Aortic Dissection: Surgical Treatment Options

Introduction This case presents a 64-year-old man with extensive Stanford type A aortic dissection, treated with hybrid surgery and subsequent aortic branch stenting. His postoperative complications raised the question of whether hybrid or conventional surgery was more appropriate. Case Presentation The patient arrived at the emergency department, where a CT scan revealed extensive aortic dissection from the sinotubular junction to the aortic bifurcation, as well as dissection of the left subclavian and renal arteries. The patient then underwent 8 hours of hybrid aortic repair surgery. This was done under selective perfusion cardiopulmonary bypass in deep hypothermia. A linear graft was used for the ascending aorta and a Hybrid Thoraflex 30mm graft for the aortic arch with stenting of the descending aorta. After 5 days, the patient underwent stenting of the left subclavian and renal arteries, and abdominal aorta. In the intensive care unit (ICU), he developed acute kidney failure, respiratory failure, pneumonia, sepsis with septic shock and anemia. After treatment in the ICU the patient’s health improved with stable hemodynamics. Discussion Stanford A aortic dissection has a significant mortality rate, ranging from 17% to 22% [1]. Treatment options include conventional or hybrid aortic arch repair. The patient's extensive aortic dissection required either a two-stage open surgery or a hybrid operation, with the latter preferred in such cases [2] and ultimately chosen. However, metaanalysis suggests that conventional surgery may offer better survival rates [3], raising the question of whether it would have resulted in a better clinical outcome. Another study has found that hybrid surgery is linked to fewer perioperative complications [4]. Given the patient's severe postoperative complications, conventional surgery may not have been more beneficial. Conclusions This patient presented with a severe Stanford A aortic dissection, necessitating urgent two-stage intervention. Despite a successful hybrid surgery, the patient’s postoperative course was marked by complications that required treatment. Given the outcome of the case, the hybrid surgical approach was likely the best option.