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2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection

      The management of ATAAD continues to evolve but emergency cardiac surgery remains the standard of care.

      Key Words

      Abbreviations and Acronyms:

      AATS (The American Association for Thoracic Surgery), ACP (anterograde cerebral perfusion), AD (aortic dissection), AR (aortic regurgitation), ATAAD (acute type A aortic dissection), CAC (comprehensive aortic center), CPB (cardiopulmonary bypass), CT (computed tomography), ECD (expert consensus document), FET (frozen elephant trunk), HTAD (hereditary thoracic aortic disorder), IMH (intramural hematoma), IRAD (International Registry for Aortic Dissection), MRI (magnetic resonance imaging), RCP (retrograde cerebral perfusion), SCI (spinal cord injury), STS (Society of Thoracic Surgeons), TEVAR (thoracic endovascular aortic repair), TTE (transthoracic echocardiography), VSARR (valve-sparing aortic root replacement)
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      Methodology

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      Section 1: Initial Medical Therapy

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      Section 2: Interhospital Transfer

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      Section 3: Surgical Triage

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        Eur J Cardiothorac Surg. 2013; 44 (discussion 359): 353-359
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        • Matsuda H.
        • Matsuo J.
        • Hori Y.
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        Thoracic endovascular repair for retrograde acute type A aortic dissection as an alternative choice.
        Gen Thorac Cardiovasc Surg. 2020;
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        Thoracic endovascular aortic repair for retrograde type A aortic dissection with an entry tear in the descending aorta.
        J Vasc Interv Radiol. 2012; 23 (460 e451): 453-460
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        Surgery for type A aortic dissection in patients with cerebral malperfusion: Results from the International Registry of Acute Aortic Dissection.
        J Thorac Cardiovasc Surg. 2019;
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        Stroke and outcomes in patients with acute type A aortic dissection.
        Circulation. 2013; 128: S175-S179
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        Management of common carotid artery dissection due to extension from acute type A (DeBakey I) aortic dissection.
        J Vasc Surg. 2013; 58: 910-916
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        • Olsson C.
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        Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD).
        Eur J Cardiothorac Surg. 2020; 58: 1027-1034
        • Kreibich M.
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        Impact of Carotid Artery Involvement in Type A Aortic Dissection.
        Circulation. 2019; 139: 1977-1978
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        • Rabinstein A.A.
        • Ackerson T.
        • Adeoye O.M.
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        • et al.
        2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
        Stroke. 2018; 49: e46-e110
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        Endovascular therapy for ischemic stroke with perfusion-imaging selection.
        N Engl J Med. 2015; 372: 1009-1018
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        Randomized assessment of rapid endovascular treatment of ischemic stroke.
        N Engl J Med. 2015; 372: 1019-1030
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        Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct.
        N Engl J Med. 2018; 378: 11-21
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        Neurological outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma.
        Circulation. 2011; 124: S163-167
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        Is surgery always mandatory for type A aortic dissection?.
        Ann Thorac Surg. 2006; 82 (discussion 1664): 1658-1663
        • Luciani G.B.
        Repair of acute type A aortic dissection in comatose patients.
        Eur J Cardiothorac Surg. 2015; 48: 951-952
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        • Norton E.L.
        • Chaudhary N.
        • Burris N.
        • Shiomi S.
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        Type A Aortic Dissection with Cerebral Malperfusion: New Insights.
        Ann Thorac Surg. 2020;
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        Treatment strategies for malperfusion syndrome secondary to acute aortic dissection.
        J Card Surg. 2020;
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        • Aranda-Michel E.
        • Bianco V.
        • Kilic A.
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        Outcomes of carotid artery replacement with total arch reconstruction for type A aortic dissection.
        Ann Thorac Surg. 2020;
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        • Dong Z.H.
        • Fu W.G.
        • Guo D.Q.
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        Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair.
        J Vasc Surg. 2018; 67: 1026-1033 e1022
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        • Briggs C.S.
        • Stanley G.A.
        • Ballast J.K.
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        Retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection.
        J Vasc Surg. 2019; 69: 24-33
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        • Lu Q.
        Retrograde type A aortic dissection complicating endovascular therapy of type B aortic dissection and descending thoracic aneurysm disease.
        Curr Opin Cardiol. 2018; 33: 581-586
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        • Habertheuer A.
        • Bavaria J.E.
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        Recurrent aortic insufficiency after emergency surgery for acute type A aortic dissection with aortic root preservation.
        The Journal of Thoracic and Cardiovascular Surgery. 2021; 161: 1989-2000
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        • Ziza V.
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        Factors favoring retrograde aortic dissection after endovascular aortic arch repair.
        J Thorac Cardiovasc Surg. 2015; 150: 136-142
        • Khoynezhad A.
        • White R.A.
        Pathogenesis and management of retrograde type A aortic dissection after thoracic endovascular aortic repair.
        Ann Vasc Surg. 2013; 27: 1201-1206
        • Estrera A.L.
        • Miller C.C.
        • Kaneko T.
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        Outcomes of acute type a aortic dissection after previous cardiac surgery.
        Ann Thorac Surg. 2010; 89: 1467-1474
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        • Desai N.D.
        • Bavaria J.E.
        • Moser W.
        • Vallabhajosyula P.
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        • et al.
        Type A aortic dissection after previous cardiac surgery: results of an integrated surgical approach.
        Ann Thorac Surg. 2014; 97 (discussion 1588-1589): 1582-1588
        • Gillinov A.M.
        • Lytle B.W.
        • Kaplon R.J.
        • Casselman F.P.
        • Blackstone E.H.
        • Cosgrove D.M.
        Dissection of the ascending aorta after previous cardiac surgery: differences in presentation and management.
        J Thorac Cardiovasc Surg. 1999; 117: 252-260

      Section 4: Cannulation and Perfusion Strategy

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        • Idrees J.J.
        • Roselli E.E.
        • Germano E.
        • Pasadyn S.R.
        • Lowry A.M.
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        Cannulation strategies in acute type A dissection repair: A systematic axillary artery approach.
        J Thorac Cardiovasc Surg. 2019; 158: 647-659 e645
        • Ghoreishi M.
        • Sundt T.M.
        • Cameron D.E.
        • Holmes S.D.
        • Roselli E.E.
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        Factors associated with acute stroke after type A aortic dissection repair: An analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database.
        J Thorac Cardiovasc Surg. 2020; 159: 2143-2154 e2143
        • Benedetto U.
        • Mohamed H.
        • Vitulli P.
        • Petrou M.
        Axillary versus femoral arterial cannulation in type A acute aortic dissection: evidence from a meta-analysis of comparative studies and adjusted risk estimates.
        Eur J Cardiothorac Surg. 2015; 48: 953-959
        • Moizumi Y.
        • Motoyoshi N.
        • Sakuma K.
        • Yoshida S.
        Axillary artery cannulation improves operative results for acute type a aortic dissection.
        Ann Thorac Surg. 2005; 80: 77-83
        • Preventza O.
        • Garcia A.
        • Tuluca A.
        • Henry M.
        • Cooley D.A.
        • Simpson K.
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        Innominate artery cannulation for proximal aortic surgery: outcomes and neurological events in 263 patients.
        Eur J Cardiothorac Surg. 2015; 48 (discussion 942): 937-942
        • Helder M.R.K.
        • Schaff H.V.
        • Day C.N.
        • Pochettino A.
        • Bagameri G.
        • Greason K.L.
        • et al.
        Regional and Temporal Trends in the Outcomes of Repairs for Acute Type A Aortic Dissections.
        Ann Thorac Surg. 2020; 109: 26-33
        • Jormalainen M.
        • Raivio P.
        • Mustonen C.
        • Honkanen H.P.
        • Vento A.
        • Biancari F.
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        Direct Aortic Versus Peripheral Arterial Cannulation in Surgery for Type A Aortic Dissection.
        Ann Thorac Surg. 2020; 110: 1251-1258
        • Kreibich M.
        • Chen Z.
        • Rylski B.
        • Bavaria J.E.
        • Brown C.R.
        • Branchetti E.
        • et al.
        Outcome after aortic, axillary, or femoral cannulation for acute type A aortic dissection.
        J Thorac Cardiovasc Surg. 2019; 158: 27-34 e29
        • Reece T.B.
        • Tribble C.G.
        • Smith R.L.
        • Singh R.R.
        • Stiles B.M.
        • Peeler B.B.
        • et al.
        Central cannulation is safe in acute aortic dissection repair.
        J Thorac Cardiovasc Surg. 2007; 133: 428-434
        • Mazzeffi M.
        • Ghoreishi M.
        • Alejo D.
        • Fonner C.E.
        • Tanaka K.
        • Abernathy 3rd, J.H.
        • et al.
        Clinical Practice Variation and Outcomes for Stanford Type A Aortic Dissection Repair Surgery in Maryland: Report from a Statewide Quality Initiative.
        Aorta (Stamford). 2020; 8: 66-73
        • O'Hara D.
        • McLarty A.
        • Sun E.
        • Itagaki S.
        • Tannous H.
        • Chu D.
        • et al.
        Type-A Aortic Dissection and Cerebral Perfusion: The Society of Thoracic Surgeons Database Analysis.
        Ann Thorac Surg. 2020; 110: 1461-1467
        • Sugiura T.
        • Imoto K.
        • Uchida K.
        • Minami T.
        • Yasuda S.
        Comparative study of brain protection in ascending aorta replacement for acute type A aortic dissection: retrograde cerebral perfusion versus selective antegrade cerebral perfusion.
        Gen Thorac Cardiovasc Surg. 2012; 60: 645-648
        • Stamou S.C.
        • Rausch L.A.
        • Kouchoukos N.T.
        • Lobdell K.W.
        • Khabbaz K.
        • Murphy E.
        • et al.
        Comparison between antegrade and retrograde cerebral perfusion or profound hypothermia as brain protection strategies during repair of type A aortic dissection.
        Ann Cardiothorac Surg. 2016; 5: 328-335
        • Comas G.M.
        • Leshnower B.G.
        • Halkos M.E.
        • Thourani V.H.
        • Puskas J.D.
        • Guyton R.A.
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        Acute type a dissection: impact of antegrade cerebral perfusion under moderate hypothermia.
        Ann Thorac Surg. 2013; 96: 2135-2141
        • Keeling W.B.
        • Leshnower B.G.
        • Hunting J.C.
        • Binongo J.
        • Chen E.P.
        Hypothermia and Selective Antegrade Cerebral Perfusion Is Safe for Arch Repair in Type A Dissection.
        Ann Thorac Surg. 2017; 104: 767-772
        • Leshnower B.G.
        • Thourani V.H.
        • Halkos M.E.
        • Sarin E.L.
        • Keeling W.B.
        • Lamias M.J.
        • et al.
        Moderate Versus Deep Hypothermia With Unilateral Selective Antegrade Cerebral Perfusion for Acute Type A Dissection.
        Ann Thorac Surg. 2015; 100 (discussion 1568-1569): 1563-1568
        • Stamou S.C.
        • McHugh M.A.
        • Conway B.D.
        • Nores M.
        Role of Moderate Hypothermia and Antegrade Cerebral Perfusion during Repair of Type A Aortic Dissection.
        Int J Angiol. 2018; 27: 190-195
        • De Paulis R.
        • Czerny M.
        • Weltert L.
        • Bavaria J.
        • Borger M.A.
        • Carrel T.P.
        • et al.
        Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe.
        Eur J Cardiothorac Surg. 2015; 47: 917-923
        • Lee T.C.
        • Kon Z.
        • Cheema F.H.
        • Grau-Sepulveda M.V.
        • Englum B.
        • Kim S.
        • et al.
        Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database.
        J Card Surg. 2018; 33: 7-18
        • Sabik J.F.
        • Lytle B.W.
        • McCarthy P.M.
        • Cosgrove D.M.
        Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease.
        J Thorac Cardiovasc Surg. 1995; 109 (discussion 890-881): 885-890
        • Shimura S.
        • Odagiri S.
        • Furuya H.
        • Okada K.
        • Ozawa K.
        • Nagase H.
        • et al.
        Echocardiography-guided aortic cannulation by the Seldinger technique for type A dissection with cerebral malperfusion.
        J Thorac Cardiovasc Surg. 2020; 159: 784-793
        • Englum B.R.
        • He X.
        • Gulack B.C.
        • Ganapathi A.M.
        • Mathew J.P.
        • Brennan J.M.
        • et al.
        Hypothermia and cerebral protection strategies in aortic arch surgery: a comparative effectiveness analysis from the STS Adult Cardiac Surgery Database.
        Eur J Cardiothorac Surg. 2017; 52: 492-498
        • Hu Z.
        • Wang Z.
        • Ren Z.
        • Wu H.
        • Zhang M.
        • Zhang H.
        • et al.
        Similar cerebral protective effectiveness of antegrade and retrograde cerebral perfusion combined with deep hypothermia circulatory arrest in aortic arch surgery: a meta-analysis and systematic review of 5060 patients.
        J Thorac Cardiovasc Surg. 2014; 148: 544-560
        • Svensson L.G.
        • Blackstone E.H.
        • Apperson-Hansen C.
        • Ruggieri P.M.
        • Ainkaran P.
        • Naugle R.I.
        • et al.
        Implications from neurologic assessment of brain protection for total arch replacement from a randomized trial.
        J Thorac Cardiovasc Surg. 2015; 150: 1140-1147 e1111
        • Preventza O.
        • Coselli J.S.
        Differential aspects of ascending thoracic aortic dissection and its treatment: the North American experience.
        Ann Cardiothorac Surg. 2016; 5: 352-359
        • Dong S.B.
        • Xiong J.X.
        • Zhang K.
        • Zheng J.
        • Xu S.D.
        • Liu Y.M.
        • et al.
        Different hypothermic and cerebral perfusion strategies in extended arch replacement for acute type a aortic dissection: a retrospective comparative study.
        J Cardiothorac Surg. 2020; 15: 236
        • Liu Y.
        • Shi Y.
        • Guo H.
        • Yu C.
        • Qian X.
        • Wang W.
        • et al.
        Aortic balloon occlusion technique versus moderate hypothermic circulatory arrest with antegrade cerebral perfusion in total arch replacement and frozen elephant trunk for acute type A aortic dissection.
        J Thorac Cardiovasc Surg. 2019;
        • Yang B.
        • Norton E.L.
        • Shih T.
        • Farhat L.
        • Wu X.
        • Hornsby W.E.
        • et al.
        Late outcomes of strategic arch resection in acute type A aortic dissection.
        J Thorac Cardiovasc Surg. 2019; 157: 1313-1321 e1312
        • Zierer A.
        • El-Sayed Ahmad A.
        • Papadopoulos N.
        • Moritz A.
        • Diegeler A.
        • Urbanski P.P.
        Selective antegrade cerebral perfusion and mild (28 degrees C-30 degrees C) systemic hypothermic circulatory arrest for aortic arch replacement: results from 1002 patients.
        J Thorac Cardiovasc Surg. 2012; 144: 1042-1049
        • Yan T.D.
        • Bannon P.G.
        • Bavaria J.
        • Coselli J.S.
        • Elefteriades J.A.
        • Griepp R.B.
        • et al.
        Consensus on hypothermia in aortic arch surgery.
        Ann Cardiothorac Surg. 2013; 2: 163-168
        • Zierer A.
        • Risteski P.
        • El-Sayed Ahmad A.
        • Moritz A.
        • Diegeler A.
        • Urbanski P.P.
        The impact of unilateral versus bilateral antegrade cerebral perfusion on surgical outcomes after aortic arch replacement: a propensity-matched analysis.
        J Thorac Cardiovasc Surg. 2014; 147 (discussion 1217-1218): 1212-1217
        • Norton E.L.
        • Wu X.
        • Kim K.M.
        • Patel H.J.
        • Deeb G.M.
        • Yang B.
        Unilateral is comparable to bilateral antegrade cerebral perfusion in acute type A aortic dissection repair.
        J Thorac Cardiovasc Surg. 2020; 160: 617-625 e615
        • Preventza O.
        • Simpson K.H.
        • Cooley D.A.
        • Cornwell L.
        • Bakaeen F.G.
        • Omer S.
        • et al.
        Unilateral versus bilateral cerebral perfusion for acute type A aortic dissection.
        Ann Thorac Surg. 2015; 99: 80-87

      Section 5: Aortic Root Management

        • Di Eusanio M.
        • Trimarchi S.
        • Peterson M.D.
        • Myrmel T.
        • Hughes G.C.
        • Korach A.
        • et al.
        Root replacement surgery versus more conservative management during type A acute aortic dissection repair.
        Ann Thorac Surg. 2014; 98: 2078-2084
        • Chiu P.
        • Trojan J.
        • Tsou S.
        • Goldstone A.B.
        • Woo Y.J.
        • Fischbein M.P.
        Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation.
        J Thorac Cardiovasc Surg. 2018; 155: 1-7 e1
        • Castrovinci S.
        • Pacini D.
        • Di Marco L.
        • Berretta P.
        • Cefarelli M.
        • Murana G.
        • et al.
        Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis.
        Eur J Cardiothorac Surg. 2016; 50: 223-229
        • Yang B.
        • Norton E.L.
        • Hobbs R.
        • Farhat L.
        • Wu X.
        • Hornsby W.E.
        • et al.
        Short- and long-term outcomes of aortic root repair and replacement in patients undergoing acute type A aortic dissection repair: Twenty-year experience.
        J Thorac Cardiovasc Surg. 2019; 157: 2125-2136
        • Bojko M.M.
        • Assi R.
        • Bavaria J.E.
        • Suhail M.
        • Habertheuer A.
        • Hu R.W.
        • et al.
        Midterm outcomes and durability of sinus segment preservation compared with root replacement for acute type A aortic dissection.
        J Thorac Cardiovasc Surg. 2020;
        • Hysi I.
        • Juthier F.
        • Fabre O.
        • Fouquet O.
        • Rousse N.
        • Banfi C.
        • et al.
        Aortic root surgery improves long-term survival after acute type A aortic dissection.
        Int J Cardiol. 2015; 184: 285-290
        • Ikeno Y.
        • Yokawa K.
        • Yamanaka K.
        • Inoue T.
        • Tanaka H.
        • Okada K.
        • et al.
        The fate of aortic root and aortic regurgitation after supracoronary ascending aortic replacement for acute type A aortic dissection.
        J Thorac Cardiovasc Surg. 2021; 161: 483-493 e481
        • Nishida H.
        • Tabata M.
        • Fukui T.
        • Takanashi S.
        Surgical Strategy and Outcome for Aortic Root in Patients Undergoing Repair of Acute Type A Aortic Dissection.
        Ann Thorac Surg. 2016; 101: 1464-1469
        • Chen S.K.
        • Qiu Z.H.
        • Fang G.H.
        • Wu X.J.
        • Chen L.W.
        Reported outcomes after aortic valve resuspension for acute type A aortic dissection: a systematic review and meta-analysis.
        Interact Cardiovasc Thorac Surg. 2019; 29: 331-338
        • Rylski B.
        • Bavaria J.E.
        • Beyersdorf F.
        • Branchetti E.
        • Desai N.D.
        • Milewski R.K.
        • et al.
        Type A aortic dissection in Marfan syndrome: extent of initial surgery determines long-term outcome.
        Circulation. 2014; 129: 1381-1386
        • Beckmann E.
        • Martens A.
        • Pertz J.
        • Kaufeld T.
        • Umminger J.
        • Hanke J.S.
        • et al.
        Valve-sparing David I procedure in acute aortic type A dissection: a 20-year experience with more than 100 patients.
        Eur J Cardiothorac Surg. 2017; 52: 319-324
        • Mosbahi S.
        • Stak D.
        • Gravestock I.
        • Burgstaller J.M.
        • Steurer J.
        • Eckstein F.
        • et al.
        A systemic review and meta-analysis: Bentall versus David procedure in acute type A aortic dissection.
        Eur J Cardiothorac Surg. 2019; 55: 201-209
        • Rosenblum J.M.
        • Leshnower B.G.
        • Moon R.C.
        • Lasanajak Y.
        • Binongo J.
        • McPherson L.
        • et al.
        Durability and safety of David V valve-sparing root replacement in acute type A aortic dissection.
        J Thorac Cardiovasc Surg. 2019; 157: 14-23 e11
        • Sievers H.H.
        • Richardt D.
        • Diwoky M.
        • Auer C.
        • Bucsky B.
        • Nasseri B.
        • et al.
        Survival and reoperation after valve-sparing root replacement and root repair in acute type A dissection.
        J Thorac Cardiovasc Surg. 2018; 156: 2076-2082 e2072
        • Nakajima T.
        • Kawazoe K.
        • Kataoka T.
        • Kin H.
        • Kazui T.
        • Okabayashi H.
        • et al.
        Midterm results of aortic repair using a fabric neomedia and fibrin glue for type A acute aortic dissection.
        Ann Thorac Surg. 2007; 83: 1615-1620
        • Rylski B.
        • Bavaria J.E.
        • Milewski R.K.
        • Vallabhajosyula P.
        • Moser W.
        • Kremens E.
        • et al.
        Long-term results of neomedia sinus valsalva repair in 489 patients with type A aortic dissection.
        Ann Thorac Surg. 2014; 98 (discussion 588-589): 582-588
        • Yang B.
        Reply From the authors: Can we just trust our suture lines!.
        J Thorac Cardiovasc Surg. 2020; 159: e105-e106
        • Lemaire S.A.
        • Ochoa L.N.
        • Conklin L.D.
        • Schmittling Z.C.
        • Undar A.
        • Clubb Jr., F.J.
        • et al.
        Nerve and conduction tissue injury caused by contact with BioGlue.
        J Surg Res. 2007; 143: 286-293
        • LeMaire S.A.
        • Schmittling Z.C.
        • Coselli J.S.
        • Undar A.
        • Deady B.A.
        • Clubb Jr., F.J.
        • et al.
        BioGlue surgical adhesive impairs aortic growth and causes anastomotic strictures.
        Ann Thorac Surg. 2002; 73 (discussion 1506): 1500-1505
        • Svensson L.G.
        Limited Intimal Aorta Tears: Royalty Torn Asunder, and a Nation Was Created.
        J Am Coll Cardiol. 2018; 71: 2786-2789
        • Kreibich M.
        • Rylski B.
        • Czerny M.
        • Pingpoh C.
        • Siepe M.
        • Beyersdorf F.
        • et al.
        Type A Aortic Dissection in Patients With Bicuspid Aortic Valve Aortopathy.
        Ann Thorac Surg. 2020; 109: 94-100
        • Mennander A.
        • Olsson C.
        • Jeppsson A.
        • Geirsson A.
        • Hjortdal V.
        • Hansson E.C.
        • et al.
        The significance of bicuspid aortic valve after surgery for acute type A aortic dissection.
        J Thorac Cardiovasc Surg. 2020; 159: 760-767 e763
        • Rylski B.
        • Desai N.D.
        • Bavaria J.E.
        • Vallabhajosyula P.
        • Moser W.
        • Pochettino A.
        • et al.
        Aortic valve morphology determines the presentation and surgical approach to acute type A aortic dissection.
        Ann Thorac Surg. 2014; 97 (discussion 1996-1997): 1991-1996
        • Chen Y.F.
        • Chien T.M.
        • Yu C.P.
        • Ho K.J.
        • Wen H.
        • Li W.Y.
        • et al.
        Acute aortic dissection type A with acute coronary involvement: a novel classification.
        Int J Cardiol. 2013; 168: 4063-4069
        • Kreibich M.
        • Bavaria J.E.
        • Branchetti E.
        • Brown C.R.
        • Chen Z.
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        Management of Patients With Coronary Artery Malperfusion Secondary to Type A Aortic Dissection.
        Ann Thorac Surg. 2019; 107: 1174-1180
        • Neri E.
        • Toscano T.
        • Papalia U.
        • Frati G.
        • Massetti M.
        • Capannini G.
        • et al.
        Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome.
        J Thorac Cardiovasc Surg. 2001; 121: 552-560

      Section 6: Ascending Aorta and Distal Anastomosis

        • Fleck T.M.
        • Tschernich H.
        • Grabenwoger M.
        • Hutschala D.
        • Koinig H.
        • Wolner E.
        • et al.
        A double patch sandwich technique for surgical repair of acute aortic dissection type A.
        Ann Thorac Surg. 2003; 76: 499-502
        • Oda T.
        • Minatoya K.
        • Sasaki H.
        • Tanaka H.
        • Seike Y.
        • Itonaga T.
        • et al.
        Adventitial inversion technique for type A aortic dissection distal anastomosis.
        J Thorac Cardiovasc Surg. 2016; 151: 1340-1345
        • Szeto W.Y.
        • Gleason T.G.
        Operative management of ascending aortic dissections.
        Semin Thorac Cardiovasc Surg. 2005; 17: 247-255
        • Tamura K.
        • Chikazawa G.
        • Hiraoka A.
        • Totsugawa T.
        • Sakaguchi T.
        • Yoshitaka H.
        The prognostic impact of distal anastomotic new entry after acute type I aortic dissection repair.
        Eur J Cardiothorac Surg. 2017; 52: 867-873
        • Danner B.C.
        • Natour E.
        • Horst M.
        • Dikov V.
        • Ghosh P.K.
        • Dapunt O.E.
        Comparison of operative techniques in acute type A aortic dissection performing the distal anastomosis.
        J Card Surg. 2007; 22: 105-110
        • David T.E.
        • Armstrong S.
        • Ivanov J.
        • Barnard S.
        Surgery for acute type A aortic dissection.
        Ann Thorac Surg. 1999; 67 (discussion 2014-1999): 1999-2001
        • Geirsson A.
        • Shioda K.
        • Olsson C.
        • Ahlsson A.
        • Gunn J.
        • Hansson E.C.
        • et al.
        Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection.
        J Thorac Cardiovasc Surg. 2019; 157: 1750-1758
        • Lai D.T.
        • Robbins R.C.
        • Mitchell R.S.
        • Moore K.A.
        • Oyer P.E.
        • Shumway N.E.
        • et al.
        Does profound hypothermic circulatory arrest improve survival in patients with acute type a aortic dissection?.
        Circulation. 2002; 106: I218-228
        • Lawton J.S.
        • Liu J.
        • Kulshrestha K.
        • Moon M.R.
        • Damiano Jr., R.J.
        • Maniar H.
        • et al.
        The impact of surgical strategy on survival after repair of type A aortic dissection.
        J Thorac Cardiovasc Surg. 2015; 150: 294-301 e291
        • Malvindi P.G.
        • Modi A.
        • Miskolczi S.
        • Kaarne M.
        • Velissaris T.
        • Barlow C.
        • et al.
        Open and closed distal anastomosis for acute type A aortic dissection repair.
        Interact Cardiovasc Thorac Surg. 2016; 22: 776-783
        • Moon M.R.
        • Sundt 3rd, T.M.
        • Pasque M.K.
        • Barner H.B.
        • Huddleston C.B.
        • Damiano Jr., R.J.
        • et al.
        Does the extent of proximal or distal resection influence outcome for type A dissections?.
        Ann Thorac Surg. 2001; 71 (discussion 1249-1250): 1244-1249
        • Stamou S.C.
        • Kouchoukos N.T.
        • Hagberg R.C.
        • Khabbaz K.R.
        • Robicsek F.
        • Nussbaum M.
        • et al.
        Does the technique of distal anastomosis influence clinical outcomes in acute type A aortic dissection?.
        Interact Cardiovasc Thorac Surg. 2011; 12: 404-408
        • Zierer A.
        • Moon M.R.
        • Melby S.J.
        • Moazami N.
        • Lawton J.S.
        • Kouchoukos N.T.
        • et al.
        Impact of perfusion strategy on neurologic recovery in acute type A aortic dissection.
        Ann Thorac Surg. 2007; 83 (discussion 2128-2129): 2122-2128
        • Bavaria J.E.
        • Pochettino A.
        • Brinster D.R.
        • Gorman R.C.
        • McGarvey M.L.
        • Gorman J.H.
        • et al.
        New paradigms and improved results for the surgical treatment of acute type A dissection.
        Ann Surg. 2001; 234 (discussion 342-333): 336-342
        • Roselli E.E.
        • Loor G.
        • He J.
        • Rafael A.E.
        • Rajeswaran J.
        • Houghtaling P.L.
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        Distal aortic interventions after repair of ascending dissection: the argument for a more aggressive approach.
        J Thorac Cardiovasc Surg. 2015; 149: S117-124 e113
        • Preventza O.
        • Price M.D.
        • Simpson K.H.
        • Cooley D.A.
        • Pocock E.
        • de la Cruz K.I.
        • et al.
        Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection.
        Ann Thorac Surg. 2015; 100: 833-838
        • Dohle D.S.
        • El Beyrouti H.
        • Brendel L.
        • Pfeiffer P.
        • El-Mehsen M.
        • Vahl C.F.
        Survival and reinterventions after isolated proximal aortic repair in acute type A aortic dissection.
        Interact Cardiovasc Thorac Surg. 2019; 28: 981-988
        • Kohl L.P.
        • Isselbacher E.M.
        • Majahalme N.
        • Evangelista A.
        • Russo M.J.
        • Hutchison S.
        • et al.
        Comparison of Outcomes in DeBakey Type AI Versus AII Aortic Dissection.
        Am J Cardiol. 2018; 122: 689-695
        • Evangelista A.
        • Isselbacher E.M.
        • Bossone E.
        • Gleason T.G.
        • Eusanio M.D.
        • Sechtem U.
        • et al.
        Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research.
        Circulation. 2018; 137: 1846-1860
        • Wang D.J.
        • Fan F.D.
        • Wang Q.
        • Li Q.G.
        • Zhou Q.
        • Wu Z.
        • et al.
        Preliminary characterization of acute aortic dissection in the mainland of China.
        Chin Med J (Engl). 2011; 124: 1726-1730
        • Muetterties C.E.
        • Menon R.
        • Wheatley 3rd, G.H.
        A systematic review of primary endovascular repair of the ascending aorta.
        J Vasc Surg. 2018; 67: 332-342
        • Preventza O.
        • Olive J.K.
        • Liao J.L.
        • Orozco-Sevilla V.
        • Simpson K.
        • Rodriguez M.R.
        • et al.
        Acute type I aortic dissection with or without antegrade stent delivery: Mid-term outcomes.
        J Thorac Cardiovasc Surg. 2019; 158: 1273-1281
        • Vallabhajosyula P.
        • Gottret J.P.
        • Bavaria J.E.
        • Desai N.D.
        • Szeto W.Y.
        Endovascular repair of the ascending aorta in patients at high risk for open repair.
        J Thorac Cardiovasc Surg. 2015; 149: S144-150
        • Roselli E.E.
        • Idrees J.J.
        • Johnston D.R.
        • Eagleton M.J.
        • Desai M.Y.
        • Svensson L.G.
        Zone zero thoracic endovascular aortic repair: A proposed modification to the classification of landing zones.
        J Thorac Cardiovasc Surg. 2018; 155: 1381-1389

      Section 7: Aortic Arch Management

        • Easo J.
        • Weigang E.
        • Holzl P.P.
        • Horst M.
        • Hoffmann I.
        • Blettner M.
        • et al.
        Influence of operative strategy for the aortic arch in DeBakey type I aortic dissection: analysis of the German Registry for Acute Aortic Dissection Type A.
        J Thorac Cardiovasc Surg. 2012; 144: 617-623
        • Poon S.S.
        • Theologou T.
        • Harrington D.
        • Kuduvalli M.
        • Oo A.
        • Field M.
        Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis.
        Ann Cardiothorac Surg. 2016; 5: 156-173
        • Salem M.
        • Friedrich C.
        • Rusch R.
        • Frank D.
        • Hoffmann G.
        • Lutter G.
        • et al.
        Is total arch replacement associated with an increased risk after acute type A dissection?.
        J Thorac Dis. 2020; 12: 5517-5531
        • Yang B.
        • Norton E.L.
        • Shih T.
        • Farhat L.
        • Wu X.
        • Hornsby W.E.
        • et al.
        Late outcomes of strategic arch resection in acute type A aortic dissection.
        J Thorac Cardiovasc Surg. 2019; 157: 1313-1321 e1312
        • Kazui T.
        • Yamashita K.
        • Washiyama N.
        • Terada H.
        • Bashar A.H.
        • Suzuki T.
        • et al.
        Impact of an aggressive surgical approach on surgical outcome in type A aortic dissection.
        Ann Thorac Surg. 2002; 74 (discussion S1857-1863): S1844-1847
        • Ohtsubo S.
        • Itoh T.
        • Takarabe K.
        • Rikitake K.
        • Furukawa K.
        • Suda H.
        • et al.
        Surgical results of hemiarch replacement for acute type A dissection.
        Ann Thorac Surg. 2002; 74 (discussion S1857-1863): S1853-1856
        • Smith H.N.
        • Boodhwani M.
        • Ouzounian M.
        • Saczkowski R.
        • Gregory A.J.
        • Herget E.J.
        • et al.
        Classification and outcomes of extended arch repair for acute Type A aortic dissection: a systematic review and meta-analysis.
        Interact Cardiovasc Thorac Surg. 2017; 24: 450-459
        • Trimarchi S.
        • Nienaber C.A.
        • Rampoldi V.
        • Myrmel T.
        • Suzuki T.
        • Mehta R.H.
        • et al.
        Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience.
        J Thorac Cardiovasc Surg. 2005; 129: 112-122
        • Sultan I.
        • Aranda-Michel E.
        • Bianco V.
        • Kilic A.
        • Habertheuer A.
        • Brown J.A.
        • et al.
        Outcomes of carotid artery replacement with total arch reconstruction for type A aortic dissection.
        Ann Thorac Surg. 2020;
        • Detter C.
        • Demal T.J.
        • Bax L.
        • Tsilimparis N.
        • Kolbel T.
        • von Kodolitsch Y.
        • et al.
        Simplified frozen elephant trunk technique for combined open and endovascular treatment of extensive aortic diseases.
        Eur J Cardiothorac Surg. 2019; 56: 738-745
        • Flores J.
        • Kunihara T.
        • Shiiya N.
        • Yoshimoto K.
        • Matsuzaki K.
        • Yasuda K.
        Extensive deployment of the stented elephant trunk is associated with an increased risk of spinal cord injury.
        J Thorac Cardiovasc Surg. 2006; 131: 336-342
        • Katayama K.
        • Uchida N.
        • Katayama A.
        • Takahashi S.
        • Takasaki T.
        • Kurosaki T.
        • et al.
        Multiple factors predict the risk of spinal cord injury after the frozen elephant trunk technique for extended thoracic aortic disease.
        Eur J Cardiothorac Surg. 2015; 47: 616-620
        • Okita Y.
        Frozen elephant trunk with Frozenix prosthesis.
        Ann Cardiothorac Surg. 2020; 9: 152-163
        • Okita Y.
        • Kumamaru H.
        • Motomura N.
        • Miyata H.
        • Takamoto S.
        Current status of open surgery for acute type A aortic dissection in Japan.
        J Thorac Cardiovasc Surg. 2020;
        • Preventza O.
        • Liao J.L.
        • Olive J.K.
        • Simpson K.
        • Critsinelis A.C.
        • Price M.D.
        • et al.
        Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients.
        J Thorac Cardiovasc Surg. 2020; 160: 20-33 e24
        • Roselli E.E.
        • Idrees J.J.
        • Bakaeen F.G.
        • Tong M.Z.
        • Soltesz E.G.
        • Mick S.
        • et al.
        Evolution of Simplified Frozen Elephant Trunk Repair for Acute DeBakey Type I Dissection: Midterm Outcomes.
        Ann Thorac Surg. 2018; 105: 749-755
        • Shrestha M.
        • Bachet J.
        • Bavaria J.
        • Carrel T.P.
        • De Paulis R.
        • Di Bartolomeo R.
        • et al.
        Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS.
        Eur J Cardiothorac Surg. 2015; 47: 759-769
        • Shrestha M.
        • Beckmann E.
        • Krueger H.
        • Fleissner F.
        • Kaufeld T.
        • Koigeldiyev N.
        • et al.
        The elephant trunk is freezing: The Hannover experience.
        J Thorac Cardiovasc Surg. 2015; 149: 1286-1293
        • Svensson L.G.
        • Rushing G.D.
        • Valenzuela E.S.
        • Rafael A.E.
        • Batizy L.H.
        • Blackstone E.H.
        • et al.
        Modifications, classification, and outcomes of elephant-trunk procedures.
        Ann Thorac Surg. 2013; 96: 548-558
        • Takagi H.
        • Umemoto T.
        • Group A.
        A Meta-Analysis of Total Arch Replacement With Frozen Elephant Trunk in Acute Type A Aortic Dissection.
        Vasc Endovascular Surg. 2016; 50: 33-46
        • Tsagakis K.
        • Dohle D.
        • Benedik J.
        • Lieder H.
        • Jakob H.
        Overall Essen's experience with the E-vita open hybrid stent graft system and evolution of the surgical technique.
        Ann Cardiothorac Surg. 2013; 2: 612-620
        • Beckmann E.
        • Martens A.
        • Korte W.
        • Kaufeld T.
        • Krueger H.
        • Haverich A.
        • et al.
        Open total arch replacement with trifurcated graft and frozen elephant trunk.
        Ann Cardiothorac Surg. 2020; 9: 170-177
        • Shrestha M.
        • Kaufeld T.
        • Beckmann E.
        • Fleissner F.
        • Umminger J.
        • Abd Alhadi F.
        • et al.
        Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: Single-center results of the first 100 patients.
        J Thorac Cardiovasc Surg. 2016; 152: 148-159 e141
        • Chen Y.
        • Ma W.G.
        • Zheng J.
        • Liu Y.M.
        • Zhu J.M.
        • Sun L.Z.
        Total arch replacement and frozen elephant trunk for type A aortic dissection after Bentall procedure in Marfan syndrome.
        J Thorac Dis. 2018; 10: 2377-2387
        • Chen Y.
        • Ma W.G.
        • Zhi A.H.
        • Lu L.
        • Zheng J.
        • Zhang W.
        • et al.
        Fate of distal aorta after frozen elephant trunk and total arch replacement for type A aortic dissection in Marfan syndrome.
        J Thorac Cardiovasc Surg. 2019; 157: 835-849
        • Girdauskas E.
        • Kuntze T.
        • Borger M.A.
        • Falk V.
        • Mohr F.W.
        Distal aortic reinterventions after root surgery in Marfan patients.
        Ann Thorac Surg. 2008; 86: 1815-1819
        • Mimoun L.
        • Detaint D.
        • Hamroun D.
        • Arnoult F.
        • Delorme G.
        • Gautier M.
        • et al.
        Dissection in Marfan syndrome: the importance of the descending aorta.
        Eur Heart J. 2011; 32: 443-449
        • Rylski B.
        • Bavaria J.E.
        • Beyersdorf F.
        • Branchetti E.
        • Desai N.D.
        • Milewski R.K.
        • et al.
        Type A aortic dissection in Marfan syndrome: extent of initial surgery determines long-term outcome.
        Circulation. 2014; 129: 1381-1386
        • Schoenhoff F.S.
        • Jungi S.
        • Czerny M.
        • Roost E.
        • Reineke D.
        • Matyas G.
        • et al.
        Acute aortic dissection determines the fate of initially untreated aortic segments in Marfan syndrome.
        Circulation. 2013; 127: 1569-1575
        • Roselli E.E.
        • Idrees J.J.
        • Lowry A.M.
        • Masabni K.
        • Soltesz E.G.
        • Johnston D.R.
        • et al.
        Beyond the Aortic Root: Staged Open and Endovascular Repair of Arch and Descending Aorta in Patients With Connective Tissue Disorders.
        Ann Thorac Surg. 2016; 101: 906-912
        • Inoue Y.
        • Minatoya K.
        • Oda T.
        • Itonaga T.
        • Seike Y.
        • Tanaka H.
        • et al.
        Surgical outcomes for acute type A aortic dissection with aggressive primary entry resection.
        Eur J Cardiothorac Surg. 2016; 50: 567-573
        • Ma W.G.
        • Zhang W.
        • Wang L.F.
        • Zheng J.
        • Ziganshin B.A.
        • Charilaou P.
        • et al.
        Type A aortic dissection with arch entry tear: Surgical experience in 104 patients over a 12-year period.
        J Thorac Cardiovasc Surg. 2016; 151: 1581-1592
        • Song S.B.
        • Wu X.J.
        • Sun Y.
        • Cai S.H.
        • Hu P.Y.
        • Qiang H.F.
        A modified frozen elephant trunk technique for acute Stanford type A aortic dissection.
        J Cardiothorac Surg. 2020; 15: 322
        • Trimarchi S.
        • de Beaufort H.W.L.
        • Tolenaar J.L.
        • Bavaria J.E.
        • Desai N.D.
        • Di Eusanio M.
        • et al.
        Acute aortic dissections with entry tear in the arch: A report from the International Registry of Acute Aortic Dissection.
        J Thorac Cardiovasc Surg. 2019; 157: 66-73
        • Shrestha M.
        • Martens A.
        • Kaufeld T.
        • Beckmann E.
        • Bertele S.
        • Krueger H.
        • et al.
        Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years.
        Eur J Cardiothorac Surg. 2017; 52: 858-866
        • Bossone E.
        • Corteville D.C.
        • Harris K.M.
        • Suzuki T.
        • Fattori R.
        • Hutchison S.
        • et al.
        Stroke and outcomes in patients with acute type A aortic dissection.
        Circulation. 2013; 128: S175-179
        • Di Eusanio M.
        • Patel H.J.
        • Nienaber C.A.
        • Montgomery D.M.
        • Korach A.
        • Sundt T.M.
        • et al.
        Patients with type A acute aortic dissection presenting with major brain injury: should we operate on them?.
        J Thorac Cardiovasc Surg. 2013; 145: S213-221 e211
        • Sultan I.
        • Bianco V.
        • Patel H.J.
        • Arnaoutakis G.J.
        • Di Eusanio M.
        • Chen E.P.
        • et al.
        Surgery for type A aortic dissection in patients with cerebral malperfusion: Results from the International Registry of Acute Aortic Dissection.
        J Thorac Cardiovasc Surg. 2019;
        • Dai X.F.
        • Chen L.W.
        • Wu X.J.
        • Dong Y.
        • Wang Q.M.
        Total Aortic Arch Reconstruction With Triple-Branched Stent Graft or Hemiarch Replacement for Acute Debakey Type I Aortic Dissection: Five-Years Experience With 93 Patients.
        J Card Surg. 2015; 30: 749-755
        • Lu S.
        • Yang S.
        • Lai H.
        • Zheng J.
        • Hong T.
        • Sun X.
        • et al.
        Open aortic arch reconstruction for acute type a aortic dissection: a single-center experience with 267 consecutive patients.
        J Cardiothorac Surg. 2016; 11: 111
        • Zhang Q.
        • Ma X.
        • Zhang W.
        • Wang Z.
        • Zhang H.
        • Zhang X.
        • et al.
        Surgical repair and reconstruction of aortic arch in debakey type I aortic dissection: recent advances and single-center experience in the application of branched stent graft.
        J Cardiothorac Surg. 2017; 12: 86
        • Evangelista A.
        • Isselbacher E.M.
        • Bossone E.
        • Gleason T.G.
        • Eusanio M.D.
        • Sechtem U.
        • et al.
        Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research.
        Circulation. 2018; 137: 1846-1860
        • Murdoch J.L.
        • Walker B.A.
        • Halpern B.L.
        • Kuzma J.W.
        • McKusick V.A.
        Life expectancy and causes of death in the Marfan syndrome.
        N Engl J Med. 1972; 286: 804-808
        • Vanem T.T.
        • Geiran O.R.
        • Krohg-Sorensen K.
        • Roe C.
        • Paus B.
        • Rand-Hendriksen S.
        Survival, causes of death, and cardiovascular events in patients with Marfan syndrome.
        Mol Genet Genomic Med. 2018; 6: 1114-1123

      Section 8: Malperfusion Management

        • Di Eusanio M.
        • Trimarchi S.
        • Patel H.J.
        • Hutchison S.
        • Suzuki T.
        • Peterson M.D.
        • et al.
        Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection.
        J Thorac Cardiovasc Surg. 2013; 145: 385-390 e381
        • Iannacone E.
        • Robinson B.
        • Rahouma M.
        • Girardi L.
        Management of malperfusion: New York approach and outcomes.
        J Card Surg. 2020;
        • Geirsson A.
        • Szeto W.Y.
        • Pochettino A.
        • McGarvey M.L.
        • Keane M.G.
        • Woo Y.J.
        • et al.
        Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations.
        Eur J Cardiothorac Surg. 2007; 32: 255-262
        • Grimm J.C.
        • Magruder J.T.
        • Crawford T.C.
        • Sciortino C.M.
        • Zehr K.J.
        • Mandal K.
        • et al.
        Differential outcomes of type A dissection with malperfusion according to affected organ system.
        Ann Cardiothorac Surg. 2016; 5: 202-208
        • Girardi L.N.
        • Krieger K.H.
        • Lee L.Y.
        • Mack C.A.
        • Tortolani A.J.
        • Isom O.W.
        Management strategies for type A dissection complicated by peripheral vascular malperfusion.
        Ann Thorac Surg. 2004; 77 (discussion 1314): 1309-1314
        • Leshnower B.G.
        • Keeling W.B.
        • Duwayri Y.M.
        • Jordan Jr., W.D.
        • Chen E.P.
        The "thoracic endovascular aortic repair-first" strategy for acute type A dissection with mesenteric malperfusion: Initial results compared with conventional algorithms.
        J Thorac Cardiovasc Surg. 2019; 158: 1516-1524
        • Uchida K.
        • Karube N.
        • Kasama K.
        • Minami T.
        • Yasuda S.
        • Goda M.
        • et al.
        Early reperfusion strategy improves the outcomes of surgery for type A acute aortic dissection with malperfusion.
        J Thorac Cardiovasc Surg. 2018; 156: 483-489
        • Yang B.
        • Norton E.L.
        • Rosati C.M.
        • Wu X.
        • Kim K.M.
        • Khaja M.S.
        • et al.
        Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: A 20-year experience.
        J Thorac Cardiovasc Surg. 2019; 158: 675-687 e674
        • Yang B.
        • Rosati C.M.
        • Norton E.L.
        • Kim K.M.
        • Khaja M.S.
        • Dasika N.
        • et al.
        Endovascular Fenestration/Stenting First Followed by Delayed Open Aortic Repair for Acute Type A Aortic Dissection With Malperfusion Syndrome.
        Circulation. 2018; 138: 2091-2103
        • Deeb G.M.
        • Williams D.M.
        • Bolling S.F.
        • Quint L.E.
        • Monaghan H.
        • Sievers J.
        • et al.
        Surgical delay for acute type A dissection with malperfusion.
        Ann Thorac Surg. 1997; 64 (discussion 1675-1667): 1669-1675
        • Sugiyama K.
        • Watanuki H.
        • Okada M.
        • Futamura Y.
        • Wakayama R.
        • Matsuyama K.
        Revascularization-first strategy in acute aortic dissection with mesenteric malperfusion.
        J Card Surg. 2020; 35: 3004-3009
        • Leshnower B.G.
        • Veeraswamy R.K.
        • Duwayri Y.M.
        • Chen E.P.
        The "TEVAR-first" approach to DeBakey I aortic dissection with mesenteric malperfusion.
        Ann Thorac Surg. 2014; 97: 693-696
        • Charlton-Ouw K.M.
        • Sandhu H.K.
        • Leake S.S.
        • Jeffress K.
        • Miller C.C.R.
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