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. 2022 Nov 8;35(6):ivac264.
doi: 10.1093/icvts/ivac264.

Retrograde type A aortic dissection: a different evil

Ana Lopez-Marco  1 , Benjamin Adams  1 , Aung Ye Oo  1
Affiliations

Retrograde type A aortic dissection: a different evil

Ana Lopez-Marco et al. Interact Cardiovasc Thorac Surg. .

Abstract

Retrograde type A aortic dissection (RTAAD) can be spontaneous or secondary to the instrumentation of the descending and thoraco-abdominal aorta. It has anatomical differences compared to antegrade type A aortic dissection that impact the management and prognosis. Treatment is not standardized. We report our approach to spontaneous RTAAD in our institution between 2018 and 2022 (n = 15). The mean age was 60.1 years and 93% were male. Aortic valve, coronary arteries and supra-aortic trunks were spared by the dissection in 80% of the cases; distal extension to iliacs was common and lower limb malperfusion was present in 4 cases (27%). The ascending aorta was dilated at presentation in 60% of the cases. Emergency surgery with arch/FET replacement was offered to 11 patients (73%); 3 patients (20%) received a limited proximal aortic repair; 1 patient was treated conservatively. Overall mortality was 47% (100% for limited proximal repair and 22% for those who received arch/FET). We advocate for aggressive treatment of RTAAD excluding the primary entry tear to prevent immediate- and mid-term complications.

Keywords: Aortic dissection; Complications in aortic surgery; Frozen elephant trunk; Retrograde aortic dissection.

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Figures

Figure 1:
Figure 1:
Coronal view of a contrast-enhanced CT in arterial phase demonstrating a retrograde type A aortic dissection with completely thrombosed proximal false lumen in the ascending aorta.
Figure 2:
Figure 2:
Axial view of a contrast-enhanced CT in arterial phase demonstrating a retrograde type A aortic dissection with patent proximal false lumen in the ascending aorta.
Figure 3:
Figure 3:
Intraoperative view of the single-use flexible bronchoscope used to inspect the arch and descending thoracic aorta during circulatory arrest. Note how the tip of the bronchoscope gently flips the dissection flap at the entry tear level.
See this image and copyright information in PMC

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