Search Continues for Optimal Approach for Type A Aortic Dissections

The continuing evolution and improvement of procedures to repair type A aortic dissections is leaving cardiothoracic surgeons with more questions than firm answers as they plan what is typically an emergency repair. 

EACTS @ STS: Which Arch Operation Should I Do?

Decision-Making During Type A Dissection Repair

Monday

7:15 a.m. – 9:15 a.m.

Room 33

“We now have several different reconstructive options for type A dissections, and we’re trying to figure out the optimal choice on both sides of the Atlantic,” said STS Past President Joseph E. Bavaria, MD, of the Hospital of the University of Pennsylvania in Philadelphia. “European surgeons have had access to some devices we don’t have in the United States because of differences in approval processes, but the decision-making process is the same for all of us.”

Joseph E. Bavaria, MD

Joseph E. Bavaria, MD

A session organized by STS and the European Association for Cardio-Thoracic Surgery will help cardiothoracic surgeons learn the best approaches to repairing type A dissections regardless of where they practice. The session will be moderated by Dr. Bavaria and EACTS President Ruggero De Paulis, MD, of the European Hospital in Rome.

Presenters from the United States and Europe will address four key questions:

  • Where does the now-classic hemiarch procedure fit into current treatment algorithms?
  • Does the total arch procedure have a place in today’s surgical armamentarium?
  • Under what circumstances should a total arch with frozen elephant trunk be used?
  • Is it appropriate to change the index procedure at the aortic arch based on the development of branched arch thoracic endovascular aortic repair (TEVAR) grafts?

“Advancing technology has brought us to an inflection point,” Dr. Bavaria said. “We have a standard approach, and we have the real possibility that the standard isn’t good enough any longer given today’s devices and procedures. We will go through each approach, analyze where it can best be utilized, and determine whether it can be utilized in all patients or if it is more appropriate for a specific subpopulation.”

The most important question in the long term is the application of evolving TEVAR technology. Both single-branch and two-branched arch grafts currently are available in clinical trial, and newer generations of grafts are under development. Surgeons are seeing the potential for not just improving survival from type A dissection repairs, but providing definitive treatment. Whether TEVAR becomes the new index approach today or at some future point, every cardiothoracic surgeon should be aware of its potential.

“A lot of changes have happened in the last few years, and more are coming in the near future,” Dr. Bavaria said. “If treatment of type A dissections is part of your practice, this session will allow you to provide your patients with optimal care.” 

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