A Perfect Storm: Type A Aortic Dissection and Prior Cardiac Surgery
Acute Type A Aortic Dissection (AAD) is a lethal disease. The overall mortality rate - even when diagnosed and treated in a timely fashion with emergent surgical intervention - exceeds 20%1. This fact alone serves as a constant reminder that this disease represents a formidable challenge to all cardiovascular professionals who encounter AAD. Cardiovascular surgeons maintain great respect for operations to deal with AAD as achieving a successful outcome is based upon executing a perfect technical operation and solving a myriad of management decisions during the procedure.
In this issue of Circulation, Stanger and colleagues2 report upon the infrequent, but extraordinarily complex situation of AAD occurring after non- aortic surgery. The incidence of AAD during or following AAD in the present report is 0.15%, which is consistent with other reports, although the true incidence of this entity is difficult to determine. While this incidence is low - the development of AAD following nor-aortic surgery is analogous to an airliner crash in today's era - infrequent, but catastrophic. Indeed, deserving of emphasis, AAD following non-aortic surgery instantly converts a low risk elective operation into a high risk "salvage" situation. Thus, the entity of AAD after non-aortic surgery is a highly complex and dangerous situation which demands skillful judgments to successfully navigate a good outcome. Two recent single center experiences with AAD illustrate that even experienced aortic surgical centers find this operation challenging3,4.
- Received September 3, 2013.
- Accepted September 4, 2013.