The Cedars-Sinai Specialist Aortic Service and Acute Aortic Dissection

The Cedars-Sinai Specialist Aortic Service and Acute Aortic Dissection

The emergency procedure to repair a Type A aortic dissection is very complex and challenging. It involves systemic cooling of the patient to reduce their metabolic rate, and periods of interruption of the circulation to most of the body’s organs. In a condition, by its very nature, it disrupts the circulation to these organs. Detailed

The emergency procedure to repair a Type A aortic dissection is very complex and challenging. It involves systemic cooling of the patient to reduce their metabolic rate, and periods of interruption of the circulation to most of the body’s organs. In a condition, by its very nature, it disrupts the circulation to these organs. Detailed attention to the conduct of cardiopulmonary bypass is critical to avoid malperfusion syndromes. An experienced team is vital to this lifesaving procedure, allowing for successful repair of the aorta while avoiding the dreaded complications of stroke, myocardial infarction or spinal cord ischemia. In surgery for Type A aortic dissection it does not suffice to be prepared for Plan A. The team must know when to switch to Plan B, and be able to deliver that competently, as well as potentially Plans C or D.

The immediate goal of surgery is, of course, to save the patient’s life, but the Smidt Heart Institute service has the capacity to look beyond the immediate situation. Improved early and long-term outcomes are proven with continued selective cerebral perfusion, aortic valve-sparing root replacement, and extension of the aortic repair distally into the arch with a frozen elephant trunk or other endovascular stent.

Preservation of the native aortic valve, as well as more directed surgical obliteration of the distal false lumen, are particularly important issues for young patients. All these possibilities require a specialized aorto-vascular surgeon. Monitoring of cerebral blood flow by infrared spectroscopy and continuous analysis of spinal cord function with motor-evoked potentials are important in having a zero-tolerance for neurological injury, and require anesthesia and neurophysiologists experienced in these techniques.

Source: https://www.cedars-sinai.org/blog/aortic-service-and-acute-aortic-dissection.html

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