Aortic dissection: incidence, natural history and impact of surgery

Journal of Clinical and Basic Cardiology 2000; 3 (3): 151-154

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Keywords: Aortendissektion,  Chirurgie,  Geschichte,  Inzidenz,  Stanford-Typ,  aortic dissection,  incidence,  natural history,  Stanford type,  surgery

Acute ascending aortic dissection is included in the differential diagnosis of patients with acute chest pain. Recent literature discussing incidence and natural history of aortic dissection are reviewed. With respect to diseases of the aorta, dissection is considered as the most common disaster and is two to three times as frequent as a rupture of the infrarenal aorta. The most recent series of patients with untreated aortic dissection involving proximal and distal aorta revealed a rate of 50 % of patients dying within 48 hours, 84 % at one month and 90 % at three months. History of surgical interventions, current surgical techniques and impact of surgery are discussed. Today, the two well-known surgical procedures for complete replacement of ascending aorta are the Bentall and the button technique. The third most commonly used technique, is the Cabrol method. The use of biological glue has greatly aided the performance of blood-tight-anastomosis on the aorta, particularly with acute dissection. Stanford type A dissection is a surgical emergency that requires urgent and expeditious diagnosis and immediate surgical intervention. Mural haematoma, which has a similar natural history, also requires prompt surgical treatment. In contrast, Stanford type B dissection should be treated medically (nonsurgical), with surgery considered only when complications develop or conservative therapy fails. J Clin Basic Cardiol 2000; 3: 151-154.