Operation

In case of an acute type A dissection, immediate emergency surgery must be performed to prevent a fatal rupture. The patient must be transported to a specialized center for this purpose, as it is a major procedure. The standard procedure during surgery is to replace the ascending aorta with a gore-tex vascular prosthesis.

If the dissection affects the aorta in close proximity to the aortic valve, a vascular prosthesis with integrated aortic valve replacement is usually used. In rare cases, the patient’s own aortic valve can be preserved and reconstructed. Depending on the patient’s condition and previous illnesses, the mortality rate within the first 30 days after surgery is between 15 and 30%.

With type B dissection, the indication for surgery is only given in certain cases (see therapy). Depending on the length/extension of the dissection, in which vital arterial branches may be blocked, the mortality rate of the operation is between 25 and 60%. In contrast, mortality for chronic type B dissection surgery is less than 10%.

In principle, type A surgery is always indicated. Without an operation, the clinical picture can lead to death within a few days. In type B aortic dissection, surgery is only indicated in case of complications.

These consist of pre-existing bleeding or displacement of vital arteries due to the pressure of the split vessel. Surgery for aortic dissection is a very serious procedure that can cause many complications. Since during the operation, some important vascular branches have to be replaced by vascular prostheses, the mortality rate during the first 30 days is very high.

This is an averaging of the statistics to make different procedures comparable. Complications include bleeding, which can constrict important adjacent structures through pressure. Basically it must be said that the clinical picture of an aortic dissection can be particularly serious and life-threatening, so that a patient can often only benefit from the operation in comparison.

Depending on the location and extent of the aortic dissection, different procedures are necessary. From a stent insertion (a vascular support) to a complete replacement of the vessel section, the different procedures can take different lengths of time. In some cases, a connection to the heart–lung machine is necessary, which requires careful preparation and follow-up.

Thus the duration of the operation can be several hours. Depending on the surgical procedure, either a stent is inserted via a large blood vessel on the thigh, where wires (catheters) are inserted into the blood vessel to the decisive point, or in the case of a so-called open procedure to open the chest, with careful preparation of the important structures. In this open procedure, the heart–lung machine is then also necessary, which removes the affected area of the vessel from the bloodstream, leaving the surgeon free to work on and replace the vessel section.