The Perioperative Management of Ascending Aortic Dissection

Anesthesia and Analgesia
Stephen H GregoryMadhav Swaminathan

Abstract

Acute aortic syndromes are a distinct group of pathologies involving the wall of the aorta that present acutely and can be potentially fatal unless treated in a timely fashion. The syndrome is dominated by aortic dissections, which comprise ≥95% of all such presentations. Those involving the ascending aorta are particularly lethal and require specific and early surgical treatment compared to dissections involving other parts of the aorta. The surgical repair of an ascending aortic dissection presents multiple challenges to the anesthesiologist. Thoughtful management throughout the perioperative period is critical for minimizing the significant morbidity and mortality associated with this condition. In this narrative review, we provide an overview of the perioperative management of patients presenting for the surgical repair of an ascending aortic dissection. Preoperative discussion focuses on assessment, hemodynamic management, and risk stratification. The intraoperative section includes an overview of anesthetic management, transesophageal echocardiographic assessment, and coagulopathy, as well as surgical considerations that may influence anesthetic management.

References

Jul 1, 1968·Thorax·H Bentall, A De Bono
Jul 3, 1999·The Annals of Thoracic Surgery·S L LansmanR B Griepp
Nov 28, 2001·The Annals of Thoracic Surgery·D L ReichR B Griepp
Sep 23, 2003·The Journal of Thoracic and Cardiovascular Surgery·Masashi TanakaTakashi Ino
Nov 7, 2003·The Annals of Thoracic Surgery·Stuart W JamiesonWilliam R Auger
Nov 3, 2004·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Kazumasa OrihashiKatsuhiko Imai
Jan 6, 2005·The Journal of Thoracic and Cardiovascular Surgery·Santi TrimarchiUNKNOWN International Registry of Acute Aortic Dissection Investigators
Mar 26, 2005·Circulation Journal : Official Journal of the Japanese Circulation Society·Koichi AkutsuTeruo Takano
Jun 24, 2005·Current Problems in Cardiology·Debabrata Mukherjee, Kim A Eagle
Jan 26, 2006·The Journal of Thoracic and Cardiovascular Surgery·Domenico PaparellaStephanie J Brister
May 17, 2006·Seminars in Cardiothoracic and Vascular Anesthesia·George Silvay, Marc E Stone
Jan 30, 2007·The Annals of Thoracic Surgery·Deborah K HarringtonRobert Stuart Bonser
Feb 10, 2007·Journal of Cardiothoracic and Vascular Anesthesia·Masakazu HayashidaShin-Ichi Takamoto
Sep 11, 2007·Journal of Vascular Surgery·Jonathan C DanielScott A LeMaire
Nov 27, 2007·Expert Review of Cardiovascular Therapy·Efstratios Apostolakis, Jeffrey H Shuhaiber
Feb 14, 2008·Seminars in Cardiothoracic and Vascular Anesthesia·André DenaultJohn M Murkin
Apr 1, 2008·The Journal of Thoracic and Cardiovascular Surgery·James C HalsteadRandall B Griepp
May 13, 2008·Interactive Cardiovascular and Thoracic Surgery·Stefanos DemertzisFrancesco Siclari
May 16, 2008·The New England Journal of Medicine·Dean A FergussonUNKNOWN BART Investigators
Dec 10, 2008·Nature Clinical Practice. Cardiovascular Medicine·John G T AugoustidesJoseph E Bavaria
Dec 23, 2008·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·T T TsaiC A Nienaber
Dec 23, 2008·The Annals of Thoracic Surgery·James P SlaterGrant V S Parr
Jan 10, 2009·European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology·E Louise Meredith, Navroz D Masani
May 5, 2009·Mayo Clinic Proceedings·Vijay S RamanathKim A Eagle
Dec 17, 2009·British Journal of Anaesthesia·J M Murkin, M Arango
Apr 17, 2010·Interactive Cardiovascular and Thoracic Surgery·Thierry V ScohyAd J J C Bogers
Apr 23, 2010·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Marieluise HarrerMartin Grabenwoeger
May 18, 2010·Journal of Cardiothoracic and Vascular Anesthesia·Marina SvyatetsJean Charchaflieh
Jul 24, 2010·Journal of Clinical Anesthesia·Stephan ZiegelerSascha Kreuer
Sep 9, 2010·European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology·Arturo EvangelistaEdyta Plonska-Gosciniak
Oct 19, 2010·The Journal of Thoracic and Cardiovascular Surgery·Evaldas GirdauskasFriedrich-Wilhelm Mohr
Oct 22, 2010·European Journal of Anaesthesiology·Christian F WeberDirk Meininger
Dec 16, 2010·Circulation·Bryan G SchwartzRobert A Kloner
Dec 24, 2010·Anesthesiology·Matthias HeringlakeThorsten Hanke
Jan 29, 2011·Journal of Cardiothoracic and Vascular Anesthesia·Klaus MartinGunther Wiesner

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