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Management of Thoracic Aortic Dissection

To identify the key insights or developments described in this article
1 Credit CME

ATAAD and TBAD (involving the ascending and descending aorta, respectively) are associated with high morbidity and mortality. Patients often present emergently in critical condition. Health care clinicians across different specialties encounter aortic dissection, and initial management is important to patient survival and long-term outcome.1,2 This article summarizes 2 guidelines on initial management and stabilization of patients presenting with ATAAD or TBAD.

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Article Information

Corresponding Author: Prashanth Vallabhajosyula, MD, MS, Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar St, New Haven, CT 06510 (prashanth.vallabhajosyula@yale.edu).

Published Online: February 16, 2023. doi:10.1001/jama.2023.0265

Conflict of Interest Disclosures: Dr Vallabhajosyula reported advisory board membership with Terumo Corp. No other disclosures were reported.

References
1.
Malaisrie  SC , Szeto  WY , Halas  M ,  et al; AATS Clinical Practice Standards Committee: Adult Cardiac Surgery.  2021 the American Association for Thoracic Surgery expert consensus document: surgical treatment of acute type A aortic dissection.   J Thorac Cardiovasc Surg. 2021;162(3):735-758. doi:10.1016/j.jtcvs.2021.04.053PubMedGoogle ScholarCrossref
2.
MacGillivray  TE , Gleason  TG , Patel  HJ ,  et al.  The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection.   Ann Thorac Surg. 2022;113(4):1073-1092. doi:10.1016/j.athoracsur.2021.11.002PubMedGoogle ScholarCrossref
3.
Suzuki  T , Isselbacher  EM , Nienaber  CA ,  et al; IRAD Investigators.  Type-selective benefits of medications in treatment of acute aortic dissection (from the International Registry of Acute Aortic Dissection [IRAD]).   Am J Cardiol. 2012;109(1):122-127. doi:10.1016/j.amjcard.2011.08.012PubMedGoogle ScholarCrossref
4.
Pape  LA , Awais  M , Woznicki  EM ,  et al.  Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection.   J Am Coll Cardiol. 2015;66(4):350-358. doi:10.1016/j.jacc.2015.05.029PubMedGoogle ScholarCrossref
5.
Harris  KM , Nienaber  CA , Peterson  MD ,  et al.  Early mortality in type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection.   JAMA Cardiol. 2022;7(10):1009-1015. doi:10.1001/jamacardio.2022.2718PubMedGoogle ScholarCrossref
6.
Goldstone  AB , Chiu  P , Baiocchi  M ,  et al.  Interfacility transfer of Medicare beneficiaries With acute type A aortic dissection and regionalization of care in the United States.   Circulation. 2019;140(15):1239-1250. doi:10.1161/CIRCULATIONAHA.118.038867PubMedGoogle ScholarCrossref
7.
Weiss  G , Wolner  I , Folkmann  S ,  et al.  The location of the primary entry tear in acute type B aortic dissection affects early outcome.   Eur J Cardiothorac Surg. 2012;42(3):571-576. doi:10.1093/ejcts/ezs056PubMedGoogle ScholarCrossref
8.
Codner  JA , Lou  X , Duwayri  YM ,  et al.  The distance of the primary intimal tear from the left subclavian artery predicts aortic growth in uncomplicated type B aortic dissection.   J Vasc Surg. 2019;69(3):692-700. doi:10.1016/j.jvs.2018.05.245PubMedGoogle ScholarCrossref
9.
Liu  D , Luo  H , Lin  S , Zhao  L , Qiao  C .  Comparison of the efficacy and safety of thoracic endovascular aortic repair with open surgical repair and optimal medical therapy for acute type B aortic dissection: a systematic review and meta-analysis.   Int J Surg. 2020;83:53-61. doi:10.1016/j.ijsu.2020.08.051PubMedGoogle ScholarCrossref
10.
Nienaber  CA , Rousseau  H , Eggebrecht  H ,  et al; INSTEAD Trial.  Randomized comparison of strategies for type B aortic dissection: the Investigation of Stent Grafts in Aortic Dissection (INSTEAD) trial.   Circulation. 2009;120(25):2519-2528. doi:10.1161/CIRCULATIONAHA.109.886408PubMedGoogle ScholarCrossref
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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
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