Original title: Endovascular Repair of Ascending Aortic Dissection. A Novel Treatment Option for Patients Judged Unfit for Direct Surgical Repair. Reference: Qingsheng Lu, et al. J Am Coll Cardiol 2013;61:1917–24.

The dissecting aneurysm Type A represents 60% or aortic dissections and a real challenge as regards both therapeutics and the adequate moment to perform it, due to the serious complications this pathology entails. This analysis included 41 patients admitted between 2009 and 2011 with aortic dissection type A; all of them received endovascular treatment due to high surgical risk. Exclusion criteria included:

No patient presented death or any other complication at hospital level, except for two that presented arrhythmias. Hospital stay was 3.3±1 days. Follow up was 26 months (16-35); intervention was repeated in one case only; no patient presented severe aortic insufficiency or death. Complete thrombosis of ascending aorta false lumen was noted in all 15 patients and descending aorta false lumen thrombosis was seen in 10 patients. There were no changes in ejection fraction or in left ventricle end-diastolic diameter; a significant reduction of proximal and distal aorta diameter was observed, and a significant increase in true lumen.

Conclusion: 

The endovascular treatment of the Ascending Aorta Type A was the appropriate option for patients considered poor candidates for conventional surgery.

Commentary: 

Being able to solve this pathology by endoprosthesis implantation, with good outcomes, encourages us to use this strategy in patients that are no candidates for surgery. An analysis made by Dr. Sobocinski in the year 2011 had concluded that half of patients could be treated with this technique, which invites us to investigate further and motivates us to develop new, more efficient devices, to cover a larger number of patients. 

Courtesy of Dr. Carlos Fava
Interventional cardiologist.
Favaloro Foundation Argentina.

Dr. Carlos Fava.