Author: Sun Xiaogang

Affiliation: Fuwai Hospital, Chinese Academy of Medical Sciences

Overview of Surgical Strategies for Aortic Root

Sun Xiaogang discusses various surgical approaches for treating the aortic root in Type A aortic dissections, including:

• Bentall Procedure: Traditional method for aortic root replacement.

• David Procedure (Valve-Sparing Root Replacement): Suitable for younger patients without significant aortic valve disease, preferred by experienced surgeons despite its complexity and higher risk.

Preoperative Neurological Complications

The presentation addresses the challenges posed by carotid dissections leading to inadequate cerebral perfusion in patients with Type A dissection, emphasizing the high surgical risk for patients with preoperative neurological complications.

Management of Visceral Organ Malperfusion Syndrome

For treating Type A dissection combined with visceral organ malperfusion syndrome, Sun recommends the “Michigan Strategy,” which involves interventional procedures like fenestration or stenting to relieve intravascular pressure and improve perfusion prior to definitive aortic surgery.

Choices in Intraoperative Arterial Cannulation

Different arterial cannulation strategies used during surgery include:

• Femoral Artery Cannulation: Commonly used but with specific challenges.

• Axillary Artery Cannulation: Preferred by Sun for Type A dissection surgeries, especially suitable for patients with abdominal or limb malperfusion syndrome.

Conclusion and Future Directions

Despite the variety of treatment options, Sun emphasizes that the key to managing Type A aortic dissection is personalized treatment. The choice of surgical strategy should be tailored to the patient’s specific conditions and the hospital’s resources. Future advancements are expected to offer safer and more effective treatment options through further clinical research and technological developments.

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