracoabdominal reconstruction for type B aortic dissection remains an unsolved problem.

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