Aortic Dissections  Surgical Treatments
Type A Dissection
Type A dissection is a serious emergency, with hourly mortality rates of 3-5% from the time that symptoms begin.
Rapid diagnosis and transfer to a tertiary care center provides the best chance for survival.
At the Aortic Surgery Program, efficient transfer plans are deployed immediately.
When patients arrive, a triage mechanism ensures tailor-made treatment which includes direct transfer to the operating room, medical stabilization, and/ or cardiac catheterization followed by surgical intervention.
Our surgeons and cardiologists work as a multidisciplinary team to ensure excellent outcomes and long-term follow up.
The program's operative mortality rate is less than 5%, compared to the national average of 15-20%.
Surgical procedures for type A dissection are tailored to the unique characteristics of each patient.
Surgery is performed to remove and reconstruct the damaged portion of the aorta and restore proper blood flow within the vessel.
Depending on the location of the dissection, the patient's aortic valve may remain intact, may require repair, or may require replacement with a prosthetic valve.
The Aortic Surgery Program has special expertise in performing valve-sparing operations, which enable patients to avoid the need for anticoagulation medication.
During the first part of surgery, the surgeon determines the extent of operation.
The possibilities include:
- Replacement of the ascending aorta and hemi-arch with a tube graft
- Tube graft replacement plus repair of the aortic valve
- Aortic root replacement plus aortic valve replacement with a mechanical valve
- Aortic root replacement plus aortic valve replacement with a homograft
- Total arch replacement with "elephant trunk" approach
- Aortic root replacement plus total arch replacement
All affected portions of the aorta are removed. If the aortic valve can be repaired, every effort is made to repair it.
Often this will involve reattachment of the valve to the graft (a technique known as re-suspension).
If the valve cannot be repaired, an appropriate valve replacement (tissue or mechanical) will be selected based upon the patient's age.
See illustrated sequences of two surgical procedures:
Type B Dissection
Treatment of type B dissection is often palliative (providing relief, but not a cure).
Along with pain medications, control of high blood pressure is the primary treatment, which reduces the pressure in the vulnerable aorta.
Medical management provides relief, but does not protect patients from the development of large aneurysms, kidney dysfunction, and late mortality.
Although open surgical repair of type B dissections is not a viable option (due to high risks of paralysis, lung dysfunction, and fatal hemorrhage), a brand-new endovascular option is providing new hope to patients with type B aneurysms.
This treatment entails the placement of a fabric-covered metal stent to close the dissected aorta.
The stent is placed through a catheter in the groin, thereby avoiding the dangers associated with open surgery.
This endovascular option is available as part of two trials currently underway at the Aortic Surgery Program at Columbia University Medical Center.
"Patients have done exceptionally well so far," according to Allan Stewart, MD.
"This treatment will potentially give people better long-term survival, with a far lower incidence of complications associated with both medical management and surgery."
Columbia's Aortic Surgery Program is the largest in the tri-state area to participate in these trials.
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