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Original Articles: Adult Cardiac

Invited Commentary

Department of Cardiothoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Leistelle 20 West, Gruner Bettenturm, Vienna, A-1090 Austria

(Email: michael.grimm{at}meduniwien.ac.at; martin.czerny{at}meduniwien.ac.at).

The authors [1] assessed the clinical outcome of surgical management of complicated acute type B aortic dissections. This is a valuable report, especially because endovascular therapy ostensibly has emerged as the therapy of first choice for this particular acute aortic syndrome.

One of the major messages that this report adds to our understanding is that conventional therapy of complicated acute type B dissections is an indispensable part of the surgeon's armentarium for managing this complex entity. As shown in this report, the logistics of the operation have been standardized, and because deep hypothermic circulatory arrest is no longer a prerequisite, the major concerns of conventional therapy have been attenuated.

Furthermore, when critically evaluating the literature, the difference between the results of endovascular therapy of complicated type B dissections and the results of conventional therapy are not as large as one might think. Nevertheless, we realize that the results of this study are obtained by an expert group with substantial knowledge in this field and that real-world results are most likely inferior.

The report outlines the often disregarded issue of peripheral malperfusion. This issue is often mentioned as visceral or renal ischemia, but as shown, the primary and secondary incidence of peripheral malperfusion requires attention. Because peripheral ischemia may also involve an extremity and be life-limiting, it is also important to take this eventuality into consideration.

Summarizing, we do not believe that this report calls the concept of endovascular management of complicated type B dissections into question, but that it alerts the physician to choose the best individual treatment option for a complex and dynamic acute aortic syndrome.

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1. Shimokawa T, Horiuchi K, Ozawa N, et al. Outcome of surgical treatment in patients with acute type B aortic dissection Ann Thorac Surg 2008;86:103-108.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Michael Grimm Martin Czerny Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Grimm, M. Articles by Czerny, M. Search for Related Content PubMed PubMed Citation Articles by Grimm, M. Articles by Czerny, M. Related Collections Great vessels Related Article