Outcomes of surgical repair Of Stanford type A aortic dissection in elderly patients

Abstract

Aortic dissection occurs when a tear in the aortic intima exposes the underlying media to the hydrodynamic forces of blood within the aortic lumen leading to dissection within the media. A false lumen is created by blood filling the space within the media between the intimal flap and the adventitia. Aortic dissection is classified as acute or chronic based upon the duration of symptoms at presentation. Aortic dissection diagnosed two weeks of the onset of symptoms is considered acute; beyond this time frame, chronic. The Stanford classification of aortic dissection distinguishes between type A and type B; Type A means the dissection includes the ascending aorta and Type B dissection does not involve the ascending aorta. The De Bakey classification subdivides the dissection process in Type I dissection involving the entire aorta, Type II dissection involving only the ascending aorta and Type III dissection sparing the ascending aorta and the arch. All mechanisms that weaken the aortic wall lead to higher wall stress, which can induce aortic dilatation and aneurysm formation, eventually resulting in aortic dissection or rupture as hypertension, which is the most common clinical predisposing factor for aortic dissection, also, three major inherited connective tissue disorders are currently known to affect the arterial walls: (1) Marfan’s syndrome, (2) Ehlers- Danlos syndrome, and (3) familial forms of thoracic aneurysm and dissection.