Commentary: Just because we can, should we do it?

Central MessageIn type A dissection, both valve-preserving root replacement and aggressive arch surgery may be performed in selected patients. The benefit of this approach still has to defined.See Article page 2017. In defined. See Acute aortic dissection remains a deadly disease challenge the surgeon. initial 24 hours carry greatest mortality, mostly due pericardial tamponade.1Fann J.I. Smith J.A. Miller D.C. Mitchell R.S. Moore K.A. Grunkemeier G. et al.Surgical management during 30-year period.Circulation. 1995; 92: II113-II121Crossref PubMed Google Scholar,2Chiu P. Evolution surgical therapy for Stanford acute dissection.Ann Cardiothorac Surg. 2016; 5: 275-295Crossref Scopus (48) Scholar primary goal treatment is survival patient by treating or preventing Replacement proximal aorta mainstay treatment. It commonly as soon diagnosis made, not infrequently at odd with unexperienced teams. Postoperative mortality related preoperative presentation patient, tamponade severity malperfusion being important determinants.2Chiu Scholar,3Easo J. Weigang E. Hölzl P.P. Horst M. Hoffmann I. Blettner al.GERAADA study group. Influence operative strategy DeBakey I dissection: analysis German registry A.J Thorac Cardiovasc 2012; 144: 617-623Abstract Full Text PDF (91) Stability repair second priority. Tubular ascending achieves long-term stability most instances.4Kunihara T. Neumann N. Kriechbaum S.D. Aicher D. Schäfers H.J. Aortic remodeling leads good valve preexistent dilatation.J 152: 430-436Abstract (30) Scholar,5Westaby S. Saito Katsumata conservative methods provide consistently low mortality.Ann 2002; 73: 707-713Abstract (174) Only certain scenarios require more surgery, ie, replacement.4Kunihara This definitely beneficial connective tissue considered other scenarios, such pre-existent dilatation.4Kunihara Scholar,6Hiratzka L.F. Bakris G.L. Beckman Bersin R.M. Carr V.F. Casey Jr., D.E. al.A Report American College Cardiology Foundation/American Heart Association task force on practice guidelines, Thoracic Surgery, Radiology, Stroke Association, Society Cardiovascular Anesthesiologists, Angiography Interventions, Interventional Surgeons, Vascular Medicine.J Am Coll Cardiol. 2010; 55: e27-e129Crossref (995) Otherwise, there no evidence that use results an advantage patient. past 2 decades, become increasingly practiced also dissection.4Kunihara setting, its increased complexity carefully weighed against avoiding anticoagulation. Similar considerations apply arch. There been discussion favor minimize probability distal dilatation subsequent surgery. majority instances, partial will suffice.1Fann Scholar, 2Chiu 3Easo 4Kunihara current paper,7Jun L. Yiping Tianyu Z. Yongshi W. Yongxin Hao al.David reimplantation simultaneous total stented elephant trunk dissection.J 2021; 161: 2017-2026.e2Abstract (6) authors have combined replacement; they achieved mortality. Comparing Bentall operation, found difference between strategies. They conclude can safely.7Jun contrast previous findings duration cerebral perfusion circulatory arrest are determinants mortality.3Easo Scholar,8Sievers H.H. Richardt Diwoky Auer C. Bucsky B. Nasseri al.Survival reoperation after valve-sparing 2018; 156: 2076-2082Abstract (19) Do positive paper imply generalized? Common sense indicates aggressiveness does always risk profile patients differ from seen standard practice. indicators, time pain onset details malperfusion, specified.7Jun seems cohort was very one; through longer possibly only stable were operated upon. addition, all analyzed procedures experienced surgeons. conclusions light limitations. More circumstances, but make it safe general principle. For surgeons, principles remain until clearer available. absence evidence, common worst alternative. David dissectionThe Journal SurgeryVol. 161Issue 6PreviewTo compare early mid-term outcomes procedure (TAR) (SET) implantation (ATAAD). Full-Text